A COMPARATIVE STUDY OF THE ACCURACY OF CONVENTIONAL RADIOGRAPHY AND CBCT (CONE BEAM CT) IN DIAGNOSIS OF JAW DISORDERS

Abstract

Accurate and timely diagnosis of jaw disorders plays a crucial role in the successful management of various odontogenic and non-odontogenic conditions, significantly impacting the patient's quality of life and the effectiveness of treatment; in this context, conventional radiography, such as panoramic radiography (OPG) and periapical radiography, has long been the backbone of diagnosis, but inherent limitations in spatial resolution, two-dimensional projections that can lead to superimposition of structures, and the inability to visualize fine three-dimensional details, often hinder the early identification and characterization of complex pathological lesions. With technological advancements, Cone Beam Computed Tomography (CBCT) has emerged as a revolutionary imaging modality offering three-dimensional reconstructions with superior spatial resolution, reduced artifacts, and enabling comprehensive evaluation of jaw bone structures, supported by a global trend of increasing CBCT adoption, however, in-depth and structured comparative studies of its diagnostic accuracy compared to conventional radiography in the specific context of jaw disorders still reveal gaps that need to be filled, particularly in the quantitative and qualitative evaluation of the comparison of both modalities against various types of jaw pathologies and the analysis of factors that influence their respective accuracy. The main objective of this study was to quantitatively and qualitatively compare the diagnostic accuracy of conventional radiography (specifically panoramic radiography) and Cone Beam Computed Tomography (CBCT) in detecting, characterizing, and identifying various types of jaw abnormalities, including cystic lesions, benign and malignant tumors, and inflammatory lesions, based on the theoretical framework of Information Theory that considers diagnostic imaging as an information transmission process, where the accuracy of diagnosis depends on the amount and quality of information that can be extracted from the image; the main hypothesis proposed was that CBCT would show significantly higher diagnostic accuracy compared to panoramic radiography in diagnosing jaw abnormalities, especially in terms of detection of small lesions, determination of lesion boundaries, and evaluation of the relationship of lesions to surrounding vital anatomical structures. This study adopted a retrospective descriptive analytical study design with a gold standard approach using histopathological data, which is justified because it allows a comprehensive evaluation of cases that have been definitively diagnosed, with a sample consisting of 150 patients (age 20-70 years, evenly gendered) who underwent panoramic radiography and CBCT imaging, covering various types of jaw abnormalities such as radicular cysts, other odontogenic cysts, ameloblastomas, odontomas, and chronic inflammatory lesions, selected through strict inclusion and exclusion criteria; the main instruments were panoramic radiography and CBCT images obtained using industry-standard digital equipment, with validity and reliability referring to the image quality of the calibrated equipment and the interpretation of experienced radiologists. Data were collected through a review of electronic medical records, including initial radiological reports and histopathological results, where two independent dental radiologists blinded to the histopathological results evaluated the images separately using a structured checklist that included parameters of lesion detection, size, shape, margins, involvement of surrounding structures, and differential diagnosis; Data analysis was performed using descriptive statistics, and inferential statistics such as the McNemar test and the Wilcoxon Signed-Rank test to compare the proportion of accurate diagnoses between the two modalities, with a statistical significance level of p < 0.05, as well as multivariate logistic regression analysis to identify predictors of accuracy. The results showed that CBCT was significantly superior to panoramic radiography in diagnosing jaw abnormalities, with overall pathological lesion detection being higher in CBCT (95.3% sensitivity) compared to panoramic radiography (78.7% sensitivity), with a highly significant difference (p < 0.001) and an effect size (Cohen's w) of 0.52; Specific analysis showed that CBCT was able to detect more small lesions (<1 cm) (92.1% versus 45.8%) and delineate lesion boundaries more accurately (96.5% versus 70.2%), with secondary analysis showing CBCT's superiority in evaluating involvement of vital structures such as the inferior alveolar nerve and maxillary sinus, although in cases of very large lesions, panoramic radiography sometimes provided a faster overview but the resolution of detail remained superior to CBCT, indicating a pattern that the accuracy of both modalities depends on the characteristics of the lesion, with CBCT consistently showing superiority in detail and precision. The main conclusion of this study is that Cone Beam Computed Tomography (CBCT) consistently demonstrates superior diagnostic accuracy compared to conventional radiography (panoramic radiography) in detecting, characterizing, and assessing jaw abnormalities, directly addressing the study's objectives and supporting the primary hypothesis. These findings enhance theoretical understanding in line with Information Theory and provide strong practical evidence to support the use of CBCT as a standard diagnostic tool for jaw abnormalities, leading to earlier diagnosis, optimal treatment planning, and improved clinical outcomes for patients. It is recommended that clinicians consider CBCT as the modality of choice and that future research explore comparisons with MRI and prospective studies on the impact of CBCT use on clinical decisions and treatment outcomes.