The recommendation of Cone Beam Computed Tomography and its effect on endodontic diagnosis and treatment planning
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PURPOSE: Although Intra-oral radiographs are foundational for diagnosis and planning treatment in dentistry, the resulting 2-dimensional image varies in interpretation requiring judgement. Cone Beam Computed Tomography provides a more detailed 3-dimensional image that may affect treatment recommendations. This study aimed to determine the basis for CBCT recommendations and its effect on diagnosis and treatment planning. METHODS: The study involved a sample of 45 cases that presented for endodontic treatment, 30 with a CBCT scan on record and 15 without. For phase I, all 45 cases were reviewed by 3 examiners without access to the CBCT scans. Four months later for phase II, the 3 examiners re-analyzed the 30 cases, this time with the associated CBCT. Intra and inter-examiner agreements were recorded and analyzed. Also, the recommendations for CBCT were compared to the AAE/AAOMR Joint Statement. RESULTS: Inter-examiners agreement in phases I and II were 65% and 72% respectively. For endodontic diagnoses, there was 19% change in the pulpal diagnosis category when CBCT was added, while there was 30% change in the apical category. The selections changed in 55% of the cases when determining etiology, and in 49% of the cases when making recommendations. CBCT was recommended 78.8% of the time when the case had a CBCT on record vs. 33% of the time in cases without. CONCLUSION: CBCT has a significant effect in determining endodontic pathology’s etiology and recommending treatment. Further, CBCT is not over prescribed in the endodontic department and the faculty adhere largely to the joint AAE/AAOMR recommendations.