The effect of cone beam CT (CBCT) on therapeutic decision-making in endodontics

Abstract

Objectives: The aim was to assess to what extent cone beam CT (CBCT) used in accordance with current European Commission guidelines in a normal clinical setting has an impact on therapeutic decisions in a population referred for endodontic problems. Methods: The study includes data of consecutively examined patients collected from October 2011 to December 2012. From 2 different endodontic specialist clinics, 57 patients were referred for a CBCT examination using criteria in accordance with current European guidelines. The CBCT examinations were performed using similar equipment and standardized among clinics. After a thorough clinical examination, but before CBCT, the examiner made a preliminary therapy plan which was recorded. After the CBCT examination, the same examiner made a new therapy plan. Therapy plans both before and after the CBCT examination were plotted for 53 patients and 81 teeth. As four patients had incomplete protocols, they were not included in the final analysis. Results: 4% of the patients referred to endodontic clinics during the study period were examined with CBCT. The most frequent reason for referral to CBCT examination was to differentiate pathology from normal anatomy, this was the case in 24 patients (45% of the cases). The primary outcome was therapy plan changes that could be attributed to CBCT examination. There were changes in 28 patients (53%). Conclusions: CBCT has a significant impact on therapeutic decision efficacy in endodontics when used in concordance with the current European Commission guidelines.

The impact of cone beam computed tomography on the choice of endodontic diagnosis

“…The fourth level included in the current study, therapeutic efficacy, has been presented elsewhere (Mota de Almeida et al . ). The most important objectives of any diagnostic test are to have a positive impact on patient outcome, level 5, and to be cost‐effective, level 6.…”

“…(), CBCT had no influence on therapy for apical lesions that were easily observed on intra‐oral radiographs but it had the ability to cause endodontic therapy changes when applying the same strict criteria as those applied in the present study (Mota de Almeida et al . ).…”

Endodontic Radiology

“…The effective radiation dose to patients when using CBCT compared to conventional radiography is much higher, and the benefi t to the patient must be outweighed by any potential risks in order to be justifi ed. Radiation dose should be kept as low as reasonably achievable (ALARA) [ 6 ]. Conventional two-dimensional (2D) radiographs provide a cost-effective, high-resolution image, which continues to be the most popular method of imaging today [ 6 ].…”

“…Radiation dose should be kept as low as reasonably achievable (ALARA) [ 6 ]. Conventional two-dimensional (2D) radiographs provide a cost-effective, high-resolution image, which continues to be the most popular method of imaging today [ 6 ]. According to the consensus report of the European Society of Endodontology, appropriate root canal treatment includes a radiographical control showing a prepared root canal tapered from crown to apex and fi lled completely without space between canal fi lling and canal walls [ 7 ].…”

Prognostic Evaluation of Endodontic Retreatment

“…The usefulness of CBCT for therapeutic decision-making in endodontics was indicated by Mota de Almeida et al 4 , whereby differences in endodontic treatment planning were compared before and after CBCT examination. The results showed that over half of the changes in treatment planning were attributed to CBCT ndings.…”