Related Experiment Video
Updated: Aug 11, 2026
Inducing Apical Periodontitis in Mice
Published on: August 6, 2019
Influence of Imaging Modality on the Detection of Periapical Lesions in Root-Filled Teeth: A Systematic Review and
Juan J Segura-Egea1, Carlos Segura-Raya1, Jenifer Martín-González1
1Department of Stomatology (Endodontic Section), School of Dentistry, University of Sevilla, Sevilla, Spain.
Background:
Apical periodontitis is a common finding in root-filled teeth (RFT) and an important indicator of treatment outcomes. Its reported prevalence may vary depending on the imaging modality used for diagnosis.
Objectives:
To estimate the prevalence of periapical lesions in RFT teeth and to assess the influence of imaging modality on these estimates: METHODS: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines and registered in PROSPERO (CRD420261320661). Electronic databases (PubMed, Scopus, Web of Science and Embase) were searched up to February 2026. Studies reporting the prevalence of periapical lesions in endodontically treated permanent teeth assessed using cone-beam computed tomography (CBCT), periapical radiography or panoramic radiography were included. Random-effects meta-analyses (DerSimonian-Laird) with logit-transformed proportions were used to estimate pooled prevalence at tooth and patient levels. Subgroup analyses and meta-regression explored the impact of imaging modality. Risk of bias was assessed using an adapted prevalence tool, and certainty of evidence was evaluated using GRADE.
Results:
Fifty-seven studies were included, comprising 64 026 root-filled teeth and 35 569 patients. The pooled prevalence of periapical lesions was 41.3% (95% CI: 38.2%-44.6%) at the tooth level and 20.5% (95% CI: 9.3%-39.4%) at the patient level. Higher detection rates were observed in studies using CBCT compared with most two-dimensional techniques. However, meta-regression showed that combined panoramic and periapical radiography produced estimates comparable to CBCT, while each modality alone yielded significantly lower values. No significant differences were found when imaging methods were grouped as two-dimensional versus three-dimensional. Substantial heterogeneity was present (I2 = 98%-99%), and potential publication bias was suggested (Egger's test, p = 0.048). Most studies showed moderate risk of bias, with low to very low certainty of evidence.
Conclusions:
Periapical lesions are highly prevalent in endodontically treated teeth. Although imaging modality influences prevalence estimates, improved detection does not rely exclusively on three-dimensional imaging. Combining two-dimensional techniques may achieve comparable results to CBCT, emphasizing the importance of diagnostic strategy. Further high-quality studies with standardized criteria are needed.
