Comparative Analysis of Examination Methods for Periapical Lesion Diagnostics: Assessing Cone-Beam Computer Tomography, Ultrasound, and Periapical Radiography

Introduction: Periapical lesions of teeth are typically evaluated using periapical X-rays (PA)
or cone-beam computer tomography (CBCT); however, ultrasound imaging (US) can also be used
to detect bone defects. A comparative analysis is necessary to establish the diagnostic accuracy of
US for the detection of periapical lesions in comparison with PA and CBCT. Objectives: This study
aimed to evaluate and compare the measurement precision of US against PA and CBCT in detecting
periapical lesions. Methods: This study included 43 maxillary and mandibular teeth with periapical
lesions. All teeth were examined clinically, radiographically, and ultrasonographically. Observers
evaluated and measured the periapical lesions on CBCT, PA, and US images. Results: The comparison
of lesion size showed that it differs significantly between the different methods of examination. A
statistically significant difference was found between CBCT and US (mean difference = 0.99 mm, 95%
CI [0.43–1.55]), as well as between CBCT and PA (mean difference = 0.61 mm, 95% CI [0.17–1.05]). No
difference was found between the US and PA methods (p = 0.193). Conclusion: US cannot replace
PA radiography in detecting pathologies but it can accurately measure and characterize periapical
lesions with minimal radiation exposure. CBCT is the most precise and radiation-intensive method
so it should only be used for complex cases.