Cone Beam CT in Endodontic Diagnosis

Cone Beam Computed Tomography (CBCT) is a valuable radiographic tool in endodontic diagnosis. With traditional 2D radiography, you see only a coronal view. Historically in endodontics, we have taken the shift shots to try and give us an "angled" view of the tooth. Remember the rule of SLOB?

With CBCT, you can evaluate the tooth from sagittal, coronal & axial views. You also have a volume of data that can be manipulated by the computer to rotate the tooth 360 degrees and look at the tooth from any angle. The longer I use this technology, the more convinced I become of its importance and value.

The following case demonstrates the benefit of CBCT in endodontic diagnosis.

This patient presented to Superstition Springs Endodontics with chief complaint of "pressure to biting and sensitive to brushing". Root canals on #14 and #15 were done approximately 10 years ago.

Our exam found mild palpation tenderness over #14 and #15. Both teeth were percussion sensitive and perio probings were normal. A large pa lesion was noted on the palatal root of #14, but since #15 was also so symptomatic, we decided to take a CBCT for more detailed radiographic exam.

This CBCT slice through #14 shows the extent of the pa lesion on the palatal root. It also shows the elevation of the floor of the sinus and the thickened adjacent sinus membrane. This appears to be a sinusitis of dental origin.

This CBCT slice through #15 shows a definite pa lesion on the MB root of #15. This also exhibits a halo effect. This image confirms the diagnosis of Symptomatic Apical Periodontitis on #15. Without this image, I would have recommended initiating treatment on #14 only. This image allows us to make a more confident diagnosis on #15 and treat both teeth simultaneously.

As an interesting side note, an inverted, impacted wisdom tooth is noted. This made the original radiograph difficult to read and see the MB lesion.

At Superstition Springs Endodontics, we are leaders in the use of CBCT in endodontics.