Detectability of artificial periapical lesions using direct digital and conventional radiography

The ability of different radiographic techniques to detect the presence of artificially created periapical lesions in mandibles of human cadavers was investigated. Conventional radiography was compared with direct digital imaging using the Digora system. Artificial lesions were created around the roots of molars in three stages: removal of lamina dura only, extension to cancellous bone, and involvement of cortical plate. Radiographs and digital images (gray scale, color, and reverse image) were obtained preoperatively and after each stage of bone removal. Images were scored on a 5-point scale by eight observers. For all image types, lesions were readily detectable after removal of lamina dura only, with increasing detectability associated with further bone removal (especially cortical plate involvement). Radiographs and gray-scale digital images were comparable at all stages, whereas color and reverse images were associated with a greater spread of diagnostic scores. Digital imaging did not enhance detectability of lesions.