Abstract

Introduction: Periapical diagnosis in endodontics depends largely on radiographic evidence of mineralized tissue changes. Cone beam computed tomography (CBCT) improves three-dimensional assessment of periapical bone loss, root anatomy, and surgical planning. However, it does not directly depict pulpal status or soft tissue inflammatory changes. This narrative review examined dental-dedicated magnetic resonance imaging (ddMRI) for periapical diagnosis compared with CBCT, with emphasis on the transition from historical dental MRI to a dedicated dental platform.

Methods: The review distinguished pre-2024 dental MRI studies performed on conventional medical MRI systems from ddMRI studies based on the low-field, coil-specific, task-oriented platform introduced by Greiser et al. in 2024. Evidence was synthesized around lesion detection, inflammatory change, lesion characterization, artifacts, radiation exposure, workflow, and clinical positioning.

Results: Dental MRI showed that MRI could detect periapical lesions, depict fluid-rich and marrow-related changes, and characterize cystic versus granulomatous lesions. Dental-dedicated MRI extends this work through localized acquisition, dedicated hardware, and task-specific sequences. Early ddMRI evidence suggests potential for evaluating pulp vitality, regeneration and periapical edema-like change within one non-ionizing examination. However, current data are limited by small feasibility studies and incomplete validation.

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