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Diagnostic accuracy comparing OPT and CBCT in the detection of non-vital bone changes before tooth extractions in patients with antiresorptive intake.

OBJECTIVES
To compare the diagnostic accuracy in detecting early non-vital bone changes between OPT and CBCT in correlation with histopathological findings before tooth extractions in patients with antiresorptive intake.


SUBJECTS
Patients with an indication tooth extraction who had received OPT and CBCT preoperatively while or after undergoing antiresorptive treatment were prospectively enrolled over a 24-month period in the PRISM trial. Imaging studies were randomly analyzed by three examiners for early non-vital bone changes using specific predefined characteristics and a 5-level scale (1 definite absence of criteria to 5 definite presence of criteria). Sensitivity and specificity values were calculated in correlation with the histopathological evaluated bone samples at the timepoint of tooth extraction.


RESULTS
130 patients with 237 treated extractions sites met the inclusion criteria. For all images evaluated by all examiners, CBCT (430/492; 87.4%; ROC: AUC = 0.88; p<0.001) was more likely to detect histopathologically confirmed non-vital bone than the OPT (132/492; 26.8%; ROC: AUC = 0.562; p= 0.115).


CONCLUSIONS
In the detection of non-vital bone changes, CBCT is superior to OPT in both sensitivity and specificity. Specific imaging characteristics allow for the prediction of early non-vital bone changes already at the time before tooth extractions.