In horses with secondary sinusitis caused by dental disease, is computed tomography more accurate than radiography for the identification of apical dental pathology?



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PICO question

In adult horses with secondary sinusitis caused by dental disease, is computed tomography more accurate than radiography for the identification of apical dental pathology?


Clinical bottom line

Category of research question


The number and type of study designs reviewed

The literature search identified four papers that were critically reviewed. The publications consist of two retrospective case-controlled studies, one clinical study and one descriptive study

Strength of evidence


Outcomes reported

Four studies reported the sensitivity of computed tomography (CT) for the diagnosis of apical dental pathology in horses presented for evaluation of clinical signs of sinus disease with histopathological evidence of apical dental pathology. All studies reported the radiographic changes present in these horses or used absence of definitive radiographic changes consistent with apical dental disease as a reason to undertake further CT evaluation. All four papers found that CT identified teeth with apical pathology that radiography had not


CT is more accurate than radiography for the diagnosis of equine maxillary apical dental pathology; however, clear guidelines on the CT changes associated with apical dental pathology are required. Loss of the lamina dura, infundibular changes or pulpal gas as singular findings on CT imaging can be seen in teeth with no underlying histopathological evidence of apical disease, and in maxillary teeth imaged in horses without clinical signs of maxillary cheek tooth pathology


How to apply this evidence in practice

The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.

Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.


Open Access Peer Reviewed


Bühler, M., Fürst, A., Lewis, F. I., Kummer, M. & Ohlerth S. (2014). Computed tomographic features of apical infection of equine maxillary cheek teeth: A retrospective study of 49 horses. Equine Veterinary Journal. 46(4), 468–473. DOI:

Henninger, W., Frame, E. M., Willman, M., Simhofer, H., Malleczek, D., Kneissl, S. M. & Mayrhofer, E. (2003). CT features of alveolitis and sinusitis in horses. Veterinary Radiology & Ultrasound. 44(3), 269–276. DOI:

Liuti, T., Smith, S. & Dixon, P. M. (2018a). A comparison of computed tomographic, radiographic, gross and histological, dental, and alveolar findings in 30 abnormal cheek teeth from equine cadavers. Frontiers in Veterinary Science. 4, 236. DOI:

Liuti, T., Smith, S. & Dixon, P. M. (2018b). Radiographic, computed tomographic, gross pathological and histological findings with suspected apical infection in 32 equine maxillary cheek teeth (2012–2015). Equine Veterinary Journal. 50(1), 41–47. DOI:

Townsend, N. B., Hawkes, C. S., Rex, R., Boden, L. A. & Barakzai, S. Z. (2011). Investigation of the sensitivity and specificity of radiological signs for diagnosis of periapical infection of equine cheek teeth. Equine Veterinary Journal. 43(2), 170–178. DOI:

Weller, R., Livesey, L., Maierl, J., Nuss, K., Bowen, I. M., Cauvin, E. R. J., Weaver, M., Schumacher, J. & May, S. A. (2001). Comparison of radiography and scintigraphy in the diagnosis of dental disorders in the horse. Equine Veterinary Journal. 33(1), 49–58. DOI:

Vol. 7 No. 2 (2022): The second issue of 2022

Section: Knowledge Summaries

Categories :  Small Animal  /  Dogs  /  Cats  /  Rabbits  /  Production Animal  /  Cattle  /  Sheep  /  Pig  /  Equine  /  Exotics  /