Impact of cone beam computed tomography (CBCT) on diagnostic thinking in endodontics of posterior teeth: A before- after study

Abstract

Objectives: The aim of this study was to evaluate the impact of limited volume CBCT upon diagnosis as part of endodontic management of posterior teeth. The null hypothesis that CBCT does not make any difference in endodontic diagnosis was tested.

Methods: A single-centre "before-after" study was conducted in a secondary healthcare establishment. Eligible patients were all adults aged 18 years or over who were referred to a specialist endodontic unit. Further inclusion criteria were that the cases were either re-treatment or de novo root canal treatment where the anatomy was judged to be complex. Exclusion criteria included vulnerable groups and de novo endodontic treatment with uncomplicated root canal anatomy. As well as a full history and clinical examination, a high quality colour photographic intraoral image, two paralleling technique periapical radiographs and limited volume CBCT examination were carried out for each patient. All components, except the CBCT dataset, were combined into a Powerpoint presentation and assessed by 4 observers. A questionnaire was designed for the observers as part of the study.

Results: CBCT information only changed the radiological findings and the final diagnosis in a minority of cases. There was no clear evidence that CBCT increases the confidence of observers or that CBCT was helpful in making a diagnosis.

Conclusions: Routine use of CBCT cannot not be justified on the basis of a change in diagnosis and carefully selected use is appropriate.

Clinical significance: CBCT is being increasingly used in the field of endodontics. The benefits gained from the use of CBCT must be carefully balanced against the increased radiation dosage. Determination of selection criteria for the use of CBCT in endodontics is, therefore, essential.

Keywords: Cone beam computed tomography; Diagnosis; Endodontics; Radiation dosage.