Top

Oral Radiology

Published in:

01-01-2021 | Original Article

Investigation of the effectiveness of CBCT and gray scale values in the differential diagnosis of apical cysts and granulomas

Authors: Meryem Etöz, Mehmet Amuk, Fatma Avcı, Ayşegül Yabacı

Published in: Oral Radiology | Issue 1/2021

Abstract

Purpose

The aim of this study was to investigate the effectiveness of cone-beam CT (CBCT) findings and gray scale values (GSV) in the differential diagnosis of apical cysts and granulomas.

Methods

Two independent researchers retrospectively analyzed the CBCT images of 21 teeth and histopathologically diagnosed them as having radicular cysts or apical granulomas. In the CBCT images, apical lesions were evaluated and categorized according to 7 criteria. These criteria were determined as relationship of lesions with dental roots, periphery of the lesion, shape, darker focus in the center, root resorption, displacement in related teeth, and cortical bone perforation. In addition, the minimum and maximum gray scale values of the lesions were measured and compared.

Results

There was a statistically significant relationship between histopathological (HP) diagnosis and well-defined cortical border and lesion shape (p = 0.003, p = 0.014, respectively). According to the HP diagnosis, no statistically significant difference was found among other variables (p > 0.05)

Conclusion

The presence of a well-defined cortical border or partial cortical border is a distinctive criterion for cysts. Additionally, the shape of the lesion was found to be a significant criterion for the separation of the two lesions. The shape of cystic lesions was circular and apical granulomas had a more curved shape. There was no relationship between the histopathological diagnosis of lesions and CBCT gray scale values.

Lin LM, Huang GTJ. In Cohen’s Pathways of the Pulp. 11th edn, Chapter 15: Pathobiology of the Periapex, Mosby-Elsevier, St. Louis, MO, USA. 2015. pp. 630–659.

Ørstavik D, Ford TRP. Essential endodontology: prevention and treatment of apical periodontitis. 2nd ed. Oxford: Blackwell Munksgaard Ltd; 2008. p. 81–134.

Nair PN, Pajarola G, Schroeder HE. Types and incidence of human periapical lesions obtained with extracted teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;81:93–102.CrossRef

Simon JH. Incidence of periapical cysts in relation to the root canal. J Endod. 1980;6:845–8.CrossRef

Nair PN. New perspectives on radicular cysts: do they heal? Int Endod J. 1998;31:155–60.CrossRef

Juerchott A, Pfefferle T, Flechtenmacher C, Mente J, Bendszus M, Heiland S, Hilgenfeld T. Differentiation of periapical granulomas and cysts by using dental MRI: a pilot study. Int J Oral Sci. 2018;10(2):17. https://doi.org/10.1038/s41368-018-0017-y.CrossRefPubMedPubMedCentral

Sonmez G, Kamburoğlu K, Yılmaz F, Koc C, Barış E, Tuzuner A. Versatility of high-resolution ultrasonography in the assessment of granulomas and radicular cysts: a comparative in vivo study. Dentomaxillofac Radiol. 2019;48:20190082.CrossRef

Aggarwal V, Singla M. Use of computed tomography scans and ultrasound in differential diagnosis and evaluation of nonsurgical management of periapical lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(6):917–23. https://doi.org/10.1016/j.tripleo.2009.12.055.CrossRefPubMed

Fernandes M, de Ataide I. Nonsurgical management of periapical lesions. J Conserv Dent. 2010;13(4):240–5. https://doi.org/10.4103/0972-0707.73384.CrossRefPubMedPubMedCentral

10.

Jorge EG, Tanomaru-Filho M, Gonçalves M, Tanomaru JM. Detection of periapical lesion development by conventional radiography or computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106(1):e56–61. https://doi.org/10.1016/j.tripleo.2008.03.020.CrossRefPubMed

11.

Guo J, Simon JH, Sedghizadeh P, Soliman ON, Chapman T, Enciso R. Evaluation of the reliability and accuracy of using cone-beam computed tomography for diagnosing periapical cysts from granulomas. J Endod. 2013;39(12):1485–90. https://doi.org/10.1016/j.joen.2013.08.019(Epub 2013 Sep 27).CrossRefPubMed

12.

Okada K, Rysavy S, Flores A, Linguraru MG. Noninvasive differential diagnosis of dental periapical lesions in cone-beam CT scans. Med Phys. 2015;42(4):1653–65. https://doi.org/10.1118/1.4914418.CrossRefPubMed

13.

Chanani A, Adhikari HD. Reliability of cone beam computed tomography as a biopsy independent tool in differential diagnosis of periapical cysts and granulomas: an in vivo study. J Conserv Dent. 2017;20(5):326–31. https://doi.org/10.4103/JCD.JCD_124_17.CrossRefPubMedPubMedCentral

14.

Lin LM, Ricucci D, Lin J, et al. Nonsurgical root canal therapy of large cyst-like inflammatory periapical lesions and inflammatory apical cysts. J Endod. 2009;35:607–15.CrossRef

15.

