**4.6 The diagnosis of cystic lesions and non-endodontic pathology**

The diagnosis of cystic lesions is very important because there is controversy about these lesions and the curation without surgical treatment, since cysts can only be diagnosed histologically, which needs surgical excision. Different studies have tried to differentiate between granuloma and cysts through radiographs, based on the different densities of the contents of the cavity. Simon et al. in 2006 using CBCT found that the diagnosis coincided with the histological examination in 13 of the 17 cases studied [39]. However, Rosenberg et al. in 2010 about 45 cases, concluded that the diagnosis did not could be confirmed with CBCT [40]. Other studies should be

**Figure 6.** *Cyst lesion and adjacent tissues affected.*

carried out to determine the diagnostic capacity of CBCT in these cases. Successful endodontic treatment depends on the correct identification of all root canals; this allows shaping, cleaning and filling.

Non-identification of the anatomy is one of the main causes of endodontic failure. Matherne et al. in 2008 compared the ability of three board-certified endodontists to detect the number of root canals on intraoral digital radiographs and CBCT images on 72 teeth extracted in 3 equal groups of upper molars, lower premolars and mandibular incisors. The observers could not detect at least one of the root canals in 40% of the teeth using 2D images, which demonstrate the advantage of CBCT over conventional radiology [41]. (**Figure 6**).

**Figure 7.** *Patient with second untreated palatine canal.*

**173**

*Applications of CBCT in Endodontics*

**4.7 Recommendations**

involvement [42, 43].

giving more predictable results.

and, consequently, misinterpretation.

**5. Conclusions**

information.

practice [44].

*DOI: http://dx.doi.org/10.5772/intechopen.89956*

Following the consensus documents prepared by the American Association of Endodontics and the European Society of Endodontics, some recommendations are established for the use of CBCT in endodontics. The first recommendation states that intraoral radiography should be the choice for endodontic treatment, while a small field CBCT would be recommended for those patients with confused or nonspecific signs with untreated teeth or with previous endodontic treatments (**Figure 7**). They also recommend that CBCT could be considered for those teeth that are more likely to have complex anatomies or accessory root canals, (**Figure 8**) also if a CBCT has not been taken before, it could be considered to locate calcified root canals. However, for postoperative follow-up, the treatment of choice should be intraoral radiography. When the possibility of a vertical fracture is suspected if the need for CBCT can be considered, the same as when an injury does not heal and we have to consider the possibility of periapical surgery and when we find perforations or separate instruments before carry out a retreat; it is also recommended when we need to assess the proximity of delicate anatomical areas as well as for the management of dento-alveolar trauma in the absence of soft tissue damage or maxillofacial

The help of CBCT technology in the diagnosis of endodontics either in the knowledge of the morphology and pathologies of the root canal system, in the evaluation of root and alveolar fractures, in the analysis of resorption, in the identification of pathologies of non-endodontic origin and in pre-surgical assessment, it is a very valuable method. Exact data lead to better treatment planning decisions

When comparing medical CT with CBCT it is verified that the accuracy has been

Conventional two-dimensional radiographs remain the most accepted and used in endodontics imaging modality. These limitations arise mainly due to the inherent projection of a three-dimensional anatomy, which leads to geometric distortions

Despite the obvious advantages of CBCT technology offered in the field of dentistry, there are some drawbacks and limitations as there is a growing concern among radiologists and maxillofacial about the increase in radiation on patients, in addition to the interpretation of these images require extensive knowledge of various structures. Because accurate diagnostic information leads to better clinical results, CBCT could prove to be a very valuable tool in modern endodontic

CBCT's relatively modern technology has added another dimension to dental radiography and is rapidly becoming the gold standard for radiographic inspections in dentistry. At present, it cannot replace periapical radiography due to cost reasons and the degree of effective radiation [45]. However the techniques will improve to reduce the radiation dose and costs. CBCT currently has a reference place in endodontics, where the increase in the number of complex cases justifies the use of

technology and the benefits to the patient are greater than the risks.

increased, a higher resolution is obtained, the reduction of the exposure time, a

Compared to conventional periapical radiography, CBCT eliminates the overlapping of surrounding structures by providing additional clinically relevant

reduction of the radiation and a lower cost for the patient is achieved.

**Figure 8.** *Upper premolar with presence of taurodontism.*
