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UBC Theses and Dissertations

Prescriptive pattern and clinical decision making in complicated endodontic cases using cone-beam computed tomography. Bhatt, Meeta


Purpose: Cone Beam Computed Tomography (CBCT) is an advanced but new imaging technique used in dentistry. Although it already has acquired a substantial literature, that literature does not include evidence-based evidence both for its indications-for-use and for its efficacy in comparison to the conventional approach to diagnosis and treatment planning. Aims: To determine the pattern of prescription of CBCT by all UBC dental programs with particular regard to the field-of-view (FOV). To determine whether the CBCT prescriptions by the Graduate Endodontics Program were compliant with the joint American-Academy-of-Oral-and-Maxillofacial-Radiology and American-Academy-of-Endodontics (AAOMR/AAE) position statement (viz guidelines). To determine by reference to the EPR whether CBCT changed the original diagnosis and/or treatment plans based on the initial clinical examination and the conventional radiographic. Methods: Ethics approval certificates H14-02191 and H15-03507 were granted for this retrospective study. All CBCT prescriptions were audited. The audit revealed that CBCT prescriptions by the Graduate Endodontics program were for a wide range of clinical reasons and worthy of further study. The pattern of prescription of CBCT was reviewed, by reference to electronic patient record (EPR), to determine whether it was compliant with the AAOMR/AAE guidelines. The statistical test, Chi-square was used. Results: All but one CBCT in the audit were for small and medium-sized FOVS. All 128 CBCT prescriptions (in 110 consecutive patients) were AAOMR/AAE-guidelines compliant. CBCT identified significantly more features than conventional radiography (p<0.001), particularly with regards to the identification of periapical lesions (p = 0.002), missed canals (p < 0.001), vertical root fractures (p = 0.004) and complex anatomy (p = 0.008). The significant results were seen with respect to change in diagnosis (p<0.001), change in treatment plan (p< 0.005). The AAOMR/AAE recommendations were found to be incomplete. Conclusion: CBCT permitted the identification of more numbers of periapical lesions, missed canal, complex anatomy and vertical root fracture than initially observable on conventional radiography. This study is perhaps the first to ‘road-test’ the AAOMR/AAE guidelines in an authentic clinical environment. It identified an important hiatus in these guidelines; they did not consider missed/extra canals in teeth which required endodontic re-treatment.

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