Published: 2021-08-27

Use of the cone-beam computed tomography-endodontic radiolucency index for determination of lesion extension in periapical periodontitis

Sanaa Shafshak, Faiz Alsubaie, Faisal Alzamil, Linah Alzughaibi, Meshal Alhaqbani, Rama Al Yamany, Saeed Basalem


Background: Periapical periodontitis is caused by extension of necrotic pulp tissue into the periodontal ligament area. cone-beam computed tomography (CBCT) facilitates better diagnosis for periapical periodontitis, especially in the absence of clinical symptoms. This study aims to use cone-beam computed tomography-endodontic radiolucency index (CBCT-ERI) to determine the extension of periapical periodontitis in post-graduate clinics of Riyadh Elm university (REU) and to record the extension of periapical periodontitis in the coronal direction along the root surface and evaluate the degree of cortical bone involvement associated with periapical radiolucency.

Methods: CBCT images for patients treated at the endodontic clinics of REU were selected for this retrospective observational study. Images were examined after inter-examiner calibrations under the same magnification, slice thickness, and resolution and the measurements were analyzed statistically.

Results: The first permanent molars were the most frequently affected by periapical periodontitis, followed by the second molars. The majority of lesions were graded with a score of 6 in length and width according to CBCT-ERI.

Conclusions: The use of CBCT-ERI revealed extensive involvement of periodontal tissues around the apices of the roots of the examined teeth. Coronal extension of periapical periodontitis was observed along the root surface. The axial view accurately detected cortical bone involvement, including thinning of the cortical bone, which was the most common manifestation (11.76%). Apical radiolucency was observed most commonly in the first molars.


CBCT, Apical periodontitis, Periapical index, Endodontic radiolucency index, Endodontics

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