Comparison of Endodontic Treatment Planning with CBCT and Periapical Radiography

Accurate and confident treatment planning is an essential part of endodontology. Diagnostic imaging helps the clinician to visualize the dental anatomy in areas that cannot be seen clinically. For years, periapical radiographs have been used as an adjunct to help endodontists diagnose pathology and aid the clinician in developing a treatment strategy. Recently a new imaging modality, cone-beam computed tomography (CBCT), has been introduced in the market and has been found to be useful in a number of applications. The diagnostic yield of CBCT images is said to be superior compared to periapical radiographs (PA) and the information gained by these scans has proven to be valuable in clinical treatment planning and decision making. We will investigate whether a preoperative CBCT significantly changes treatment decisions from a preoperative PA radiograph. The aims of this study are to determine whether or not additional useful information can be obtained by CBCT and if that additional information can be used to improve treatment planning. Thirty endodontic cases taken from a private practice endodontic office were chosen randomly to be included in this study. Each case was required to have a preoperative digital PA radiograph as well as a preoperative CBCT volume of the same tooth. Three board certified endodontists were then shown the 30 preoperative radiographs and asked to choose from a list a preliminary diagnosis and a preliminary treatment plan based on that diagnosis. Two weeks later the same endodontists were shown the 30 preoperative CBCT volumes and again asked to choose from the same list a preliminary diagnosis and a preliminary treatment plan based on that diagnosis. Their treatment planning choices were then compared to see if there was a change from the radiograph to the CBCT volumes. A modification in each examiner’s treatment plan, between the two imaging modalities was recorded in 19 out of 30 cases (63.3%)(P=0.001), 17 out of 30 cases (56.6%)(P=0.012), and 20 out of 30 cases (66.7%)(P=0.008). We conclude that a preoperative CBCT volume provides information capable of modifying a clinician’s treatment plan from a preoperative PA radiograph on average 62.2% of the time, within the confines of this study.