Application Of Cone Beam Computed Tomography In Endodontic Treatment

Since 1899, when Kells first reported on determining the root length based on the image of an instrument in the canal on X-ray film, X-rays became a necessary means of endodontic practice.

Nearly a century later, based on the initial effects of Computed Tomography (CT) and CT, since 1981 Cone Beam Computed Tomography (CBCT) has been used in dentistry; in 1996 it was introduced and applied in the endodontic field.


The most important advantage of CBCT in the endocrine system is the description of three-dimensional anatomical features in the mouth. CBCT types refactor the projection data to provide correlation of images in three intersecting planes.
In addition, as the reconstruction of CBCT data is created spontaneously with a personal computer, data can re-orientate their spatial relationship. CBCT provides clinicians with information and visual images of the complex relationship between the teeth with pathological and anatomical features in the bones of the jaw and jaw, such as the sinuses, cavities, and lower jaw.

Summary of CBCT Advantages

  • 3D images in provided.
  • Accurate picture.
  • Increased sensitivity and specificity to cavities, periodontal and periostatic lesions.
  • Patient’s comfort – no more film or sensor in the mouth.
  • Visible soft tissue.


The application of CBCT in endodontic treatment is indicated in the following clinical cases:

C-shaped canal tube in the second large molars

A C-shaped second large mesenteric root. This anatomic change causes difficulty in endodontic treatment including the identification and cleaning of the canal system and the risks associated with endodontic treatment. Regular X-rays cannot help dentists to identify this uncommonality.


Case 1: Below is the case of teeth 47 that looks like only two legs. 
Figure 1
Symptoms of persistent pain although preparation in both canals was good. This case is introduced and treated under the aid of a microscope to help detect the C-shaped canal system. Symptoms disappear upon end of treatment. If CBCT wasused at the beginning of treatment, it would have saved more time (multiple appointments) for the patient.
Case 2: CBCT shows C-shaped canals in teeth 36 and 46.
Figure 2a
Figure 2b: CBCT shows that the outer limb has not been treated
Figure 2c: Re-treat of root canals
Figure 2d: The second unoccupied tube was untreated at both teeth 16, 17. Note that the outer tube was close to tooth 16 is nearly penetrated


CBCT improves sensitivity and specificity in the diagnosis of primate lesions compared to traditional films. Analysis of diagnostic methods shows that periapical inflammation is found more frequently in CBCT films than in conical films.

Figure 3a. Film around the tip does not show any infection around the tip of the tooth 24

Figure 3b. CBCT films show lenses around the tip of the tooth 24

This patient comes from a groin abscess outside the small left mesentery. Teeth 24 with a seal is still good, pain when typing. This tooth looks fine on the film around the apex, no cracked root is found in this area or in the opposite jaw. Consideration should be given to whether we should remove the old seal is important because the possibility that the root canal is affected is very high.

CBCT films show lesions around the apex. Proceed to antibiotics for 5 days and then treat marrow. The pulp is determined to be necrotic after pulp opening. After the treatment, the initial symptom was over.

Some other applications

CBCT films outperform classic X-ray films in the diagnosis of root fracture, and are proven valid for predicting the true time of injury in the diagnosis and treatment of facial traumatic injuries.

The low resolution of the CBCT is not suitable for detecting vertical fracture except in severe cases.

Figure 4: CBCT film helps detect the vertical root fractures near R17 and R27.