A novel volume based cone beam computed tomography periapical index

Abstract

Introduction: The purpose of this study was to evaluate the variations in volume of periapical lesions scored using cone beam computed tomography periapical index (CBCTPAI) and develop a new volume based periapical index. Methods: Cone beam computed tomography images were obtained from InteleViewerTM. Teeth with a periapical radiolucency or with a history of endodontic treatment were included in this study. Using three-dimensional medical imaging processing software (Mimics ResearchTM), the maximum diameter of 273 periapical lesions and their corresponding CBCTPAI score was determined. The software was then used to determine the volume of the lesions using a semi-automatic segmentation technique. Results: There was a substantial variation in the volume for CBCTPAI scores 3, 4 and 5, which was demonstrated by the variance and range, thus making it difficult to use the current CBCTPAI as a method to predict volume and treatment outcomes. A new index, cone beam computed tomography periapical volume index (CBCTPAVI), was developed using partition classification analysis. The results for the new index demonstrated high levels of sensitivity, specificity, precision, and area under the curve, all at 0.90 or more, except one sensitivity for CBCTPAVI 1 at 0.875. Overall, the accurate classification rate was 98.169% and root mean square error rate was low at 0.07. Conclusions: The proposed CBCTPAVI will allow clinicians to classify lesions based on their true three-dimensional size, accurately assess healing of lesions, and predict treatment outcomes.