Comparison of Endodontic Diagnosis and Treatment Planning Decisions Using Cone-beam Volumetric Tomography Versus Periapical Radiography

Introduction: Accurate and confident treatment planning is an essential part of endodontic practice. Periapical radiographs have been used to aid in the diagnosis of pathology and to help establish an appropriate treatment strategy. Recently, a new imaging modality, cone-beam volumetric tomographic (CBVT) imaging, has been shown to be a useful tool in a number of endodontic applications. The aim of this study was to compare the relative value of preoperative periapical radiographs and CBVT scanning in the decision-making process in endodontic treatment planning. Methods: Thirty endodontic cases completed in a private endodontic practice were randomly selected to be included in this study. Each case was required to have a preoperative digital periapical radiograph and a CBVT scan. Three board-certified endodontists reviewed the 30 preoperative periapical radiographs. Two weeks later, the CBVT volumes were reviewed in random order by the same evaluators. The evaluators were asked to select a preliminary diagnosis and treatment plan based solely on their interpretation of the periapical and CBVT images. Diagnosis and treatment planning choices were then compared to determine if there was a change from the periapical radiograph to the CBVT scan. Results: A difference in treatment plan between the 2 imaging modalities was recorded in 19 of 30 cases (63.3%, P = .001), 17 of 30 cases (56.6%, P = .012), and 20 of 30 cases (66.7%, P = .008) for examiners 1, 2, and 3, respectively. Conclusions: Under the conditions of this study, preoperative CBVT imaging provides additional information when compared with preoperative periapical radiographs, which may lead to treatment plan modifications in approximately 62% of the cases.