The use of CBCT in endodontic diagnostics
Featured Products Promotional FeaturesPosted by: Dental Design 9th June 2023
Achieving an accurate diagnosis is essential for carrying out effective and precise endodontic treatment. Having a clear diagnosis forms the basis of your treatment plan, ensuring predictable results. It is important to consider all of the methods available to form an accurate diagnosis including thorough examinations, pulp vitality testing and radiographs. Radiographs are considered an essential aspect of endodontic diagnosis and treatment planning.[i] This includes traditional radiographic methods, and CBCT imaging. The latter has become much more popular in recent years, and is shown to be an effective diagnostic tool in endodontics.[ii]
Diagnosis in endodontics
Traditionally, there are a number of methods which can be used to assess the health of the dental pulp. Initially, an intra- and extra-oral examination should be carried out to evaluate the patient’s general dental health, look for any areas of swelling or tenderness, and any discolouration. From here, there are a number of diagnostic tests which should be used to gauge the health of the dental pulp. It may be useful to palpate the gingiva, or gently tap on a tooth to test for tenderness and swelling. It may also be appropriate to evaluate a tooth’s mobility – excessive movement may be a sign of periodontal issues or root fracture.[iii] Pulp vitality testing is another useful method which assesses the pulp’s response to different stimuli including electric current, heat, and cold.[iv] The response to these stimuli will reveal any sensitivity indicating fractures in the teeth, infected pulp, and/or pulp necrosis. However, these are not the most accurate diagnostic tools.[v]
For a precise endodontic diagnosis, a radiograph is essential. It is important that high-quality images are obtained both to ensure that they can be used in diagnosis, and that patients are not exposed to radiation unnecessarily. Radiographs can indicate the presence of illness and disease.[vi] They also enable the clinician to identify any complex root structures, previously treated canals, and canals in need of treatment. In some cases, it may be possible that, if radiographs are not taken before treatment, root canals can be missed entirely. If a clinician relies on an apex locator alone, and a canal is left untreated, the pulp is likely to remain or become infected, resulting in the need for re-treatment.[vii]
The efficacy of traditional radiographs and CBCT imaging
Though radiography is an essential tool for diagnosis and treatment planning in endodontic cases, traditional imaging methods have limitations. These include the 2D nature of the images, anatomical noise, and distorted details. This can make the detection of pathologies difficult. CBCT imaging, on the other hand, overcomes these challenges by providing the ability to produce 3D images.[viii] Because of this, it is becoming more popular to use CBCT imaging in the diagnostics stage, to ensure accuracy, and supply a reliable basis for treatment planning, with many advocating for its day-to-day use for a range of endodontic applications.[ix]
CBCT imaging can be used for a number of diagnostic indications including: periapical inflammation, trauma, highlighting complex root canal systems, identifying canals in need of treatment/re-treatment and locating damaged canals with precision.[x] CBCT is a particularly useful tool for treatment planning too, superior to traditional methods in the detection of root canals. CBCT images offer clinicians wide ranging, clear, and relevant information, with limited distortion, facilitating treatment planning decisions which lead to more predictable outcomes.[xi] It may also be useful to use CBCT imaging to assess the clinical outcome of endodontic treatment, and during follow up treatments.[xii]
The CS 8200 3D Neo Edition CBCT system, from Carestream Dental, allows you to make an accurate endodontic diagnosis with ease. The high performance CBCT system is the ideal imaging solution for your practice, delivering enhanced diagnostics and treatment planning capabilities. For optimal visibility, the system offers the broadest range of fields of view in its category, and uses exclusive CS MAR (metal artifact reduction) technology to minimise the appearance of metal artifacts and avoid misinterpretation. The level of detail delivered by the CS 8200 3D Neo Edition is ideal for endodontic applications.
When carrying out endodontic diagnosis, ensure you have the equipment available to help you make an accurate diagnosis and treatment plan effectively. The ability to create a precise treatment plan is vital for a predictable outcome. CBCT imaging is shown to produce clear and accurate images, ideal for endodontic diagnosis, and the management of more complex endodontic issues, compared with traditional radiographs. By choosing equipment which maximises clarity and minimises distortions, you boost your diagnostic capabilities, ensuring high-quality results.
