Clinical Applications of Cone-Beam Computed Tomography in Endodontics: A Systematic Review

Review Article

J Dent App. 2014;1(2): 16-20.

Clinical Applications of Cone-Beam Computed Tomography in Endodontics: A Systematic Review

Li Jingyi, Lim J Z Adrienne, Lum H B Song, Saion A M Muhamad and Mei Li*

Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand

*Corresponding author: Li Mei, Department of Oral Sciences,Faculty of Dentistry, University of Otago.310 Great King Street, Dunedin, 9016, New Zealand

Received: June 17, 2014; Accepted: June 20, 2014; Published: June 22, 2014


Background: The application of cone-beam computed tomography (CBCT) in endodontics has been increased in popularity nowadays. The manufacturers of CBCT devices have advocated the benefits of using CBCT, but the scientific evidences supporting these claims are insufficient to date. The use of CBCT in endodontics is still poorly understood.

Methods: The following databases were searched: Pubmed, Embase, Web of Science, and Cochrane Library. The keywords used for electronic search included "CBCT", "cone-beam computed tomography", and "endodontics". Only human studies were reviewed. The quality of the included studies was evaluated by assessing study design, outcome measurementsand statistical analysis.

Results: A total of 283 articles were identified and 42 met the inclusion criteria. Study topics included root canal morphology, periapical radiographs, apical periodontitis, procedural errors, root fractures, endodontic working length and root resorption. The average methodological quality of studies was not high, only about 65 percent of the maximum score on average.Studies on the identification of root canal morphology; periapical diseases as well as root fractures suggested some advantages that CBCT could offer. We could not prove CBCT was better than conventional 2-D imaging for aiding diagnosis, planning treatment and treatment outcome. High quality evidences supporting the use of CBCT as the first radiographic technique of choice are still insufficient.

Conclusion: CBCT has advantages on the identification of root canal morphology, periapical diseases and root fractures.The benefits of CBCT provided to each case should outweigh the extra radiation exposure it produces. Well-designedquantitative clinical studies are still needed to determine the value of CBCT on diagnosis, treatment and treatment outcome.


The application of cone-beam computed tomography (CBCT) in dentistryhas causeda paradigm shift from two-dimensional (2-D) to three-dimensional (3-D) approach for imagingoral structures. An increasing number of studieson CBCT have recentlybeen published. The growing interest of the applications of CBCT in dental practices has resulted in a revolution in dentofacial imaging. The role of CBCT imaging techniqueshas also been expanded from diagnosis to image guidance of operative and surgical dental procedures [1, 2].

The mechanism of CBCT imaging is using a rotating gantry to which an x-ray source and detector are fixed. A cone-shaped source of ionizing radiation is directed through the middle of the area of interest, and then detected by x-ray detector on the opposite side. The x-ray source and detector rotate around a rotation fulcrum fixed within the center of the region of interest while multiple images are taken and subsequently reconstructed on a computer to form a 3-D data set [1].

The applications of CBCT in endodontitics have been investigated and discussed in various studies [3,4]. CBCT has been considered useful in endodontics as it can provide 3-D images for the detection of fractured endodontic file, strip root perforation, root fractures, and root resorption. In addition, CBCT can also aid visualization of the number and location of roots and canals, identification of unidentified canal, c-shaped canal systems and diagnosis of periapical lesions. The benefits of CBCT have been extensively advised, but there search evidences supporting the advantage of usage of CBCT imaging in dental applications are still insufficient to date [3].

The aim of this systematic review is to systematically review the studies of CBCT in endodontics and assess the quality of evidence supporting the benefits of CBCT application in endodontics.

Material and Methods

Electronic databases

The followingelectronic databases were searched in order to find the suitable publications. PubMed (1966 - 2013); MEDLINE (1966 - 2013), Web of Science (1980 - 2013), Embase (1980 - 2013), and Cochrane Library (1993 - 2013). Gray literatures were not searched and only English articles were included in this study

Search strategy

The following search strategy was used for Pubmed search. "Endodontics" or "Endodontic" or "endo", "Cone Beam CT" or "Cone Beam" or "Cone Beam computed tomography" or "CBCT" or "computed tomography" or "volume CT". This search strategy was modified accordingly for the other electronic databases search mentioned above.

Study Selection

Databases were searched independently by three reviewers (reviewer L.S.H.B searched PubMed, reviewer L.J.Z. searched MEDLINE and Embase, reviewer M.A.S. searched Cochrane Library). Only human studies were included. Reviews, letters, and case reports were not included in this review. A mutual agreement was made by all thethree reviewersabove to resolve any differences regarding which articles to be included or excluded.

Quality assessment

All three reviewers (L.S.H.B, L.J.Z. and M.A.S.) evaluated the quality of the included studies based on a scoring system describedpreviously [2]. This scoring system used 15 criteria evaluating study design, outcome measurements and statistical analysis. The quality score of each study included in this review was assessedand calculated. The scores were averaged as percentages and the mean qualitywas rated (Q) as Q<60% = poor quality; 60%≤Q ≤75% = moderate quality; Q> 75% = good quality [2,5].


After removal of duplicates, 205 articles were assessedfor eligibility. An additional 163 articles were excluded after reviewing full-text, mainly due to failing to meet inclusion criteria such as non-human studies. Finally, 42 articles were included for assessment.

The included 42 studies were further divided into seven categoriesbased on their topics (Table 1-7): root canal morphology (12 articles) [6-17], apical periodontitis (7 articles) [18-24], periapical radiograph (6 articles) [25-30], root fracture (6 articles) [31-36], root resorption (4 articles) [37-40], procedural errors (4 articles) [41-44], and working and obturation length (3 articles) [45-47].