Volumetric measurements from manually drawn segmentations of periapical lesions in cone-beam computed tomography scans correlate with the inflammatory activity classified using the dental apical inflammation score

Abstract

Introduction: The Dental Apical Inflammation Score (DAIS) is a semi-quantitative histopathological score used to categorise apical inflammatory lesions. This score has shown clinical potential for assessment of wound-healing and infection risk in post-apical lesions. Objective: This retrospective study aimed to investigate whether periapical lesion volume measurements obtained using manual segmentation on cone-beam computed tomography (CBCT) scans were related to the DAIS categorisation. In addition, the correlations of periapical lesion volume with treatment, anatomical sites, and histological diagnosis criteria were explored. Material and methods: CBCT scans and histopathological findings of specimens from a cohort of 153 patients were used in this study. Volumetric measurement of the apical lesions was performed using MeVisLab© software. Fisher's exact test and Kruskal–Wallis H-test were performed to examine the relationship between lesion volume and different factors. Results: Lesions with a DAIS of 4 showed a significantly larger mean volume than those with a DAIS of 2 (p-value of 0.0377). Lesion volumes also showed a significant difference (p-value of 0.0157) in relation to the histological diagnosis types, with diagnosis based on the presence of radicular cysts being associated with a larger mean lesion volume than that based on the proportion of radicular cysts. Discussion/conclusions: The volume of the preoperative periapical lesion correlates with both the DAIS category and histological diagnosis and can be used to assess inflammatory infiltrations, facilitating clinical decision-making and treatment-plan optimisation.

Keywords

• Dental apical inflammation score
• Periapical lesions
• Cone-beam computed tomography
• Volumetric measurements