Does a combination of two radiographs increase accuracy in detecting acid-induced periapical lesions and does it approach the accuracy of cone-beam computed tomography scanning?

J Endod. 2012 Feb;38(2):131-6. doi: 10.1016/j.joen.2011.10.013. Epub 2011 Dec 6.


Introduction: The purpose of this study was to determine whether the use of a combination of 2 images (storage phosphor plates [SPPs] and F-speed films [Eastman Kodak, Rochester, NY]) with a 10° difference in horizontal beam angulation resulted in better detectability of chemically created periapical defects than when only 1 image was used and whether a detectability as good as that achieved by limited cone-beam computed tomography (LCBCT) scanning could be achieved.

Methods: Lesions were created by 1, 1.5, and 2 hours of acid application apical to extracted teeth in jaw specimens. After repositioning, teeth were radiographed with Accu-I-Tomo LCBCT, Digora Optime SPP system, and F-speed films. The SPPs and films were exposed at 0° and 10° horizontal angulations. The diagnostic accuracy (Az) was compared using 2-way analysis of variance; pair-wise comparisons were performed using the post hoc t test. Kappa was used to measure interobserver agreement.

Results: A combination of 2 exposures with a 10° difference in horizontal angulation caused an increase, although not statistically significant, in the accuracy of both films and SPPs for all acid durations (P > .05) compared with when only 1 exposure was used. The accuracy did not approach that of LCBCT.

Conclusions: Using a combination of 2 exposures instead of 1 did not significantly increase the accuracy in detecting acid-induced lesions at the apices of single-rooted premolars. The accuracy of LCBCT was superior.

Publication types

  • Comparative Study

MeSH terms

  • Bicuspid / diagnostic imaging
  • Cone-Beam Computed Tomography / methods*
  • Cone-Beam Computed Tomography / standards
  • Humans
  • Perchlorates / adverse effects
  • Periapical Diseases / diagnostic imaging*
  • Radiographic Image Enhancement / methods*
  • Radiographic Image Enhancement / standards
  • Radiography, Bitewing / methods*
  • Radiography, Bitewing / standards
  • Radiography, Dental, Digital / methods
  • Radiography, Dental, Digital / standards
  • Time Factors
  • Tooth Apex / diagnostic imaging
  • Tooth Socket / diagnostic imaging
  • Tooth Socket / drug effects
  • X-Ray Film
  • X-Ray Intensifying Screens


  • Perchlorates