Welcome to Julian Webber's blog where he muses on a range of topics including some of his most interesting cases,
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CBCT and finding the evidence


Radiography, or the taking of X-rays, is probably more critical to dentists in the diagnosis of endodontic disease than any other dental procedure. In fact, diagnosing endodontic disease probably accounts for a significant percentage of the x-rays taken on a non-routine basis in general dental practice.

But for those of us in specialist practice, the routine x-ray sometimes isn’t enough. It only delivers a two-dimensional image of the roots of a single tooth. Which means we can’t see the whole tooth, the adjacent teeth or the surrounding structures. The solution is cone beam computed tomography (CBCT) which provides a 3-D image of the problem area, providing a comprehensive picture from every possible aspect.

We use small volume CBCT on many of our patients. Its invaluable imagery helps us accurately assess or identify the following:

  • the presence of endodontic disease (apical periodontitis)
  • bone defects
  • complex anatomy
  • a concealed root canal
  • Resorption and perforations
  • the impact of trauma

If it’s straightforward endodontic disease, we have a good chance of saving the tooth, if there is a vertical crack, there is little chance.

For our patients, the small additional costs of a referral for a CBCT image are well worth the investment. We send the patient to Cavendish Imaging, which is just down the road in Harley Street and we prescribe which area of the mouth should be scanned – for instance, a small volume image of the lower right first molar and surrounding teeth. No more than 20 minutes after the scan has been taken, it’s on the Cavendish Imaging website for us to assess. If we see there is a vertical crack in an ailing tooth, we don’t end up wasting the time and money of the patient. But the patient is reassured because they know we have done everything we can to save the tooth.

Of course, radiography should be kept to a minimum and CBCT uses ionizing radiation. We have to remember ALARA, the principle of “as low as reasonably achievable” when using the technique. However, the dose is lower than a conventional CT scan and a similar one to a pan-oral which is usually taken for orthodontic purposes.

In root canal therapy, getting the right diagnosis is all important. An accurate appraisal of the cause of the patient’s problem allows me to save a tooth which might otherwise be lost or conversely, confidently abandon a tooth that has no hope of being saved. I predict that because it’s invaluable for diagnosis and this is so critical to endodontics, CBCT will become more widely used as costs of the equipment go down.

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