The practice of endodontics is currently in a period of rapid evolutionary advancement. This article is the first in a 3-part series that will outline the areas of endodontics that have received the most revolutionary improvements. This first article illustrates cone beam computed tomography (CBCT) and its impact on our ability to 3-dimensionally diagnose and treat complex root canal systems. The second article will review the recent advances in disinfection that have brought us closer to our goal of completely disinfecting the root canal system. Finally, the third article in this series will illustrate recent advances in our ability to provide a precise and consistent 3-dimensional (3-D) seal of the entire root canal system from the apex to the cavosurface.
INTRODUCTION
CBCT has enabled the practitioner to evaluate endodontic anatomy and disease in a new way.1 Adding the third dimension in radiographic evaluation has helped close the gap in radiographic interpretation.2 Our ability to 3-dimensionally view and manipulate individual anatomy that we encounter in clinical practice has vastly increased our efficacy in diagnosis.3-5 Furthermore, the ability to render these images at such a microscopic level helps guide successful treatment. This capability to noninvasively and accurately visualize the patient’s teeth in such a way is remarkable, considering where we were just 10 short years ago.
CBCT was valuable in the diagnosis of the unique appearing radiolucent lesion in the following case). When the patient presented for evaluation and treatment of this radiolucent lesion, comprehensive pulpal testing was done. Tooth No. 28 was verified to be nonvital. Although very suggestive of a lateral LEO, the definitive diagnosis that this lesion’s origin was due to extension of endodontic disease emanating from No. 28 was not yet made. The midroot, cystic appearing lesion did not have periapical involvement. Upon CBCT evaluation, a lateral portal of exit could be seen in the center of this osseous defect ( This aided in the diagnosis of a LEO.9,10 The information granted by the CBCT also impacted the efficacy of treatment as the infected lateral system was more easily located and opened with a sharp J-curve of a stiff No. 15 hand file We know that the ability to locate and physically instrument intricate areas of the root canal system increases successful disinfection.11 The post-operative digital image illustrates that the upward facing lateral canal was successfully sealed After nonsurgical treatment had been completed, surgical intervention was done due to the appearance and size of the lesion. When the radicular cyst (confirmed histologically) was removed, correlation between what CBCT illustrated preoperatively and what could be visualized directly through the surgical microscope was accomplished).
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