Dr. Rob Roda, Associate Editor of the Journal of Endodontics and the Endodontic Consultant to the Arizona State Board of Dental Examiners, spoke with Dr. John O’Keefe about his lecture during the CARDP meeting and which evolved around the updated guidelines on Cone Beam Computed Tomography.
3-D imagery has revolutionized diagnosis and decision-making and currently, is widely used in endodontics.
New guidelines recommend that CBCT should be used correctly but, judiciously. These guidelines are clinically-based compared to those of other organizations. To this effect, they discuss clinically-relevant situations where CBCT would enhance clinical and patient outcomes.
- Recommendation 1: Intraoral radiographs should be considered the imaging modality of choice in the evaluation of the endodontic patient.
- Recommendation 2: Limited FOV CBCT should be considered the imaging modality of choice for diagnosis in patients who present with contradictory or nonspecific clinical signs and symptoms associated with untreated or previously endodontically treated teeth.
- Recommendation 3: Limited FOV CBCT should be considered the imaging modality of choice for initial treatment of teeth with the potential for extra canals and suspected complex morphology, such as mandibular anterior teeth, and maxillary and mandibular premolars and molars, and dental anomalies.
- Recommendation 4: If a preoperative CBCT has not been taken, limited FOV CBCT should be considered as the imaging modality of choice for intra-appointment identification and localization of calcified canals.
- Recommendation 5: Intraoral radiographs should be considered the imaging modality of choice for immediate postoperative imaging.
- Recommendation 6: Limited FOV CBCT should be considered the imaging modality of choice if clinical examination and 2-D intraoral radiography are inconclusive in the detection of vertical root fracture.
- Recommendation 7: Limited FOV CBCT should be the imaging modality of choice when evaluating the nonhealing of previous endodontic treatment to help determine the need for further treatment, such as nonsurgical, surgical or extraction.
- Recommendation 8: Limited FOV CBCT should be the imaging modality of choice for nonsurgical retreatment to assess endodontic treatment complications, such as overextended root canal obturation material, separated endodontic instruments, and localization of perforations.
- Recommendation 9: Limited FOV CBCT should be considered as the imaging modality of choice for presurgical treatment planning to localize root apex/apices and to evaluate the proximity to adjacent anatomical structures.
- Recommendation 10: Limited FOV CBCT should be considered as the imaging modality of choice for surgical placement of implants (26).
- Recommendation 11: Limited FOV CBCT should be considered the imaging modality of choice for diagnosis and management of limited dento-alveolar trauma, root fractures, luxation, and/or displacement of teeth and localized alveolar fractures, in the absence of other maxillofacial or soft tissue injury that may require other advanced imaging modalities (27).
- Recommendation 12: Limited FOV CBCT is the imaging modality of choice in the localization and differentiation of external and internal resorptive defects and the determination of appropriate treatment and prognosis (28, 29).
- Recommendation 13: In the absence of clinical signs or symptoms, intraoral radiographs should be considered the imaging modality of choice for the evaluation of healing following nonsurgical and surgical endodontic treatment.
- Recommendation 14: In the absence of signs and symptoms, if limited FOV CBCT was the imaging modality of choice at the time of evaluation and
treatment, it may be the modality of choice for follow-up evaluation. In the presence of signs and symptoms, refer to Recommendation #7.
Watch the video interview
Dr. Roda received his BS in Biology (1977) and DDS degrees (1981) at Dalhousie University in Halifax, Canada and practiced as a general dentist in Nova Scotia for 10 years. He earned his MS in Oral Biology and Certificate of Specialty in Endodontics at Baylor College of Dentistry in Dallas in 1993 and became a Diplomate of the American Board of Endodontics in 1998.
Dr. Roda is a former, President of the American Association of Endodontics. He is the Secretary/Treasurer of the Arizona Dental Association (AzDA), Endodontic Consultant to the Arizona State Board of Dental Examiners, Visiting Lecturer at the Arizona School of Dentistry and Oral Health, and Associate Editor of the Journal of Endodontics. He is a member of the American Dental Association (ADA), American Association of Endodontists (AAE), the Canadian Academy of Endodontics, and a Fellow of the ICD and ACD. His outside interests include golf, lecturing, astronomy, skiing, and computers.