Influência da associação do exame de tomografia computadorizada Cone Beam no diagnóstico de casos endodônticos e periodontais de diferentes complexidades

Abstract

An accurate diagnosis is the first step to outlining the correct planning and resolution of a case. Among the diagnostic difficulties in dentistry, changes involving the pulp canal and periodontal support tissues are considered of high diagnostic complexity. Cone Beam Computed Tomography (CBCT) may be indicated in these cases and increasingly in preoperative planning. The present cross-sectional study aimed to compare the evaluation between periapical radiography (PR) and CBCT in the diagnostic variation of endo-periodontal changes with root damage and without root damage. Sixty specialists, 30 Endodontists, and 30 Periodontists evaluated 10 cases that included endodontic and/or periodontal changes; root fractures/trenches; root perforations; root resorptions, and combined endo-periodontal lesions. The clinical cases were evaluated firstly from the clinical history of the element involved and its periapical radiograph (M1) and soon after, with the association of the tomographic section of the tooth in question (M2). For each evaluation, the probable diagnosis of the clinical condition was established. Furthermore, the specialists determined the perception of diagnostic complexity and treatment indication for each case when both imaging exams were available. Chi-square statistical tests were applied, considering a 5% significance level. The results showed that the diagnostic variation between M1 and M2 was 48.5% overall. In the comparison between Endodontists and Periodontists, there was no statistical difference in the diagnostic variation with CBCT (p=0.568) and the indication of conservative treatment or not (p=0.741). However, there was variation in the perception of diagnostic complexity (p=0.017), in which Endodontists classified more cases as high complexity and Periodontists opted for medium complexity. In the comparison between endo periodontal clinical conditions, there was a significant difference (p<0.001) in the three categories: diagnostic variation, perceived complexity, and therapeutic indication. The CBCT made a difference in evaluating these alterations in both groups, justifying its request even in the preoperative moment in high-complexity cases. We conclude that CBCT helps diagnose cases involving pulp and periodontal tissues and may interfere with the therapeutic strategy of these cases for these specialists. The evaluation criteria applied to analyze these cases may explain the difference in diagnostic complexity established by Endodontists and Periodontists.