The Use of CBCT in Identifying Endodontic Lesions

Editor’s note – We recently had the opportunity to speak with Dr. Jeffery B. Price, Clinical Associate Professor and Director of Oral & Maxillofacial Radiology at the University of Maryland School of Dentistry, regarding his work in co-authoring the first chapter of Clinical Applications of Digital Dental Technology. Featuring CBCT scans captured by the CS 9300 system, we asked Dr. Price to explain a little more about the clinical case behind the images.

CBCT image of the posterior left mandible scanned on a CS 9300 unit.

Images courtesy of Dr. Price from Clinical Applications of Digital Dental Technology

Reconstructed panoramic image from a CS 9300 unit

The patient was originally sent to my office to be evaluated for an endodontic lesion. Through the use of cone beam CT, we were able to identify two lesions in the quadrant around tooth #19 and tooth #20 on the axial view.

This was actually a classic example of osseous dysplasia, rather than an inflammatory lesion. Having the ability to look at cross sections at this area of pathology makes being able to make the diagnosis radiographically more predictable. It can be a difficult diagnosis, especially for general practitioners who don’t see this a lot. But when you have a cone beam CT image and can generate slices in different reconstructed areas—like this coronal or cross-sectional view—you can get a better idea of the pathology that’s occurring in the area.

Once you make a radiographic diagnosis of osseous dysplasia, you don’t have to perform a biopsy; rather, you can monitor the tooth or area in question. And in this particular case, there were additional lesions in other areas of the mouth as well. This case is confirmation of the value to the patient of the proper use of advanced imaging to confirm the radiographic diagnosis of osseous dysplasia, which avoids more invasive treatment for the patient if misdiagnosis of an inflammatory process such as pulpal pathology was made.

Jeffery B. Price, DDS, MS Contributor