Cone Beam CT images in the evaluation of periapical lesions for making treatment decisions including surgical and non-surgical endodontic methods

Shah, Punit, and Ashok Balasundaram

Two-dimensional imaging methods such as periapical view and bitewing radiographs have been traditionally used in making treatment decisions  for e.g. root canal therapy and/or periapical surgery involving periapical lesions.  Three-dimensional imaging modalities such as Cone Beam Computed Tomography (CBCT) has been widely available for most dentomaxillofacial applications. The aim of this study was to determine if CBCT images would alter the treatment decision process involving endodontic periapical lesions when compared with conventional periapical radiographic images. Twenty four teeth from the same number of patients with periapical lesions > 3 mm were selected. Periapical radiographs were taken initially using CCD sensors. Subsequently CBCT images were taken of the tooth in question. Six observers (endodontist) were asked to view the periapical images and CBCT images in separate sessions and assign a treatment plan for each tooth based on the images. The treatment options included Root canal treatment, Root canal treatment and Periapical surgery, Periapical surgery only  and no endodontic treatment (extraction, implant etc.). Results indicate there was no difference in the treatment decisions with the two imaging modalities. Treatment decisions are not altered with a newer imaging modality (CBCT) from this study. However,  it is to be seen if a study with a larger population and clinical information provided to the observers would alter the results obtained from this study.