Why CBCT

is a Game Changer
for Endodontics

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For over 25
years, cone beam computed
tomography (CBCT)
has transformed the way doctors
do dentistry. The advancement
of this technology has become a
valuable asset for patient diagnosis
in many workflows, as well as in
treatment planning where traditional
radiography falls short.

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THIS IS PARTICULARLY TRUE for complex end-
odontic cases in which a conventional radiograph
hasn’t produced enough information. By using
CBCT imaging for diagnosis, endodontists can find
extra canals and unusual anatomy that might not be
visible using 2D imaging and plan a patient’s care
ahead of time. CBCT scans are useful for detecting
periapical lesions, root canal anatomy and the
spatial relationship of roots to nearby anatomical
structures. There is also a better view of the location,
type and shape of structures within the root.

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Clinical situations where CBCT has proven to be highly beneficial
WHILE CBCT is not necessarily
warranted for routine endodontic diag-
nosis or for screening purposes when
patients aren’t presenting
with clinical signs and symptoms,
practitioners are advised to use
CBCT when “the need for imaging
cannot be met by lower-dose two-
dimensional radiography.”1
Common clinical situations include:
■ During endodontic treatment/assessment/applications:
If a comprehensive diagnosis has been completed and an endodontist
needs more information, a CBCT scan can be a useful adjunct.2
■ Surgical assessment: Several recent studies show that CBCT imaging has
an impact on surgical assessment. One, for instance, found that CBCT imaging
was more precise than 2D images when it came to determining the size of
a lesion.3
■ Evaluating pathosis: Research shows that using a CBCT scan in combi-
nation with a magnetic resonance imaging (MRI) scan can provide a more
precise diagnosis of complex periapical pathosis than either one alone.4
■ Temporomandibular joint (TMJ) assessment: According to recent
research, CBCT is an effective imaging technology for diagnosing a variety
of TMJ conditions.5
1
aaomr.org/wp-content/uploads/2021/09/aae-aao- 3
aae.org/specialty/communique/how-cbct-is-chang-
mr-2015update.pdf ing-surgical-outcomes-assessment
2
 nline-dzz.com/archive/issue/article/dzzint-2-
o 4
pubmed.ncbi.nlm.nih.gov/34938018
2021/5659-103238-dzz-int20210007-cbct-in-surgical-
endodontics-a-must-have
5
ncbi.nlm.nih.gov/pmc/articles/PMC4277441
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How CBCT can be used in endodontic workflows

A CBCT UNIT is about the size of a panoramic

machine and doesn’t have a large footprint in
a dental practice. Generally, dentists take 3D
images while a patient is seated or standing in
the exam room or in a dedicated imaging area.
Using software, they can process that data into
a scan within minutes. The images can be dis-
played in the axial, sagittal and coronal planes
simultaneously.

There are a number of situations where using

CBCT imaging may be helpful to endodontists:
■ Detecting apical periodontitis: CBCT scan-
ning allows for the detection of radiolucent
endodontic lesions before they show up on
a conventional radiograph.6 One study found
that using 3D scans allowed for the detection
of 62% more periapical lesions than two-
angled periapical radiographs. This can allow
6
researchgate.net/publication/47369313_Cone_Beam_Comput-
for earlier detection of periodontal disease. ed_Tomography_CBCT_in_Endodontics

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■ Pre-surgical assessment: Endodontists often use CBCT imaging to
identify the anatomical relationship of the root apices to important
neighboring anatomical structures, such as the inferior dental canal,
mental foramen and maxillary sinus. This can help prevent injuries
during surgery. It is possible to use a CBCT scan to accurately deter-
mine the thickness of the cortical plate, the cancellous bone pat-
tern, fenestrations and the inclination of roots involved in periapical
surgery. Practitioners may also use a CBCT scan to assess the root
morphology, bony topography and the number of root canals.

■ Evaluating dental trauma: A 3D scan can be used to assess the se-

verity of alveolar and luxation injuries. A CBCT scan can also be used
to find horizontal root fractures. In one study, it performed better than
the 2D intraoral scan or digital radiographic methods.7

■ Studying root canal anatomy: It is not always possible to spot the

number of root canals with a conventional radiograph. The CBCT
unit can reconstruct images to allow for the view of resorption le-
sions, revealing the point of entry and the exact location, as well as
lesions that were not previously discovered.

