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. Results: CBCT was associated with significantly greater detection of imaging features associated with endodontal disease than IDR overall ( 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.