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. 2014;43(4):20130137.
doi: 10.1259/dmfr.20130137. Epub 2014 Mar 10.

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

F J Mota de Almeida  1 , K Knutsson, L Flygare
Affiliations

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

F J Mota de Almeida et al. Dentomaxillofac Radiol. 2014.

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.

Keywords: cone beam computed tomography; decision-making; endodontics; therapeutics.

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Figures

Figure 1
Figure 1
Our questionnaire regarding usefulness of cone beam CT (CBCT) examination adapted from the original questionnaire of Wittenberg et al.
Figure 2
Figure 2
Study flow. CBCT, cone beam CT.
Figure 3
Figure 3
57-year-old female who had complained of apical tenderness of tooth 23 for several years. Intraoral radiographs (sensitivity of 0.55 and specificity of 0.98 for apical periodontitis) did not reveal apical pathology, and cold and electrical pulp tests were indecisive. Tentative planning before cone beam CT examination was 6-month follow-up. 1.5 months later cone beam CT examination (higher sensitivity and specificity than intraoral radiographs for apical periodontitis) revealed the apex of tooth 23 fenestrating the buccal cortical plate, and a rounding of the tooth apex confirming the clinical suspicion of apical periodontitis. Orthograde endodontic treatment revealed a necrotic pulp, and symptoms were relieved after treatment. (a) Mesial eccentric and (b) orthogonal intraoral radiographs; (c) coronal plane and (d) sagittal plane cone beam CT examination of tooth 23.
Figure 4
Figure 4
Fryback and Thornbury's framework of the efficacy of diagnostic imaging.
See this image and copyright information in PMC

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