Imaging for Periapical Abscess
For a periapical abscess, you should order an intraoral periapical X-ray using a dedicated film holder and beam aiming device—CT imaging is not indicated for initial diagnosis. 1
Initial Diagnostic Imaging
Intraoral periapical radiograph is the first-line imaging modality for suspected periapical abscess, preferably using a paralleling technique with a dedicated film holder and beam aiming device 1
CBCT (cone beam CT) is explicitly NOT indicated in the initial diagnostic phase of periapical tissue swelling, despite its superior accuracy in detecting endodontium-originated periapical disease 1
The strength of this recommendation is Grade A with Level III evidence, making it a strong guideline-based recommendation 1
When to Consider Advanced Imaging
CBCT should only be reserved for suspect or unclear cases after traditional intraoral examination has been performed and remains inconclusive 1
CBCT can highlight periapical disease more accurately than standard intraoral X-rays, but this does not justify its use as first-choice examination 1
The limitation to advanced imaging only after initial radiography reflects the ALARA principle (As Low As Reasonably Achievable) for radiation exposure 1
Special Circumstances
If a fistula is present, the intraoral radiograph should be taken with a gutta-percha cone inserted inside the fistula tract to accurately trace its origin 1
- This technique has Grade A strength of recommendation with Level III evidence 1
Common Pitfalls to Avoid
Do not order CT or CBCT as your initial imaging study—this exposes patients to unnecessary radiation when simpler imaging suffices 1
Do not skip the use of film holders and beam aiming devices—these are specifically recommended to optimize image quality and diagnostic accuracy 1
Be aware that in posterior areas (upper and lower), superimposition of bony structures may make periapical examination difficult on plain films, but this still does not justify routine CBCT use 1