Evaluating cone-beam computed tomography vs. intraoral radiography for the detection of endodontal disease in dogs: diagnostic performance and inter-rater agreement

Introduction: The comparative diagnostic utility of cone-beam computed tomography (CBCT) and intraoral dental radiography (IDR) for endodontal disease in dogs remains unclear. Accordingly, this study evaluated both imaging modalities against histopathologic findings as the gold standard. Methods: In this prospective observational study, client-owned dogs undergoing evaluation for suspected endodontal disease were imaged with both CBCT and IDR under general anesthesia. Forty-six teeth from 16 dogs were included. Four radiographic features-periapical lucency, failure of pulp canal narrowing, external inflammatory root resorption, and loss of crown integrity-were independently scored by five blinded evaluators using a standardized qualitative scale. Histopathological assessment of pulp vitality was available for 18 teeth. Diagnostic performance, inter-rater agreement, and modality-related effects were analyzed using mixed-effects models and concordance statistics. Both modalities demonstrated high sensitivity for identifying non-vital teeth, but limited specificity, reflecting disease prevalence within the histopathology subset. Inter-rater agreement was modest for both modalities and was affected primarily by scoring variability among evaluators rather than systematic differences in scoring patterns. Discussion: CBCT demonstrated superior detection of periapical lucency compared with IDR in dogs. Nonetheless, inter-rater variability remains a significant limitation, emphasizing the need for standardized image interpretation and integration with clinical findings.