Three-Dimensional CBCT Analysis Of Endodontic-Periodontal Lesions

To differentiate endodontic-periodontal lesions (EPL) from periodontal-endodontic lesions (PEL) using cone-beam computed tomography (CBCT) 3D reconstruction and quantify lesion characteristics. Nine EPL and nine PEL cases underwent small-field CBCT scans. Lesions were reconstructed into 3D models using Mimics software and segmented into three types: (1) isolated lesions, (2) lesions with teeth, (3) lesions with teeth and surrounding bone. Morphological patterns (root encapsulation, lesion fusion) were analyzed. For EPL cases (n=9), lesion areas were measured at apical, middle, and coronal levels. Mesiodistal, buccolingual, and vertical dimensions of 17 apical lesions were quantified via CBCT software. EPL lesions exhibited flask-shaped root encapsulation with separated apical lesions, whereas PEL lesions lacked encapsulation and showed fused apical pathology. EPL lesion areas decreased coronally (apical > middle > coronal, p<0.05). Vertical spread (crown direction) exceeded horizontal spread (p<0.05), while horizontal dimensions (mesiodistal, buccolingual) and vertical spread from the apex showed no difference (p>0.05). EPL is characterized by vertical bone resorption extending to the alveolar crest, distinguishing it from PEL. Apical lesions dominate in size and spatial distribution, supporting clinical sub-classification.