Cotti E, Campisi G, Ambu R, Dettori C. Ultrasound real time imaging in differential diagnosis of periapical lesions. Int Endod J. 2003;36:556–63.CrossRef

16.

Tikku AP, Bharti R, Sharma N, Chandra A, Kumar A, Kumar S. Role of ultrasound and color doppler in diagnosis of periapical lesions of endodontic origin at varying bone thickness. J Conserv Dentistry. 2016;19(2):147.CrossRef

17.

Adibi S, Shakibafard A, Karimi Sarvestani Z, Saadat N, Khojastepour L. Effect of cortical bone thickness on detection of intraosseous lesions by ultrasonography. Radiol Res Practice. 2015. https://doi.org/10.1155/2015/797593.CrossRef

18.

Reeves TE, Mah P, Mc David WD. Deriving Hounsfield unit using grey levels in cone beam CT: a clinical application. Dentomaxillofac Radiol. 2012;41:500–8.CrossRef

19.

Razi T, Niknami M, Alavi GF. Relationship between Hounsfield Unit in CT Scan and Gray Scale in CBCT. J Dent Res Dent Clin Dent Prospects. 2014;8:107–10.PubMedPubMedCentral

20.

Bastami F, Shahab S, Parsa A, Abbas FM, Noori Kooshki MH, Namdari M, Lisar HA, Rafiei T, Fahimipour F, Salehi M, Jafari M. Can gray values derived from CT and cone beam CT estimate new bone formation? An in vivo study. Oral Maxillofac Surg. 2018;22(1):13–20. https://doi.org/10.1007/s10006-017-0657-7(Epub 2017 Oct 31).CrossRefPubMed

21.

Naitoh M, Hirukawa A, Katsumata A, Ariji E. Evaluation of voxel values in mandibular cancellous bone: relationship between cone-beam computed tomography and multislice helical computed tomography. Clin Oral Implants Res. 2009;20:503–6.CrossRef

22.

Cassetta M, Stefanelli LV, Pacifici A, Pacifici L, Barbato E. How accurate is CBCT in measuring bone density? A comparative CBCT-CT in vitro study. Clin Implant Dent Relat Res. 2014;16:471–8.CrossRef

23.

Nasim A, Sasankoti Mohan RP, Nagaraju K, Malik SS, Goel S, Gupta S. Application of cone beam computed tomography gray scale values in the diagnosis of cysts and tumors. J Indian Acad Oral Med Radiol. 2018;30:4–9.CrossRef

24.

Shrout MK, Hall JM, Hildebolt CE. Differentiation of periapical granuloma and radicular cyst by digital radiometric analysis. Oral Surg Oral Med Oral Pathol. 1993;76:356–61.CrossRef

25.

Simon HS, Enciso R, Malfaz JM, Roges P, Perry MB, Patel A. Differential diagnosis of large periapical lesion using cone beam computed tomography measurement and biopsy. J Endod. 2006;32:833–7.CrossRef

26.

Shear M. Cysts of the oral regions. 3rd ed. Oxford: Wright; 1992.

27.

Bornstein MM, Bingisser AC, Reichart PA, Sendi P, Bosshardt DD, von Arx T. Comparison between radiographic (2-dimensional and 3-dimensional) and histologic findings of periapical lesions treated with apical surgery. J Endod. 2015;41(6):804–11. https://doi.org/10.1016/j.joen.2015.01.015(Epub 2015 Apr 8).CrossRefPubMed

28.

Pitcher B, Alaqla A, Noujeim M, Wealleans JA, Kotsakis G, Chrepa V. Binary decision trees for preoperative periapical cyst screening using cone-beam computed tomography. J Endod. 2017;43(3):383–8. https://doi.org/10.1016/j.joen.2016.10.046.CrossRefPubMed

Title: Investigation of the effectiveness of CBCT and gray scale values in the differential diagnosis of apical cysts and granulomas
Authors: Meryem Etöz
Mehmet Amuk
Fatma Avcı
Ayşegül Yabacı
Publication date: 01-01-2021
Publisher: Springer Singapore
Published in: Oral Radiology / Issue 1/2021
Print ISSN: 0911-6028
Electronic ISSN: 1613-9674
DOI: https://doi.org/10.1007/s11282-020-00459-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Investigation of the effectiveness of CBCT and gray scale values in the differential diagnosis of apical cysts and granulomas

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Maxillofacial manifestations of Proteus syndrome: a systematic review with a case report

Oral radiology goes to the next stage

Usefulness of contrast-enhanced CT in the evaluation of depth of invasion in oral tongue squamous cell carcinoma: comparison with MRI

An unusual case of melanoma metastasis in the buccal space: learning by mistakes to distinguish it from salivary neoplasms

Schwannoma arising from the sublingual glandular branch of the lingual nerve radiologically masquerading as sublingual gland tumor

The effect of selective serotonin reuptake inhibitors on the human mandible