Current Radiographic Examination Including Periapical, Bitewings, and/or CBCT

Uraba et al reported that cone-beam computed tomography (CBCT) imaging is effective at detecting approximately 20% more periapical lesions than are periapical radiographs, particularly in the maxillary anterior and posterior teeth.8

When a patient presents for restorative treatment and reports that a tooth is asymptomatic, a dentist may assume that the pulpal and periradicular diagnosis is within normal limits and hence may skip the above objective clinical tests, with the possible exception of taking a radiograph. However, using only a dental radiograph to determine the etiology of tooth pain and the pretreatment pulpal and periradicular status may lead to a pulpal and periradicular misdiagnosis (Figure 3). Therefore, a clinician must perform all five objective tests to obtain an accurate pretreatment pulpal and periradicular diagnosis.

Figure 3.
Determining a diagnosis with a radiograph only can lead the clinician to treat tooth No. 29 because of the distal decay.
Determining a diagnosis with a radiograph only can lead the clinician to treat tooth No. 29 because of the distal decay. However, if the proper diagnostic tests are performed on tooth No. 29, it should reveal the pulp tested necrotic and it is tooth No. 30 that has a symptomatic irreversible pulpitis.