Applications of CBCT in Endodontics

*Jesús Mena Álvarez and Álvaro Zubizarreta Macho*

### **Abstract**

There are many articles published in recent years on the use of CBCT in endodontics and this diagnostic technique is increasingly required in order to have a more accurate prognosis of the teeth to be treated. The purpose of this chapter is to discuss the use of Conical Beam Computed Tomography (CBCT) in the field of endodontics. This issue is controversial at the moment because of the increase in the radiation to which patients are being subjected; however, we know that sometimes the X-rays taken with different angles in relation to some teeth depending on the different cases are incompatible in form and density, which does not allow us to make an exact diagnosis. The use of CBCT would have provided an image of greater diagnostic value in those cases. In addition, the use guidelines published by the American Endodontics Association and the American Radiology Association jointly mark the way forward and the use we can give the CBCT for the diagnosis of complex cases.

**Keywords:** CBCT, endodontics, tomography, root canal treatment

#### **1. CBCT description**

CBCT is the technique that allows three-dimensional reconstruction, but using a conical beam to decrease the dose for the patient compared to conventional CT. For almost a century, dentists have been studying a 2D representation of a 3D structure, that structure is the tooth. This simplification of the information produces inherent disadvantages, among which the anatomical structures in the plane of the roots and apices of the teeth studied mask many details, which occur mainly in the area of the upper molars, where the zygomatic arch or the breast can complicate the detail of the posterior anatomy of the roots of the teeth, which entails a complicated diagnosis and treatment [1]. In practice this means that radiolucent areas may not be identified, being able to find difficulties in relating the position of the apex in proximity to vital structures and not being able to detect the exact situation of the calcifications of the teeth. The correct identification of the morphology and anatomy of the root canals can be difficult, as well as the identification of root fractures and root resorption [2].

We can rule out a series of milestones in the history of CBCT and radiology beginning in 1895 when Wilhelm Roentgen discovered X-rays in Germany, but it is not until 1896 when the first intraoral radiography is performed by Edmond Kells in New Orleans. Already in 1967 Godfrey Hounsfield developed the first CT scanner and in 1971 it was introduced in medical examination. In 1990 Tachibana and Matsumoto reported the first use of CT in endodontics and in 1997 Quantitative

Radiology produced the first CBCT, the New Tom 9000, for dental use after Arai's pioneering work in Japan and in Mozzo in Italy, obtaining in 2001 the first CBCT licensed for use in the US [3].
