In Vivo Detection of External Apical Root Resorption Induced by Apical Periodontitis Using Periapical Radiography and Cone-Beam Computed Tomography


  • Stephanie Diaz Huamán
  • Maya Fernanda Manfrin Arnez
  • Fernanda Maria Machado Pereira Cabral de Oliveira
  • Andiara De Rossi
  • Léa Assed Bezerra Silva
  • Francisco Wanderley Garcia Paula-Silva


Tooth Resorption, Diagnostic Imaging, Radiography, Dental


Objective: To compare the accuracy of periapical radiography (PR) and cone-beam computed tomography (CBCT) for the detection of external apical root resorption (EARR) due to root canal contamination. Material and Methods: Dog’s teeth with experimentally induced root resorption due to root canal contamination underwent or not root canal treatment (n=62). True positives (TP), false positives (FP), true negatives (TN), and false negatives (FN) in PR and CBCT diagnoses were determined using histopathologic findings as the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (TP + TN) in the diagnosis of EARR were calculated. Data were compared using chi-squared test (⍺=0.05). Results: EARR was detected in 35% of roots by PR, in 47% by CBCT, and in 50% of the roots by microscopy (p=0.03 PR versus microscopy; p=0.67 CBCT versusmicroscopy). Overall, CBCT produced more accurate diagnoses than PR (p=0.008). PR and CBCT allowed the identification of large resorption in 100% of the cases and showed the same accuracy. However, for small resorptions, PR showed an accuracy of 0.83, whereas CBCT showed an accuracy of 0.96 (p=0.003). Conclusion: Cone-beam computed tomography showed higher accuracy in detecting external apical root resorption of endodontic origin.


Andreasen JO. External root resorption: its implication in dental traumatology, paedodontics, periodontics, orthodontics and endodontics. Int Endod J 1985; 18(2):109-18.

Huang XX, Fu M, Hou BX. Morphological changes of the root apex in permanent teeth with failed endodontic treatment. Chin J Dent Res 2019; 22(2):113-22.

Li F, Li J, Zhang D, Wu F. Role of computed tomography scan in dental trauma: a cross-sctional study. Dose Response 2018; 16(3):1559325818789837.

Shruthi N, Murthy BV, Sundaresh KJ, Mallikarjuna R. Diagnosis demystified: CT as diagnostic tool in endodontics. BMJ Case Rep 2013; 2013:bcr2013010312.

Kaeppler G. Applications of cone beam computed tomography in dental and oral medicine. Int J Comput Dent 2010; 13(3):203-19.

Patel S, Brown J, Semper M, Abella F, Mannocci F. European Society of Endodontology Position Statement: Use of cone beam computed tomography in Endodontics: European Society of Endodontology (ESE) developed by. Int Endod J 2019; 52(12):1675-8.

de Paula-Silva FW, Wu MK, Leonardo MR, da Silva LA, Wesselink PR. Accuracy of periapical radiography and cone-beam computed tomography scans in diagnosing apical periodontitis using histopathological findings as a gold standard. J Endod 2009; 35(7):1009-12.

de Paula-Silva FW, Santamaria M, Jr. Leonardo MR, Consolaro A, da Silva LA. Cone-beam computerized tomographic, radiographic, and histologic evaluation of periapical repair in dogs' post-endodontic treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108(5):796-805.

de Castro RMC, Maia-Filho E, Nelson-Filho P, Segato R, de Queiroz A, Paula-Silva F, et al. Single vs two-session root canal treatment: a preliminary randomized clinical study using cone beam computed tomography. J Contemp Dent Pract 2016; 17(7):515-21.

Vaz de Souza D, Schirru E, Mannocci F, Foschi F, Patel S. External cervical resorption: A comparison of the diagnostic efficacy using 2 different cone-beam computed tomographic units and periapical radiographs. J Endod 2017; 43(1):121-5.

