Clinical Applications of Cone-Beam Computed Tomography in Endodontics: A Systematic Review

Background: The application of cone-beam computed tomography (CBCT) in endodontics has been increased in popularity nowadays. The manufacturers of CBCT devices have advocated the benefits of using CBCT, but the scientific evidences supporting these claims are insufficient to date. The use of CBCT in endodontics is still poorly understood. Methods: The following databases were searched: Pubmed, Embase, Web of Science, and Cochrane Library. The keywords used for electronic search included "CBCT", "cone-beam computed tomography", and "endodontics". Only human studies were reviewed. The quality of the included studies was evaluated by assessing study design, outcome measurementsand statistical analysis. Results: A total of 283 articles were identified and 42 met the inclusion criteria. Study topics included root canal morphology, periapical radiographs, apical periodontitis, procedural errors, root fractures, endodontic working length and root resorption. The average methodological quality of studies was not high, only about 65 percent of the maximum score on average.Studies on the identification of root canal morphology; periapical diseases as well as root fractures suggested some advantages that CBCT could offer. We could not prove CBCT was better than conventional 2-D imaging for aiding diagnosis, planning treatment and treatment outcome. High quality evidences supporting the use of CBCT as the first radiographic technique of choice are still insufficient. Conclusion: CBCT has advantages on the identification of root canal morphology, periapical diseases and root fractures.The benefits of CBCT provided to each case should outweigh the extra radiation exposure it produces. Well-designedquantitative clinical studies are still needed to determine the value of CBCT on diagnosis, treatment and treatment outcome.