The Recommendation of Cone-beam Computed Tomography and Its Effect on Endodontic Diagnosis and Treatment Planning

Although intraoral radiographs are foundational for diagnosis and planning treatment in dentistry, the resulting 2-dimensional image varies in interpretation requiring judgment. Cone-beam computed tomographic imaging provides a more detailed 3-dimensional image that may affect treatment recommendations. This study aimed to determine the basis for CBCT recommendations and the effect on diagnosis and treatment planning. The study involved a sample of 45 cases that presented for endodontic treatment, 30 with a CBCT scan on record and 15 without. For phase 1, all 45 cases were reviewed by 3 examiners without access to the CBCT scans. For phase 2, 4 months later, the 3 examiners reanalyzed the 30 cases, this time with the associated CBCT scan. Intra- and interexaminer agreements were recorded and analyzed. Also, the recommendations for CBCT were compared with the American Association of Endodontists/American Academy of Oral and Maxillofacial Radiology joint statement. Interexaminer agreement in phases 1 and 2 was 65% and 72%, respectively. For endodontic diagnoses, there was a 19% change in the pulpal diagnosis category when CBCT imaging was added, whereas there was a 30% change in the apical category. The selections changed in 55% of the cases when determining etiology and in 49% of the cases when making recommendations. CBCT imaging was recommended 78.8% of the time when the case had a CBCT on record versus 33% of the time in cases without. CBCT imaging has a significant effect in determining the etiology of endodontic pathoses and in recommending treatment. Furthermore, CBCT imaging is not overprescribed in the endodontic department, and the faculty members adhere to the American Association of Endodontists/American Academy of Oral and Maxillofacial Radiology recommendations.