Deliga Schroder AG, Westphalen FH, Schroder JC, Fernandes A, Ditzel Westphalen VP. Accuracy of different imaging CBCT systems for the detection of natural external radicular resorption cavities: an ex vivo study. J Endod 2019; 45(6):761-7.

Goller Bulut D, Ugur Aydin Z. The impact of different voxels and exposure parameters of CBCT for the assessment of external root resorptions: A phantom study. Aust Endod J 2019; 45(2):146-53.

Deliga Schroder AG, Westphalen FH, Schroder JC, Fernandes A, Westphalen VPD. Accuracy of digital periapical radiography and cone-beam computed tomography for diagnosis of natural and simulated external root resorption. J Endod 2018; 44(7):1151-8.

Cordeiro RdCL, Leonardo MR, Silva LABd, Cerri PS. Desenvolvimento de um dispositivo para padronizaçäo de tomadas radiográficas em cäes. RPG Rev Pós-Grad 1995; 2(3):138-40. [In Portuguese].

Heney CM, Arzi B, Kass PH, Hatcher DC, Verstraete FJM. The diagnostic yield of dental radiography and cone-beam computed tomography for the identification of dentoalveolar lesions in cats. Front Vet Sci 2019; 6:42.

Takeshita WM, Chicarelli M, Iwaki LC. Comparison of diagnostic accuracy of root perforation, external resorption and fractures using cone-beam computed tomography, panoramic radiography and conventional & digital periapical radiography. Indian J Dent Res 2015; 26(6):619-26.

Bender IB. Factors influencing the radiographic appearance of bony lesions. J Endod 1982; 8(4):161-70.

Alimohammadi R. Imaging of dentoalveolar and jaw trauma. Radiol Clin North Am 2018; 56(1):105-24.

European Commission. Directorate-General for Energy. Directorate D — Nuclear Energy. Unit D4 — Radiation Protection. Radiation Protection nº 172. Cone Beam CT for Dental and Maxillofacial Radiology. Evidence-Based Guidelines; 2012. 154p.

American Academy of Pediatric Dentistry. Prescribing dental radiographs for infants, children, adolescents and individuals with special health care needs. Pediatr Dent 2017; 39(6):205-7.

Oenning AC, Jacobs R, Pauwels R, Stratis A, Hedesiu M, Salmon B. Cone-beam CT in paediatric dentistry: DIMITRA project position statement. Pediatr Radiol 2018; 48(3):308-16.

Oenning AC, Pauwels R, Stratis A, De Faria Vasconcelos K, Tijskens E, De Grauwe A, et al. Halve the dose while maintaining image quality in paediatric Cone Beam CT. Sci Rep 2019; 9(1):5521. Erratum in: Sci Rep 2020; 10(1):2474

Dogan MS, Callea M, Kusdhany LS, Aras A, Maharani DA, Mandasari M, et al. The evaluation of root fracture with cone beam computed tomography (CBCT): an epidemiological study. J Clin Exp Dent 2018; 10(1):e41-e8.

Patel S, Dawood A, Ford TP, Whaites E. The potential applications of cone beam computed tomography in the management of endodontic problems. Int Endod J 2007; 40(10):818-30.

May JJ, Cohenca N, Peters OA. Contemporary management of horizontal root fractures to the permanent dentition: diagnosis - radiologic assessment to include cone-beam computed tomography. Pediatr Dent 2013; 35(2):120-4.




How to Cite

Huamán, S. D. ., Arnez, M. F. M. ., de Oliveira, F. M. M. P. C. ., De Rossi, A. ., Silva, L. A. B. ., & Paula-Silva, F. W. G. . (2022). In Vivo Detection of External Apical Root Resorption Induced by Apical Periodontitis Using Periapical Radiography and Cone-Beam Computed Tomography. Pesquisa Brasileira Em Odontopediatria E Clínica Integrada, 22, e210163. Retrieved from



Original Articles