Our office selectively uses a Carestream CS 9000 3D CBCT (cone beam computerized tomography) unit to allow us to view 3 dimensional (3D images of your tooth and surrounding structures.  This technology allows us to overcome some significant limitations found with 2 dimensional imaging  (traditional dental X-rays) and will help us to clearly see the extent of features of a tooth or dental condition that we could only see occasionally with 2D images.

Only a small group of endodontists utilize CBCT, and selective use of CBCT is fast becoming the standard of care in the specialty.  A CBCT image will definitively show things such as additional canals, bone loss patterns characterisitc of root fractures, resorbtion, as well as the full extent of bone loss around a tooth due to endodontic disease.  While traditional dental X-rays will always be used with root canal work, 3D CBCT technology surpasses many of the limitations of 2D images such as superimposition of structures, foreshortening, elongation, etc.

Selective use means that we do not scan every patient prior to performing an endodontic procedure.  We follow the recomendations of the American Association of Endodontists/American Association of Oral and Maxillofacial Radiology position statement which was revised in 2015 and can be found here:

AAE/AAOMR 2015 Position Statement on the Use of Cone Bean-Computed Tomography in Endodontics

Low, in 2008** published research showing that the use of CBCT allows dentists to identify 34% more areas of bone loss due specifically to root canal problems than can be seen with 2D X-rays alone.**  To word this another way, if we are relying only on 2D images, we are not seeing at least a third of the lesions that are present in our patients as we examine and work to arrive at a diagnosis prior to performing endodontic procedures.

Additionally, Fayed, et al, *** in 2012  published a series of case studies which identified five specific findings consistent with vertical root fractures, and only one of these findings was visualization of the actual fracture.  There are some very specific changes in the PDL space and supporting bone that are consistent with a vertical root fracture, and unfortunately, these findings can not be identified in many instances using  traditional 2 dimension radiographs due to inherent limitations of 2D imaging such as superimposition.***  CBCT often gives the opportunity to identify cases of vertical root fracture which have advanced to the point of the prognosis being poor, and we can then avoid the time and expense for all involved of an unnecessary procedure.

The use of CBCT in endodontics, when used selectively per the 2015 AAE/AAOMR position statement, can take a lot of guess work out of the proposed procedure by allowing us to know exactly how many canals are in a tooth, as well as the relationship of the canals to root anatomy, and the full extent of any periapical lesion.

What other types of lesions or pathology concerns can be deteced with CBCT imaging? There are many odontogenic and non odontigenic lesions and anatomical concerns which we have been able to identify as coincidental findings.  Our office has found fibroosseous lesions, osseous lesions, severely resorbed impacted teeth which were the cause of the symptoms while the patient believed that a root canal treament in a different tooth in the affected quadrant was required.  Additionally, we have found cystic lesions that were not readliy defined with a 2D periapical image.  When needed, our CBCT volumes are read by a Michigan Licensed Oral Maxilofacial Radiologist (OMR).

Our office also provides an outside imaging only service which is frequently utilized by local Endodontists, Oral Surgeons, and General Dentists who wish to identify anatomical concerns related to endodontic work,  implant placement, or suspected pathology.  Local colleagues have been very appreciative of this service,  Referrals for imaging only are done with a different referral form and an overead by the OMR is required.

Our machine has the highest resolution (76 microns) and among the lowest radiation dose compared to similar units on the market.  The radiation dose is similar to the amount received by one to two periapical “D speed” films, or 1-5 days of background radiation depending on the patient and area scanned.   In order to reduce radiation exposure, our unit scans a small field of view (50mmx37mm), and our unit does not require a panorex image prior to acquiring the 3D scan.  Our unit is fully accessible for those in a wheelchair.

Selective utilization of the Carestream CS 9000 3D will allow us to continue to provide the highest level of care, and will also reduce the number of costly and time consuming exploratory procedures.

For more information on these topics please call our office.

** Low KMT, Dula K, Bürgin W, von Arx T., J Endod 2008;34:557–562

*** Fayed, et. al.,  J. Endod 2012; 38:1435-1442

Also refer to the below links:

AAE/AAOMR Joint Statement -- Use of Cone Beam Computed Tomography in Endodontics   2015 Update

ENDODONTICS - Colleagues for Excellence - Cone Beam-Computed Tomography in Endodontics



Holland Root Canal Specialists
Michael A. Smith, DDS, MS
12662 Riley St. Suite #130
Holland, MI 49424

ph. 616-399-6811
fx. 616-399-6812