Radiographic, computed tomographic, gross pathological and histological findings with suspected apical infection in 32 equine maxillary cheek teeth (2012-2015).

Authors: Liuti T, Smith S, Dixon P M

Journal: Equine veterinary journal

DOI: 10.1111/evj.12729 PubMed: 28772346Log in to save

Summary

# Editorial Summary Maxillary cheek tooth apical infections represent a substantial clinical challenge in equine dentistry owing to their propensity for spreading into surrounding bone, yet the diagnostic reliability of computed tomography (CT) in detecting these lesions had not been rigorously validated against pathological findings. Liuti, Smith and Dixon extracted 32 infected maxillary cheek teeth from 29 horses following CT and radiographic diagnosis, then subjected the teeth to further imaging alongside gross and histological examination to establish which imaging modality most accurately reflected actual disease. Whilst conventional radiography identified apical changes in only 53% of infected teeth (17/32), CT detected radiographic and computed tomographic signs indicative of apical infection in all 32 cases, with 97% agreement between CT diagnosis and pathological findings on extraction and histological analysis. A single false-positive CT finding—small gas pockets in one tooth—represented the only discordance, suggesting CT imaging is substantially more sensitive and specific than radiography for identifying maxillary cheek tooth apical disease in clinical practice. For practitioners managing horses with suspected apical infections, these findings reinforce CT as the imaging modality of choice when diagnostic confirmation is required prior to extraction, particularly where radiographic findings are equivocal or clinical signs persist despite normal radiographs.

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Practical Takeaways

•CT imaging is significantly more sensitive than radiography for diagnosing maxillary cheek tooth apical infections and should be the preferred imaging modality when this condition is suspected
•A positive CT diagnosis of apical infection has high predictive value (97%) for actual pathological disease, supporting confidence in CT-based treatment decisions
•Radiographic negative results should not exclude apical infection; CT should be pursued when clinical signs persist despite negative radiographs

Key Findings

•CT imaging detected pulpar and apical changes indicative of apical infection in 32/32 (100%) teeth, compared to radiography which detected changes in only 17/32 (53%) teeth
•Pathological changes were confirmed in 31/32 (97%) extracted teeth on gross and histological examination, with 97% agreement between CT diagnosis and extracted tooth pathology
•One tooth showed gas pockets on CT imaging without corresponding pathological changes on extraction, representing the only discordant finding

Conditions Studied

maxillary cheek teeth apical infectionperiapical disease

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