One essential aspect of truly successful endodontic care is the ability to preserve as much of the natural, healthy dentition as possible. Such treatment includes anything from vital pulp therapies, to root canal treatment and retreatment, or surgical endodontics.[i]
When removing infected and unsalvageable dental pulp, the intricacies of the root canal systems within each tooth can be both complex and unpredictable. Yet, understanding them completely is essential. Commencing care without an informed comprehension of the anatomy of the treatment site can create the opportunity for failure, and the removal of excess healthy tissue. For practitioners aligned with the philosophy of minimally invasive dentistry, this is an important factor for complete success.
The imaging system you choose can help to develop this understanding in each unique case, and today’s 3D solutions, often cone-beam computed tomography (CBCT) scanners, may be essential in a variety of instances. Used in the right way, complications in endodontic care may be few and far between.
Looking at the problem differently
In complex endodontic cases, the anatomy of the root canal system can hinder complete cleaning, causing inflammation to persist or reoccur and potentially require retreatment.[ii] With a better understanding of the root system of a tooth, clinicians may be better equipped to provide improved treatment outcomes.
This is especially the case where there is uncertainty around a patient’s dentition. When treating a permanent mandibular first molar, for example, you must be sure that a patient has the conventional two roots instead of three. The estimated prevalence of a third root varies, and could be between 3% and 33%.[iii] The mandibular first molar is the tooth most often in need of endodontic therapy – confidence in whether your patient has two or three roots when approaching treatment is essential.iii
Conventionally, 2D radiographs have been the method of choice for identifying the number of roots of a given tooth. Periapical X-rays are the most common approach. However, only 60% of the atypical ‘third roots’ are seen with such a process – a straight distolingual root may be overlapped by the distobuccal root, for example.[iv] Based solely on this, a clinician may be ill-equipped to treat a patient when informed only by radiographs. A CBCT scan would present a 3D image of the tooth anatomy, leading to a confident recognition of the present structure and condition when treatment planning for reduced complications and better results.
Be aware that CBCT should not be a replacement for intraoral radiography, but it may be an appropriate adjunct when other methods of data collection are insufficient.[v]
Changes to your practice
By implementing a CBCT scanner into your practice, you can treat a greater number of patients entirely in-house, from case presentation to completion. In complex cases, individuals do not need to be referred to a second practitioner, at a separate location, at an entirely different date and time – an understandable inconvenience for many – and instead can have a streamlined treatment experience. This may create a better impression of your care, which is ever important for word-of-mouth recommendations.
You would also be able to welcome to your practice patients from other clinicians through referrals, creating a new income stream.
For some endodontic specialists, a sizeable portion of their daily cases will be retreatments. This will likely focus on difficult clinical needs, and having an in-house CBCT scanner can allow you to take your own radiographs, and treat patients from a fresh perspective, without referring them to even more dental professionals.
Informed decisions
Whenever you provide endodontic treatment, you must be able to confidently and effectively ensure that patients attain high-quality care that minimises the risk of retreatment being needed, or treatment failing overall. Doing otherwise would actively go against the General Dental Council (GDC) Standards for the Dental Team.[vi]
You must ensure you have the clinical skill to carry out treatment, but also the imaging systems available to inform care at an adequate level of detail. The demand is inevitably high in endodontics, where working to small margins makes all the difference – and your imaging system should reflect that.
Clinicians could choose a solution like the CS 9600 CBCT Scanner from Carestream Dental, an extraordinarily versatile unit that blends together 2D panoramic and cephalometric imaging, CBCT imaging, 3D facial scanning and 3D model scanning. With an exceptional image resolution of up to 75 microns, it is perfect for endodontic needs, with the ability to capture full mouth scans in outstanding detail. A low-dose mode for both 2D and 3D images allows you to process impressive results whilst exposing patients to just a fraction of the conventional radiation dose.
High-quality endodontic care is all about detail, and with in-house CBCT scanners clinicians may find rewards in both treatment outcomes, and business growth.
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Author: Nimisha Nariapara
Nimisha is the Trade Marketing Manager at Carestream Dental covering the UK, Middle East, Nordics, South Africa, Russia and CIS regions. She has worked at Carestream Dental for the past 7 years, where she has developed her marketing skills and industry knowledge to bring the core values and philosophy of the company to the market.
[i] Neelakantan, P., Liu, P., Dummer, P. M., & McGrath, C. (2020). Oral health–related quality of life (OHRQoL) before and after endodontic treatment: a systematic review. Clinical oral investigations, 24, 25-36.
[ii] de Kuijper, M. C., Meisberger, E. W., Rijpkema, A. G., Fong, C. T., De Beus, J. H., Özcan, M., … & Gresnigt, M. M. (2021). Survival of molar teeth in need of complex endodontic treatment: Influence of the endodontic treatment and quality of the restoration. Journal of Dentistry, 108, 103611.
[iii] Ballullaya, S. V., Vemuri, S., & Kumar, P. R. (2013). Variable permanent mandibular first molar: Review of literature. Journal of Conservative Dentistry and Endodontics, 16(2), 99-110.
[iv] Aung, N. M., & Myint, K. K. (2022). Three-rooted permanent mandibular first molars: a meta-analysis of prevalence. International Journal of Dentistry, 2022.
[v] Johnstone, M., & Evans, M. (2023). Clinical and medico‐legal considerations in endodontics. Australian Dental Journal, 68, S153-S164.
[vi] General Dental Council, (2019). Standards for the dental team. (Online) Available at: https://www.gdc-uk.org/standards-guidance/standards-and-guidance/standards-for-the-dental-team [Accessed June 2024]
