Applications of cone beam computed tomography in endodontics

Background Endodontic disease can adversely affect the quality of life and therefore early diagnosis and consequent timely treatment is of paramount importance for the Endodontist. Radiology is an essential component in treatment planning, disease monitoring and assessment of treatment outcome. Periapical radiographs and panoramic radiography are frequently utilised but they provide only two-dimensional representation of three-dimensional structures. The advent of cone beam computed tomography (CBCT) offers three-dimensional accuracy of the hard tissue images with a reasonable cost and this has revolutionised imaging of the dentomaxillofacial structures. This imaging system has been seen to overcome some limitations of conventional radiography, as brought out in this review. The improvement in the accuracy is, however, accompanied at the cost of increased radiation exposure to the patient. Nevertheless, smaller areas of exposure are normally appropriate for endodontic imaging, and adjustment in the exposure parameters can further moderate the effective dose (Loubele et al. 37(6):309-18, 2008). Aims and objectives The aim of this review is to present the pertinent literature on the various applications of cone beam computed tomography in the field of endodontics. Methods Literature was electronically searched on the following sources; Medline and Keats Library. Further, a manual search was performed on the following journals: International Endodontic Journal, Journal of Endodontics, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, Endodontology, Journal of Dental Research, European Journal of Oral Sciences & Odontology and Dentomaxillofacial Radiology. A preliminary search was performed to gain an idea of the available literature using keywords ‘Cone Beam Computed Tomography’ to view the volume of the literature evident and identify questions to be addressed in this review. The initial search showed 243 potential articles. After scrutinising the titles and abstracts of the retrieved articles, 70 relevant studies were reviewed in full text. Furthermore, ‘published guidelines on the use of CBCT’ were also searched so as to include the results as an additional source material. All the articles eligible to be included in the review were in the English language and ranged from the year 1960 to the present. Also all the studies reviewed were based on the various uses of cone beam computed tomography in the field of endodontics. The keywords used to search were ‘Cone Beam Computed Tomography (CBCT)’, ‘Conventional radiography’, ‘Applications of CBCT in endodontics’, ‘CBCT and tooth morphology’, ‘CBCT and apical periodontitis’, ‘CBCT and vertical root fractures’, ‘CBCT and resorption’, ‘CBCT and pre-surgical assessment’, ‘CBCT and dento-alveolar trauma’ and ‘CBCT and endodontic outcome’. Results Every case is unique and CBCT should be considered only after studying each case individually. CBCT imaging needs to be adopted or used where information from conventional imaging systems is either inadequate for the management of endodontic problems or inconclusive. Having said that, it is safe to state that CBCT imaging has the potential to become the first choice for endodontic treatment planning and outcome assessment, especially when new scanners with lower radiation doses and enhanced resolution would be available.

Efficacy evaluation of a cordless ultrasonic unit in achieving reduction of bacterial load within a root canal system as compared to a conventional ultrasonic unit and negative pressure irrigation

Introduction Increase in efficacy during root canal irrigation may contribute to better treatment outcomes. This study investigated the efficacy of ultrasonic and negative pressure irrigation systems using sodium hypochlorite (NaOCl) in the reduction of bacterial load in human teeth. One hundred thirty-one single-rooted teeth were cleaned and shaped, autoclaved, and incubated with E. faecalis. Teeth were randomly assigned to three experimental groups (n = 40) and treated in the presence of 1% sodium hypochlorite using EndoUltra cordless ultrasonic, conventional ultrasonic, and Endovac negative pressure irrigation. Syringe irrigation controls were treated with 1% sodium hypochlorite and phosphate-buffered saline via side-vented needle irrigation. All groups with NaOCl received 5% sodium thiosulfate neutralization for 5 min after treatment. Samples of root canal fluid and dentin chips were acquired from canals before and after treatment, incubated on BHI agar, and colony forming units categorized according to quantity. Wilcoxon rank-sum and Bonferroni tests were used for statistical analysis. p values less than 0.05 were considered significant. Results Endovac group was significantly better in eliminating bacteria from the root canals than 1% NaOCl (p = 0.006) and PBS syringe irrigation (p = 0.015). However, it was not significantly different from the two ultrasonic groups (p > 0.05). Both ultrasonic groups showed better performance than 1% NaOCl and PBS syringe irrigation, however, not statistically significant (p < 0.03). There was no significant difference between the two ultrasonic devices (p > 0.05). Conclusion EndoVac may be an important tool for bacterial load reduction in oval canals.