Study Of Cone Beam Computed Tomography (CBCT) Application In Diagnosis And Treatment Of Endodontic Problems

Objective:The paper is aimed to study the role of CBCT in diagnosis and treatment of endodontic problems compared with conventional radiography, and evaluate the potential application of CBCT in endodontics through analysis of clinical cases.Methods:CBCT is a PROMAX3D imaging system manufactured by Finnish company Planmeca, and dental X-ray machine is Heliodent Vario X-ray machine manufactured by German company Sirona. Routine clinical examination was taken on 119 endodontic patients treated in our hospital during November 2007 and March 2010, and comparative analysis was carried out using conventional radiography (periapical radiograph or panoramic radiograph) and CBCT.73 cases of Pulp diseases and periapical diseases,40 cases of root fracture,6 cases of idiopathic resorption were involved in this study. The patients included 92 males and 27 females, aged from 16 to 89 years old, with average age at 53 years old. All cases were diagnosed jointly by the author, one directing radiographer, one chief physician and one associate chief physician.Results:Through comparative observation of 119 clinical cases, Compared with conventional radiographs, through 3D anatomic images (sagittal, axial and coronal) by CBCT, physicians can diagnose and analyze anatomic images of different angles and tomography in any interested regions, and anatomical structure of pulp cavity can be displayed clearly, and furthermore, morphological structure of dental pulp can be clearly observed through different tomography thickness from different angles as required. CBCT can provide more image information before and in clinical root canal treatment, monitoring post-operative effect and guiding diagnosis and treatment planning of difficult and complicated endodontic problems. CBCT can clearly display the position, nature, degree and scope of periapical periodontitis, and can discover periapical periodontitis which cannot be displayed by conventional radiography. CBCT can discover root fracture which cannot be detected by periapical radiography in the diagnosis of root fracture, and identify the detailed position and type of root fracture. It can determine suspected clinical cases of root fracture in periapical radiography through three-dimensional analysis. CBCT can screen root fracture without clinical symptoms, which can help determine treatment protocols prior to endodontic surgery. CBCT can discover external and internal tooth resorptions at early stage, display position, shape, size and degree of tooth damage as well as changes of peripheral alveolar bone, and determine the scope and degree of the resorption which cannot be determined by conventional radiography.Conclusions:Through reconstructed 3D images, CBCT can clearly display the anatomical structure of pulp cavity, which would provide three-dimensional image information before and in root canal treatment and evaluate post-operative effect. The application of CBCT can discover apical periodontitis as soon as possible and assess the size, scope, nature and position of the lesion. CBCT can also be used to assess non-endodontic pathosis, clearly display the position of root fracture through clinical data, determine the type of root fracture and identify early root fracture, and CBCT has much higher sensitivity than conventional radiography in identification of root fracture. CBCT can clearly display external and internal resorption, identify the scope and degree of resorption three-dimensionally, help to determine treatment plan for root resorption. CBCT has great advantage over conventional radiography in the diagnosis and treatment of endodontic problems. The three-dimensional images provided by CBCT can help physicians to get endodontic problems and play an important role in improving clinical diagnosis and treatment of endodontic problems.