PAGD Keystone Explorer Winter 2020

Keystone Explorer | Winter 2020 7 dentistry issues Q to 40 percent of the cases when using periapical radiographs compared to an accurate diagnosis in 76.6 percent to 83.3 percent of the cases when using CBCT. The previous study also demonstrated that the treatment plan may be directly influenced by information gained from a CBCT scan as the examiners altered their treatment plan after viewing the CBCT scan in 62.2 percent of the cases overall (ranging from 56.6 percent to 66.7 percent). In a recent study, the influence of CBCT imaging on clinical decision-making choices among different specialists (prosthodontists, endodontists, oral surgeons, and periodontists) in endodontic treatment planning was evaluated. 12 CBCT imaging had a substantial impact on endodontic decision making among specialists, particularly in high- difficulty cases. After viewing the CBCT scan, the extraction option increased significantly (P < .05). The previous studies indicated that CBCT had a significant influence on the examiner’s treatment plan. The problem of incorrect, delayed, or inadequate endodontic diagnosis and treatment planning places the patient at risk and could result in unnecessary or inappropriate treatment. Important information that can be visualized in CBCT imaging, such as canal transportation and the extent of the root canal filling, may be difficult to interpret on a 2-D radiograph. The additional information obtained from CBCT can be a key determining factor in the decision- making process. Although imaging is a very important diagnostic tool in endodontics, it should always be used as an adjunct to the clinical exam. The addition of subjective and objective clinical findings to CBCT should allow for an even more accurate clinical diagnosis and appropriate treatment plan. Cases 1 through 3 are examples of utilizing CBCT imaging in diagnosis and its impact on treatment planning cases with pre- and post-treatment symptoms and pathology. C A S E N O . 1 Figure 1:1: (a) Periapical radiograph of teeth 7 and 8. Treatment was initiated on both teeth before referral to an endodontist. (b) Clinical picture showing normal soft tissue color and architecture. (c) and (d) are sagittal CBCT images showing facial perforations on teeth 7 and 8, respectively. Important information that can be visualized in CBCT imaging, such as canal transportation and the extent of the root canal filling, may be difficult to interpret on a 2-D radiograph. The additional information obtained from CBCT can be a key determining factor in the decision- making process.