7
researchgate.net/publication/47369313_Cone_Beam_Comput-
ed_Tomography_CBCT_in_Endodontics

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DR. RICO D. SHORT

An endodontist’s perspective on CBCT

TO LEARN MORE about the use of CBCT within endodontics,
we connected with Dr. Rico D. Short, a board-certified endodontist,
microsurgical root canal specialist at Apex Endodontics, clinical assis-
tant professor at the Augusta University Dental College of Georgia
— and avid proponent of 3D imaging. Dr. Short decided to purchase a
CBCT unit for his practice in 2017 when he realized how much it would
enable him to provide more definitive answers to patients whose cases
were otherwise ambiguous. For instance, if a patient presented with
pain on the upper right side, he would typically take a 2D image and,
if he didn’t see anything, take a wait-and-see approach. However, when
he saw that endodontists could get to the bottom of these cases or do
so more quickly with CBCT imaging, this won him over. “It helps us to
diagnose a lot of cases that would be undiagnosable,” he says.

For example, he finds that in some trauma cases, there is a crack on

the back side of the root, providing him with the information he needs
to decide if he should do a root canal. Dr. Short also routinely uses
CBCT scans in cases of retreatment. “It looks good on the X-ray but
a lot of times, we see these cases have a hidden canal on the back of
the root,” he explains.

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DR. RICO D. SHORT

Comparison of 2D to 3D images

WHILE DR. SHORT agrees that both 2D and 3D images have their
strengths and weaknesses, 3D images, in particular, provide more
comprehensive views of the mouth than a 2D scan. “With 2D images,
you’re only seeing one side of the tooth,” says Dr. Short. “With 3D,
you can see an infection or crack on the back side. You can actually
take slices and look at certain areas of the tooth. It’s almost like you
3D
can travel through the tooth from the top down and know where all
the canals are, and where the infections are located.” He likens a 3D
scan to GPS. It can re-route you from a tooth where there is no prob-
lem and direct you to one where
an issue does exist, he explains. Dr. Short likens a 3D scan
“Or, if you are doing surgery, you
to GPS. It can re-route
will know you cannot go a certain
distance or you will hit a nerve,” you from a tooth where
he adds.
there is no problem and
direct you to one where
2D
an issue does exist.

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DR. RICO D. SHORT

The impact of adding a CBCT unit

on Dr. Short’s practice
WHEN DR. SHORT first got his CBCT unit, he used it sparingly
— maybe once or twice a week. But as he got comfortable with
it, he found it had more uses. “Now I use it on every trauma
case and every retreatment case,” he says. Four years after he
purchased it, he estimates that he uses the machine with ap-
proximately four to five patients per day.
Incorporating CBCT into his practice has shown him how his
clinical intuition, while mostly accurate, isn’t always correct.
“It was close, but it wasn’t always right,” he says. “There were
a couple of cases where my experience was wrong. The tooth
was not cracked. There was another canal
there. CBCT saved the patient’s tooth.” I use it on every
Understanding how to use the unit is essential trauma case and every
to getting the most out of it, says Dr. Short.
“You have to get education and training to retreatment case.”
make sure what you are looking at is some-
Dr. Rico Short
thing real, versus an artifact,” he says.

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 31 30

1
3D CBCT
rendering

CASE Tooth 30 or 31?

Nº A CBCT Assisted
Diagnosis
1 2
IN ONE CASE, Dr. Short saw a patient
who came in with pain on the lower right. 31
30
“Pulp testing was inconclusive,” he says. Completion

“Nothing significant showed up on the 2D

imaging.” 1.9mm

Once he did a 3D scan, he detected an PAP

infection on the mesial root of tooth num-

ber 30 and decided to perform endodon-
3 4
tic treatment. He performed a root canal
and upon access found there was a small 1 2D PA or periapical film. Failed to reveal
a small crack.
crack, and the pulp was necrotic. Dr. Short
2 CBCT bone rendering image.
was able to address the situation in one 3 Coronal slice of the 3D image. There
visit and eliminate the patient’s pain. There 4 Exits is periapical pathology (PAP) on the
mesial root.
were 4 separate portals of exits.
4 2D PA of the completion of the
root canal.
“The patient expressed relief the next DL
5 2D off-angled PA showing all
day,” he says. DB
ML
4 canals with separate portals of
5 MB
exits; a unique case.

