Why Talk About the “Failure” of Dental Radiology?
Radiology is a cornerstone of modern dental diagnostics. Yet, despite its pivotal role, it is not without limitations or errors that can significantly compromise diagnosis and treatment outcomes.
Understanding where and why radiological techniques may fail is essential for improving patient care and refining clinical protocols.
In this post, we will explore the technical, diagnostic, and educational shortcomings that contribute to the perceived "failures" of dental radiology, supported by scientific literature published in the past 7 years.
1. Inherent Limitations of 2D Imaging Techniques
Traditional radiographic tools like periapical and panoramic X-rays reduce complex three-dimensional structures into flat images.
This compression can result in distortions, overlap of anatomical structures, and misinterpretation.
For example, in endodontics, distortion rates range from 3.4% in periapical images to over 14% in orthopantomograms, depending on patient positioning and technique used.
Panoramic radiographs, while useful for initial screening, often lack the detail required for precise diagnosis, especially for individual teeth or soft tissues.
2. Technical and Human Errors in Image Acquisition and Interpretation
Improper patient positioning, tongue placement, or patient movement during exposure can cause radiographic errors.
A 2022 study from Lima found the most frequent errors in digital panoramic radiographs were incorrect tongue positioning (55.4%) and poor posture (48.2%).
In addition, misinterpretation of radiographs—confusing normal anatomical features with pathology—is a persistent issue, often stemming from inadequate training and a lack of ongoing education.
3. Challenges in Evaluating Endodontic Treatment Outcomes
Periapical radiographs are routinely used to assess the success of endodontic treatment. However, their diagnostic accuracy has been questioned.
In one study, while 78% of cases were clinically considered successful, only 41% showed radiographic success.
Cone-beam computed tomography (CBCT) has been shown to be significantly more sensitive in detecting periapical failures, with up to 77% detection rates compared to 7% by periapical radiographs.
4. Are Technological Advances the Ultimate Solution?
Emerging technologies, particularly artificial intelligence (AI), have shown promise in enhancing radiographic interpretation.
Deep learning algorithms are outperforming general dentists in identifying interproximal caries on bitewing radiographs in some studies. Still, these systems are not without flaws.
AI models remain susceptible to image artifacts and require high-quality training datasets. Moreover, they should complement—not replace—clinical judgment and diagnostic skills.
Conclusion
Toward a More Reliable Radiology in Dentistry
Dental radiology is indispensable but not infallible. Recognizing its limitations and the sources of diagnostic failure is crucial for clinical excellence.
Continued education, the adoption of advanced technologies, and a critical, reflective approach are essential to minimizing errors and enhancing diagnostic reliability.
References
This systematic review critically evaluated the diagnostic accuracy of periapical radiographs compared to histological findings in identifying periapical lesions. The study found that periapical radiographs often lack the precision needed to distinguish between different types of periapical pathologies, such as cysts and granulomas. Out of 16 studies analyzed, only two supported the reliability of periapical imaging for accurate diagnosis. The authors concluded that relying solely on periapical radiographs could lead to misdiagnosis and unnecessary invasive treatments.
This systematic review identified six key factors influencing errors in the interpretation of dental radiographs: clinical experience, clinical knowledge and technical ability, case complexity, time pressure, cognitive load, and the quality of dental education and training. The study emphasizes that these interrelated factors contribute significantly to diagnostic inaccuracies. The authors advocate for enhanced training programs and awareness to mitigate these errors and improve diagnostic outcomes.
