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
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
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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: http://dx.doi.org/10.1111/evj.12174
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: https://doi.org/10.1111/j.1740-8261.2003.tb00454.x
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: https://doi.org/10.3389/fvets.2017.00236
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: https://doi.org/10.1111/evj.12729
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: https://doi.org/10.1111/j.2042-3306.2010.00148.x
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: https://doi.org/10.2746/042516401776767458
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