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Nimisha Nariapara
Bio
Nimisha is the Trade Marketing Manager at Carestream Dental covering the UK, Middle East, Nordics, South Africa, Russia and CIS regions. She has worked at Carestream Dental for the past 7 years, where she has developed her marketing skills and industry knowledge to bring the core values and philosophy of the company to the market.
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[i] Patel, S., et al. “European Society of Endodontology position statement: Use of cone beam computed tomography in Endodontics: European Society of Endodontology (ESE) developed by.” International endodontic journal 52.12 (2019): 1675-1678. https://endomishra.co.uk/wp-content/uploads/2021/04/Patel_et_al-2019-International_Endodontic_Journal.pdf
[ii] Rosen, Eyal, et al. “The effect of imaging modality on the evaluation of the outcome of endodontic surgery.” Dentomaxillofacial Radiology 51.8 (2022): 20220164. https://www.birpublications.org/doi/pdf/10.1259/dmfr.20220164
[iii] Carrotte, P. “Endodontics: Part 2 Diagnosis and treatment planning.” British dental journal 197.5 (2004): 231-238.
https://hama-univ.edu.sy/newsites/dentist/wp-content/uploads/2019/04/endodoncia_parte_2.pdf
[iv] Carrotte, P. “Endodontics: Part 2 Diagnosis and treatment planning.” British dental journal 197.5 (2004): 231-238.
https://hama-univ.edu.sy/newsites/dentist/wp-content/uploads/2019/04/endodoncia_parte_2.pdf
[v] Carrotte, P. “Endodontics: Part 2 Diagnosis and treatment planning.” British dental journal 197.5 (2004): 231-238.
https://hama-univ.edu.sy/newsites/dentist/wp-content/uploads/2019/04/endodoncia_parte_2.pdf
[vi] Carrotte, P. “Endodontics: Part 2 Diagnosis and treatment planning.” British dental journal 197.5 (2004): 231-238.
https://hama-univ.edu.sy/newsites/dentist/wp-content/uploads/2019/04/endodoncia_parte_2.pdf
[vii] Segura-Egea, Juan J., Alicia Jiménez-Pinzón, and José V. Ríos-Santos. “Endodontic therapy in a 3-rooted mandibular first molar: importance of a thorough radiographic examination.” Journal-Canadian Dental Association 68.9 (2002): 541-545. http://cda-adc.ca/jcda/vol-68/issue-9/541.pdf
[viii] Patel, S., et al. “European Society of Endodontology position statement: Use of cone beam computed tomography in Endodontics: European Society of Endodontology (ESE) developed by.” International endodontic journal 52.12 (2019): 1675-1678. https://endomishra.co.uk/wp-content/uploads/2021/04/Patel_et_al-2019-International_Endodontic_Journal.pdf
[ix] Rosen, Eyal, et al. “The effect of imaging modality on the evaluation of the outcome of endodontic surgery.” Dentomaxillofacial Radiology 51.8 (2022): 20220164. https://www.birpublications.org/doi/pdf/10.1259/dmfr.20220164
[x] Patel, S., et al. “European Society of Endodontology position statement: Use of cone beam computed tomography in Endodontics: European Society of Endodontology (ESE) developed by.” International endodontic journal 52.12 (2019): 1675-1678. https://endomishra.co.uk/wp-content/uploads/2021/04/Patel_et_al-2019-International_Endodontic_Journal.pdf
[xi] Boquete-Castro, Ana, et al. “Applications and advantages of the use of cone-beam computed tomography in endodontics: An updated literature review.” Saudi Endodontic Journal 12.2 (2022): 168. https://www.saudiendodj.com/article.asp?issn=1658-5984;year=2022;volume=12;issue=2;spage=168;epage=174;aulast=Boquete-Castro
[xii] Venskutonis, Tadas, et al. “The importance of cone-beam computed tomography in the management of endodontic problems: a review of the literature.” Journal of endodontics 40.12 (2014): 1895-1901. https://www.researchgate.net/profile/Tadas-Venskutonis/publication/266390872_The_Importance_of_Cone-beam_Computed_Tomography_in_the_Management_of_Endodontic_Problems_A_Review_of_the_Literature/links/5a0fe50ea6fdccc2d7984185/The-Importance-of-Cone-beam-Computed-Tomography-in-the-Management-of-Endodontic-Problems-A-Review-of-the-Literature.pdf
