The clinical applications of cone beam computed tomography in endodontics

• Main Author: Patel, Shanon
• Published: King's College London (University of London) 2012
• Subjects: 617.6
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.631257

A series of 5 investigations assessed the application of cone beam computed tomography (CBCT) for the management of endodontic problems. Cone beam computed tomography improved the detection of the presence and absence of simulated periapical lesions in human dry mandibles. The overall sensitivity was 0.248 and 1.0 for periapical radiography and CBCT respectively. The receiver operating characteristics (ROC) area under the curve (AUC) values were 0.791 and 1.000 for intraoral radiography and CBCT, respectively. There was no improvement in the detection of artificially created vertical root fractures (VRF) in root treated teeth using CBCT compared with periapical radiographs. The overall AUC value of incomplete and complete VRF was 0.53 for periapical radiography and 0.45 for CBCT (p=0.034). The overall sensitivity of periapical radiography (0.05) was lower than CBCT (0.57) regardless of the extent of the VRF (p=0.027). Periapical radiographs (0.98) had a higher overall specificity than CBCT (0.34), (p=0.027). The prevalence of periapical radiolucencies of 273 individual roots in 151 teeth viewed with CBCT (48%) of teeth treatment planned for endodontic treatment was significantly higher when compared with periapical radiographs (20%). Periapical radiographs and CBCT scans of 123 of the teeth in 99 patients assessed 1 year after completion of primary root canal treatment were compared to their respective pre-treatment periapical radiographs and CBCT scans. Analysis by tooth revealed that the ’healed’ rate (absence of periapical radiolucency) was 87% using periapical radiographs and 62.5% using CBCT (p<0.001). This increased to 95.1% and 84.7% respectively when the ’healing’group (reduced size of periapical radioiUcency) was included (p<0.002). Outcome diagnosis of teeth showed a statistically significant difference between systems (p<0.001). The influence of periapical radiography and CBCT for the detection and management of in-vivo root resorption lesions was assessed. Periapical radiography ROC ADC values were 0.780 and 0.830 for diagnostic accuracy of internal and external cervical resorption respectively. The CBCT ROC AUC values were 1.000 for both internal and external cervical resorption. There was a significantly higher prevalence (p=0.028) for the correct treatment option being chosen with CBCT compared with intraoral radiographs. These investigations demonstrated that CBCT is more effective in diagnosis ex vivo and in vivo periapical radiolucencies, and for the diagnosis and management of root resorption. However, CBCT did not improve the detection of VRF in this experimental model.