Is Cone-Beam Computed Tomography an Essential Diagnostic Tool for Endodontic Practice?

One of the major limitations of traditional periapical radiography is its two-dimensional representation of three-dimensional structures. It is proposed, quite rationally, that the ability to evaluate an area of interest in three dimensions would be of great diagnostic value in endodontics. The advent of cone beam computed tomography (CBCT) appears to offer this as a realistic possibility for practitioners. However, all diagnostic and therapeutic interventions must be evidence-based, so we must consider whether this new imaging modality is appropriate for the purpose of endodontic diagnosis. As CBCT has been in use in dentistry since 1998, a considerable body of literature regarding its use is now available. CBCT shows promise in improving diagnosis of apical periodontitis, resorbtive lesions, and detection of root canals and in pre-surgical planning. Several shortcomings have also been highlighted however, such as poor image quality if there is patient movement, artefact production, poor resolution, cost and training requirements. As of now, its use can be recommended as good practice in very select cases, such as pre-surgical assessment where proximity to important structures is a concern. As of yet however, there remains a paucity of evidence for its routine use in clinical endodontic situations due to insufficient quality research. It is commonly unjustifiable due to the increase in radiation exposure over traditional radiography and there is a significant capital investment required to purchase one of these machines in return for limited evidence-based use. For now, cone beam computed tomography cannot be deemed an essential diagnostic tool for endodontic practice.