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Narrow field CBCT has many applications in Endodontics and reduces the negative effects of anatomic noise, geometric distortion and technique sensitivity observed on 2D images.
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Narrow field CBCT provides earlier detection of apical periodontitis than conventional 2D radiographs providing improved diagnostic value, treatment efficiency and outcome assessment.
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Narrow field CBCT provides excellent image resolution at reduced radiation exposure as compared to mid or large field of view CBCT.
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CBCT
Cone Beam Computed Tomography Updated Technology for Endodontic Diagnosis
Section snippets
Key points
Case #1: Maxillary Left First Bicuspid—Diagnosis: Pulpal Necrosis/Symptomatic Apical Periodontitis
Identification of root structure, curvature, and location are hampered in 2D radiographs by anatomic noise (Fig. 1).6 In this case, CBCT (Figs. 2 and 3) assisted with the preoperative identification of the presence, location, shape, and lengths of 3 separate distinct roots. Note the accurate orientation, size, and location of apical periodontitis clearly observed on sagittal (see Fig. 2) and coronal views (see Fig. 3).16 Treatment is clearly supported by preoperative knowledge of root anatomy.
Case #2: Mandibular Left First Molar, Diagnosis: Irreversible Pulpitis/Symptomatic Periodontitis
Preoperative identification of the number, location, and length of canals is facilitated with a CBCT scan (Fig. 4, Fig. 5, Fig. 6, Fig. 7). Successful endodontic treatment depends on treating all canals (see Fig. 7).22 In tooth #19, a midmesial canal is observed on the preoperative axial scan (see Fig. 5) and verified clinically (see Fig. 6).
Case #3: Maxillary Left Central Incisor Diagnosis—Pulpal Necrosis/Symptomatic Apical Periodontitis
Canal obliteration may represent dystrophic calcifications (DC, calcification of degenerating or necrotic tissue pulp stones23) or calcific metamorphosis (CM, A process of mineralization after trauma24) (Fig. 8, Fig. 9, Fig. 10, Fig. 11). The mechanism for dentin deposition in CM has been debated by the profession and is still unclear.25, 26 It has been suggested that the severity of the injury may be related to the rate of deposition.27 The predominance of literature suggests that despite the
Case #4: Maxillary Left Central Incisor Diagnosis—Pulpal Necrosis/Symptomatic Apical Periodontitis
Treatment of lateral canals requires pretreatment knowledge of their presence and location (Fig. 12, Fig. 13, Fig. 14, Fig. 15).31 2D radiology does not provide adequate information to predictably locate and treat this entity.32, 33 Successful endodontic treatment depends on the adequate debridement of bacteria from all spaces.31 CBCT technology assists the practitioner with identifying the specific location of lateral canals (see Figs. 13 and 14). Overcoming the obstacle of identifying and
Fenestration Case #5
Identification of a fenestration can assist in planning apical surgery (Fig. 16, Fig. 17, Fig. 18).35 CBCT offers the opportunity to accurately evaluate an area of apical periodontitis for size, volume, and location before surgery.36 Some studies find no value in apical grafting, while others advocate that the need for grafting is based on the volume of the space to be grafted.37 These studies suggest that larger lesions may not heal successfully from apical surgery without grafting, due to a
Identifying cysts
A radicular cyst is a common odontogenic lesion of inflammatory origin. The ability to distinguish a cyst from a granuloma has been studied over the years.40, 41, 42, 43, 44, 45 Various studies have suggested that the presence of an opaque lamina provides evidence of a cyst. A study by Ricucci and colleagues46 refutes this theory. In support, one only needs to return to the findings of Seltzer, Bender, Bhaskar47 and more recently by Lalonde,40 to see that cysts, granulomas, and abscess all have
Trauma
Traumatic injuries to the dentition result in 1 of 3 outcomes. First, teeth may regain vital responses to tests due to revascularization. Second, teeth may remain nonresponsive to vitality tests due to aseptic necrosis (without apical periodontitis), or third, teeth may become infected and develop acute or chronic apical periodontitis (Fig. 35, Fig. 36, Fig. 37).51, 52 CBCT can help the clinician make an earlier diagnosis. Generally necrotic changes are evident within 3 months of the trauma.53,
Conclusions
The previous examples identify the value of CBCT for Endodontics. Narrow field of view CBCT facilitates diagnosis, treatment and outcome assessment while adhering to ALARA principles. Additional applications for this technology can be expected within the Endodontic field as a result of the explosion of research in the imaging field.
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The Journal of the American Dental Association
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