Diagnostic Accuracy of Pulp Sensibility Tests and Radiographic Findings for Endodontic-Periodontal Lesions

Accurate diagnosis of endodontic-periodontal (endo-perio) lesions remains challenging because pulpal and periodontal diseases often present with overlapping clinical and radiographic features. This study aimed to evaluate and compare the diagnostic accuracy of pulp sensibility tests and radiographic findings for endo-perio lesions using latent class analysis.

This prospective cross-sectional diagnostic accuracy study included 100 teeth diagnosed with endo-perio lesions. Clinical examination, periodontal assessment, pulp sensibility testing, and radiographic evaluation were performed for all included teeth. Pulp sensibility assessment included cold testing using Endo-Ice and electric pulp testing. Digital periapical radiographs and cone-beam computed tomography were used for radiographic evaluation in selected cases. Lesions were categorized as endo-origin, perio-origin, or true combined lesions. Latent class analysis was used to estimate diagnostic sensitivity, specificity, predictive values, and prevalence in the absence of a definitive gold standard. Agreement between pulp sensibility tests and radiographic findings was analysed using Cohen's kappa statistics.

Among the evaluated teeth, endo-origin lesions were identified in 42 (42.0%), perio-origin lesions in 34 (34.0%), and true combined lesions in 24 (24.0%). Most endo-origin lesions demonstrated non-vital pulp responses, which were observed in 32 teeth (76.2%), whereas normal pulp responses were predominantly associated with perio-origin lesions, which were identified in 18 teeth (52.9%). Latent class analysis demonstrated an acceptable model fit (p = 0.34). Pulp sensibility tests showed significantly higher sensitivity than radiographic evaluation. Radiographic findings demonstrated a higher estimated specificity (85%; 95% CI: 76-94%) than pulp sensibility tests (78%; 95% CI: 68-88%). Agreement analysis showed a fair-to-moderate agreement between the two diagnostic methods.

Pulp sensibility tests demonstrated superior sensitivity, whereas radiographic findings showed comparatively greater specificity for diagnosing endo-perio lesions. A combined diagnostic approach using both sensibility testing and radiographic assessment may improve diagnostic accuracy and support effective treatment planning.