DIAGNOSTIC ACCURACY OF DIGITAL RADIOGRAPHY VERSUS CONE BEAM CT IN DETECTING PERIAPICAL LESIONS IN POSTERIOR TEETH

Background: Accurate detection of periapical lesions is critical for successful endodontic outcomes, yet conventional digital radiography (DR) is limited by its two-dimensional nature, particularly in anatomically complex posterior regions. While cone-beam computed tomography (CBCT) offers three-dimensional imaging, its comparative diagnostic accuracy requires systematic appraisal to guide evidence-based clinical use. Objective: This systematic review aims to compare the diagnostic accuracy of digital radiography versus cone-beam computed tomography in detecting periapical lesions in posterior teeth. Methods: A systematic review was conducted following PRISMA guidelines. Electronic searches were performed in PubMed, Scopus, Web of Science, and the Cochrane Library for studies published between 2019-2024. Inclusion criteria encompassed clinical studies directly comparing DR and CBCT for periapical lesion detection in posterior teeth, using histology or clinical follow-up as a reference standard. Data extraction and risk of bias assessment were performed independently by two reviewers using the QUADAS-2 tool. Results: Eight studies comprising 1,243 posterior teeth were included. CBCT demonstrated consistently and significantly higher sensitivity (range: 0.92-0.98) compared to DR (range: 0.54-0.78) across all studies (p < 0.001). The superiority of CBCT was most pronounced in maxillary molars and for detecting early or small lesions. Specificity was high for both modalities, though slightly superior for CBCT (0.94-0.99 vs. 0.87-0.96 for DR). Conclusion: CBCT exhibits significantly superior diagnostic accuracy for detecting periapical lesions in posterior teeth compared to digital radiography, particularly in anatomically complex areas. These findings support the selective use of CBCT when conventional radiographs are inconclusive. Future research should focus on standardized protocols and cost-effectiveness analyses.