Why Endodontists Should Add 3D Imaging to Their Practice

By Dr. Nestor Cohenca

I have been using cone beam computed tomography (CBCT) since 2003; in fact, I believe I am one of the first endodontists to incorporate this technology into my practice. In the time since, the evolution of CBCT systems has been impressive.

At its core, I find the following benefits to be instrumental when it comes to utilizing 3D imaging in my endodontic and traumatology cases:


Real-Life Application

Better understanding of anatomical landmarks

  • With a 2D radiograph, you’re missing 1/3 of the picture.

  • Superimpositions can make it difficult to make an accurate diagnosis; in fact, scientific evidence indicates approximately 30% of apical lesions not being diagnosed on 2D films. (Patel et al. Int Endod J. 2011; Cheung Int Endod J. 2013)

  • Being able to identify the source of the problem or etiology allows the clinician to develop the best treatment plan. Whether the tooth is predictably savable or not will determine if endodontic treatment is best for the patient or if another option (such as an implant) is preferable.

Capable of taking scans before, during and after treatment – when necessary

  • When a pre-operative CBCT is indicated, I study the scan carefully in order to be prepared to manage the case. This is true for both surgical and non-surgical scenarios. With root canal retreatments, for example, it’s critical to understand exactly why the case is failing and what should be accomplished to make it successful.

  • Intraoperative scans are indicated when the procedure is not progressing as I had hoped. In such cases, I have the ability to alter the plan according to the reality of the clinical situation.

  • Post-treatment scans allow me to see whether the tissues are healing as I would expect—an especially critical requirement for patients with systemic diseases, immune-suppression or diabetes, who could be impacted by persistent infections.

Improved Patient Care

  • I see a number of patients who have been on medication for years because no one could determine the source of their chronic pain. By utilizing CBCT in my diagnosis, I was able to treat the underlying problem in order to resolve the pain and stop the medications.

  • CBCT radiation is relatively low when compared to medical spiral CT; in fact, it’s comparable to 1-5 days of background radiation (focused FOV). This allows me to adhere to the As Low As Reasonably Achievable (ALARA) principle while obtaining diagnostic-quality images

  • I can save patients money by determining the best possible treatment plan, rather than trying different procedures with unpredictable results. Being able to exclude unsavable teeth will save patients time, money and bone!


The bottom line is that CBCT allows endodontists to make the correct diagnosis followed by the best treatment plan and its clinical implementation. 3D imaging system has definitely changed the way I analyze and handle my endodontic and trauma cases.

Having a CBCT unit in my practice has significantly improved the quality of care we provide to our patients. We treat 3D anatomical structures; therefore we should diagnose and treat our patients accordingly. CBCT opened a completely new perspective. I contemplate every single case three- dimensionally. Even when plain 2D radiographs are indicated, my approach is different. CBCT provides us to improve our preoperative diagnosis and treatment strategy. Thus, potentially increasing the outcome of the therapy and avoiding further complications.

About Dr. Nestor Cohenca

Dr. Cohenca serves as Professor of Endodontics and Pediatric Dentistry at the University of Washington and Seattle Children Hospital. He is a Diplomate of the American Board of Endodontics and was one of the pioneers in the use of CBCT and is considered one of the experts on this field.

Carestream Dental Blog Administrator Contributor