Cone Beam Computed Tomography (CBCT)


CBCT is a recent imaging technology that allows one to visualize the tooth in 3-D. In endodontics, it is a powerful adjunctive tool for diagnosis.

In endodontics, CBCT can help with:
•  Differentiation of pathosis from normal anatomy
•  Relationship with important anatomical structure
•  Management of abnormal dental anatomy, (C shape, accessory canal, extra root)
•  External vs. internal resorption
•  Root perforation and separated instrument management
•  Retreatment and apical surgery treatment planning
•  Trama cases
•  Looking for calcified canals
•  Difficult diagnosis

Case 1


Extra lateral root in Max central incisal: 22 YO Asian female. Presented to clinic with no symptoms. However, she reported a draining sinus tract on the gum area of #9.
Dx: necrotic pulp with chronic suppurative asymptomatic abscess. PA radiograph showed an accessory root to the distal of the tooth #9. A CBCT was then take to verify. RCT was recommended and completed. In this case, the CBCT was very useful in providing landmarks and measurements in looking for the canal. This case was completed in multiple visits. At the completion appointment, the sinus tract had healed, this shows that the irritants were effectively removed.
CBCT
Pre-op
Post-op

Case 2


Unusual canal anatomy: 36 YO Caucasian female with no significant health history presented to office for a root canal therapy procedure. Patient has a limited opening, and has a dental history of a bilateral reducing click on her TMJ. No pain was ever experienced in the past. On clinical examination, #20 was sensitive to biting, percussion. Noted a narrow 7mm deep probing at the DB aspect of root. Noted also bilateral lingual mandibular tori. PA radiograph showed apical RL, Note also the canal space disappeared near the mid root area and reappeared at the apical aspect of the root. RCT was recommended. and access was made through the occlusal table of #20. Located the main canal, but noted mid-root bifurcation which then rejoined at the apical of canal. Canals ware then cleaned, shaped, and irrigated. Ca (OH) 2 was placed in the canals as intra-appointment medication. At the second appointment, her symptoms had subsided. RCT was then completed. This is also known as the 1:2:1 canal system.
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