OR09 - Correlation of the Detection of Replicated Periradicular Bone Loss via Digital Periapical Radiographs and Cortical Bone Loss in Human Cadaver Mandibles

Abstract: Bender showed that at least 12.5% cortical bone loss was required for radiographic visibility of periradicular lesions. However, with innovations in digital radiography, this tenet may not hold. This study aimed to determine whether simulated periradicular lesions in cadaver mandibles can be detected with digital periapical radiography prior to the involvement of the cortical bone. Five teeth in four cadaver hemi mandibles were selected, and initial periapical images and cone-beam volumes were acquired (Time 0). Study teeth were carefully extracted, a size 2 cotton pellet was placed at the apex of the socket, and 40µl of 70% perchloric acid was applied to the cotton. At 3, 6, 9, and 12 hours the cotton was removed, the teeth replaced, periapical and CBCT images generated, teeth removed, fresh cotton placed, and fresh acid applied. CBCT was used as a qualitative measure for cortical bone loss analysis. Periapical radiographs were reviewed by four examiners using a custom Likert scale, ANOVA data analysis was conducted. The presence of a lesion was overestimated with the initial periapical radiographs. At Time 9, loss of medullary and involvement of cortical bone was apparent via CBCT. However, the periapical interpretations showed no statistical agreement as to the presence or absence of a lesion. Majority of the examiners were inconsistent for the detection of a periradicular lesion between Time 9 to 12 intervals. Within the limits of this initial study, periradicular lesions may be poorly detected by digital periapical radiography though some loss of cortical bone has occurred.