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CASE
Nº 2 CBCT for Diagnosis
and Anatomy

IN ANOTHER CASE, a patient came in with

pain in the upper left quadrant. Pulp testing 15
3D LFOV
?? CBCT
was inconclusive, and when Dr. Short did 2D
imaging, no obvious pathologies showed
up. When Dr. Short did a 3D scan, it revealed
periapical pathology on three roots on tooth
number 15. In addition to the pathology, the
anatomy of the tooth was tortuous. 1 2

Dr. Short discovered the palatal root was 1 You can’t see any pathology in the area
on the 2D PA (periapical) film.
very long and had a gradual curve. Beyond
2 Limited field of view (LFOV), pathology
that, the canals only became visible with the is seen on CBCT.
CBCT scan. “On the 2D image, you couldn’t MB2 3 Arrow is pointing to an accessory canal
or MB2; showing the complexity of the
tell how many canals it had — maybe one case.
root, two roots,” says Dr. Short.
In one visit, Dr. Short performed a root canal.
3
Nonetheless, with treatment, the patient re-
ported being asymptomatic the next day.

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DR. RICO D. SHORT

Ultimately, Dr. Short believes CBCT is an asset for his

practice. Although CBCT scans aren’t a perfect fit for
every situation, cases like these have persuaded him that
his investment was well worth it. “It reinvigorated me and
my practice as an endodontist,” he says. “It allowed me to
be able to give excellent patient education. For the most
part, 90% of my patients like new technology and things
that will make them
feel better. It is an 90% of my patients like Conclusion
awesome tool for
new technology and things FOR DR. SHORT — and many
my practice.”
that will make them feel other doctors — CBCT has
opened an exciting window
better. It is an awesome into improved diagnostics and
tool for my practice.” treatment planning. While 2D
imaging still solves for many
Dr. Short endodontic cases, CBCT has
proven to be a valuable addition
for many practices.

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 Dr. Rico D. Short is a board-certified endo-
dontist, author and speaker. In addition,
he is an expert spokesperson on endodon-
tics for the American Dental Association,
a professional organization representing
approximately 161,000 U.S. dentists.
Dr. Short attended the Medical College of
Georgia School of Dentistry to attain a Doctor
of Dental Medicine degree in 1999. In 2002,
he earned his post doctorate degree in end-
odontics from Nova Southeastern University.
DR. RICO D. Dr. Short became a diplomate of the Ameri-
SHORT can Board of Endodontics in 2009. His private
practice, Apex Endodontics P.C., was opened
in 2004 and is located in Smyrna, Georgia,
just outside of Atlanta, Georgia.  both businesses and citizens of our country
Dr. Short has authored three books, “End-
odontic Keys and Cases: A Clinical Guide to
Modern Root Canal Therapy,” “Getting to the
Root of Your Problem: 365 Days of Inspiration-
al Thinking” and “In the Eye of a Storm: 45
Days of Turbulence and Peace.” In addition,
he has published over 1,000 articles on social
media involving case studies in endodontics.
They are called “The SHORT Case of the
Day” in which he has a robust worldwide
following of over 100,000 dentists. Dr. Short
was named one of the top “40 Under 40”
dentists in America by Incisal Edge maga-
zine in 2013, a top “20 Alumni Under 40” by
Augusta University and has been named in
Dentistry Today consistently as one of the top
leaders in continuing education. In October
2012, Dr. Short was selected as a panelist for
the Affordable Care Act. He was invited to
the White House to give his personal opinion
on how the Affordable Care Act would affect
from a health care provider perspective.
He is very philanthropic in his community. 
Dr. Short has established an annual scholar-
ship at the Dental College of Georgia in
Augusta, formally known as the Medical
College of Georgia School of Dentistry.
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 DISCOVER EVEN MORE BENEFITS
ABOUT ADDING CBCT TO YOUR
PRACTICE – SCAN HERE

Additional resources

For additional
guidance deploying
CBCT in your dental Webinars on CBCT Articles on CBCT
practice, visit: 1. New Rules of Endodontic Retreatment
1. The No-Nonsense Guide to the Role
of CBCT in Endodontic Diagnosis 2. Debating CBCT? What You Need to Know
and Treatment Planning
3. Why More General Dental Practices are
2. Demystified: Cracked Teeth and Turning to CBCT
Vertical Root Fractures
[Diagnosis and Treatment Planning] 4. Digital Implant Planning in Your Practice
5. 3D Imaging Implant Treatment Planning
3. CBCT in Action: Interpretation
in Endodontics 6. Cracked Teeth and Vertical Root Fractures
7. How CBCT Can Supercharge Your
Endodontics Practice

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