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Pathological changes associated with\n                      <jats:styled-content style=\"fixed-case\">AP<\/jats:styled-content>\n                      may not be visible on radiographic images and may linger without causing any symptoms. Clinicians rely mostly on clinical examination and imaging techniques to establish a diagnosis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      The aim of this review was to answer the following question using the\n                      <jats:styled-content style=\"fixed-case\">PICO<\/jats:styled-content>\n                      format: In the adult human permanent dentition (P), what is the efficacy of diagnostic imaging of the periapical tissues (I) using histopathology as a reference standard (C) in the diagnosis of apical periodontitis, in terms of diagnostic accuracy (O).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      <jats:styled-content style=\"fixed-case\">MEDLINE<\/jats:styled-content>\n                      ,\n                      <jats:styled-content style=\"fixed-case\">EMBASE<\/jats:styled-content>\n                      , Scopus and Cochrane Library were searched for English articles published through October 2021. At least two independent reviewers evaluated the study design, imaging modality used, histopathological assessment, outcome measures, results and conclusions for each article. The risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies\u20102.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The initial search strategy identified 544 articles. Seven articles were included for analysis in the final review, all of which involved tissue samples obtained from cadavers. No clinical studies were identified that met the eligibility criteria. A consistently low sensitivity score and negative predictive value were reported for periapical radiography, especially in comparison to CBCT, which scored highly. Both modalities achieved high scores for specificity and positive predictive value. Diagnostic accuracy of CBCT was lower for root\u2010filled teeth in comparison to non\u2010root\u2010filled teeth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Assessment of the periapical tissues using periapical radiographs was shown to have a low to moderate agreement with the histopathological assessment. CBCT was reported to be more accurate than PR and demonstrated a good agreement with histopathology, especially for non\u2010root\u2010filled teeth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This review identified a need for greater standardization in methodology and reporting, and as the findings are based on cadaver studies, their clinical relevance must be interpreted with caution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p>PROSPERO (CRD42021272147).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/iej.13921","type":"journal-article","created":{"date-parts":[[2023,4,17]],"date-time":"2023-04-17T07:13:10Z","timestamp":1681715590000},"page":"326-339","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Efficacy of imaging techniques for the diagnosis of apical periodontitis: A systematic review"],"prefix":"10.1111","volume":"56","author":[{"given":"Ali","family":"Hilmi","sequence":"first","affiliation":[{"name":"Department of Endodontology King's College London Dental Institute  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0614-6951","authenticated-orcid":false,"given":"Shanon","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Endodontology King's College London Dental Institute  London UK"},{"name":"Specialist Practice  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazim","family":"Mirza","sequence":"additional","affiliation":[{"name":"Department of Endodontics, Arthur A. 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