Impact of Cone Beam Computed Tomography on Treatment Planning in Endodontics
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The use of Cone Beam Computed Tomography (CBCT) is rapidly increasing in all areas of dentistry, as it provides valuable 3D information of the area under investigation in a matter of minutes. However, the radiation dosage is higher than that of conventional radiographic images. It is advisable that CBCT should be used only in cases where clinically indicated. The aim of our study is to evaluate the impact of limited volume CBCT upon treatment planning as part of endodontic management of posterior teeth. The materials and methods were, Thirty five patients selected from primary care referrals to a specialist endodontic unit in a leading UK dental hospital. For each patient, a dental and medical history, an intraoral image, parallax periapical radiographs and CBCT data set were taken. Four observers, General Dental Practitioners (GDPs)were selected to examine the data. Additionally, the author of this work also independently examined all the cases in her capacity as a third year Endodontic resident. A questionnaire was designed for the observers. The information for all the 35 patients was examined by the observers on two separate dates about 3 months apart. On one date, all the information was given to them but, on the other the CBCT images were withheld. This study dealt with only three questions relating to treatment planning. The availability of CBCT imageschanged the final treatment plan for extraction, endodontic treatment and endodontic re-treatment in a minority of cases (15% to 35%). Three out of the fours GDPs found the availability of CBCT more helpful in reaching a final treatment plan. This was, however, statistically significant with only one of the GDPs (p<0.05).The fifth observer (the thirdyear Endodontic resident) also found CBCT helpful in reaching a final treatment plan which was statistically significant (p<0.05). The main conclusion that follows from this work is that CBCT images are vital for certain complex endodontic treatments and should not be used routinely for all endodontic cases. The study also highlighted the need for training on the interpretation of CBCT images by dentists who use such images in their work place.