3D imaging in the endodontic practice

Dr. Bruno Azevedo discusses imaging that is revolutionizing the endodontic practice

3D imaging technology is revolutionizing the endodontic practice by allowing endodontists to better diagnose, treat, and follow up cases. Since the year 2001, when the J. Morita Manufacturing Corporation launched the first-ever small field-of-view, low-dose, high-resolution cone beam computer tomography (CBCT) scanner, endodontists started to see the value of being able to evaluate a tooth in 3D. For the first time, clinicians were able to evaluate and assess root canal anatomy and endo-dontic complications such as resorptions, perforations, and root fractures. It became evident that 3D technology allowed better visualization of apical periodontitis, especially apical lesions in close proximity to the maxillary sinus floor, which have a high probability to be missed using only 2D imaging. For the past 15 years, endodontists have had a fantastic diagnostic tool at their disposal, and just recently, the American Association of Endodontics together with the American Association of Oral Maxillofacial Radiology has released a joint position statement highlighting the importance of 3D imaging in endodontics. According to this document, Use of Cone Beam Computed Tomography in Endodontics 2015 Update, 3D imaging should be considered the imaging modality of choice when:

• Evaluating contradictory or non-specific clinical signs and symptoms associated with untreated or previously endodontically treated teeth
• Treating teeth with the potential for extra canals and suspected complex morphology
• Identification and localization of calcified canals and root resorptions
• Detecting vertical fractures
• Evaluating the non-healing of previous endodontic treatment to help determine the need for further treatment, such as no surgical, surgical, or extraction
• Considering nonsurgical retreatment to access endodontic treatment complications, such as overextended root canal obturation material, separated endodontic instruments, and localization of perforations
• Presurgical treatment planning
• Placing dental implants
• Diagnosing and managing limited dental alveolar trauma, acute fractures, luxation, and/or displacement of teeth and localize alveolar fractures

Longtime users of CBCT imaging in the endodontic practice have reported that on top of the undisputed diagnostic value of this technology, they have gains on chair time leading to an increase in productivity since 3D imaging allows clinicians to better predict outcomes avoiding start procedures where endodontic therapy is contraindicated. It is also important to note that several articles in the literature demonstrate that incorporating 3D imaging technology during the treatment plan phase can change the clinical approach in over 50% of the time in comparison to when treatment plans are done when CBCT is not available.

CBCT scanners designed for the endodontic practice, such as J. Morita’s Veraviewepocs 3D F40, allows for small-volume, high-resolution, and low-dose scanning of specific areas in the mouth. With the help of new technologies such as panoramic scout view, clinicians can scan a particular area of the mouth with sniper precision. Another advantage is the fast acquisition time, which is 9.4 seconds. Faster acquisition time in high-resolution scans tends to avoid motion artifacts that can decrease the final resolution of
the volume.

Since imaging is an indispensable part of all the phases of the endodontic treatment, endodontists should consider CBCT imaging for their patients when available. This technology will continue to evolve and integration with rapid prototyping manufacturing, surgical planning software and bio-printing will allow new treatments to emerge soon. The sky is no longer the limit.