THE ROLE OF CONE-BEAM COMPUTED TOMOGRAPHY IN THE DIAGNOSIS AND TREATMENT PLANNING OF COMPLEX ROOT CANAL ANATOMY: A NARRATIVE REVIEW
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6537Keywords:
Cone-beam Computed Tomography, CBCT, Endodontics, Root Canal Anatomy, Endodontic Diagnosis, Treatment Planning, Periapical Lesions, Root Resorption, Vertical Root Fracture, Three-dimensional ImagingAbstract
Cone-beam computed tomography (CBCT) has become an increasingly important imaging modality in contemporary endodontics, particularly in cases involving complex root canal anatomy and diagnostic challenges that cannot be adequately resolved using conventional two-dimensional radiography. The three-dimensional nature of CBCT imaging allows detailed assessment of root and canal morphology, identification of additional canals, detection of periapical pathology, evaluation of root resorption, and assessment of complex anatomical variations. Its application may therefore contribute to more accurate diagnosis and improved treatment planning in selected endodontic cases.
The aim of this narrative review is to critically evaluate the current role of CBCT in the diagnosis and treatment planning of complex root canal anatomy, with particular emphasis on anatomical assessment, identification of additional root canals, detection of periapical lesions, diagnosis of root resorption and vertical root fractures, and the influence of CBCT findings on clinical decision-making. The review also discusses important technical factors affecting diagnostic performance, including voxel size, field of view, image resolution, and metal-related artefacts.
Current evidence indicates that CBCT provides greater diagnostic information than conventional periapical radiography in several complex endodontic situations. Its ability to visualize anatomical structures in three dimensions may improve detection of additional canals and facilitate treatment planning in teeth with unusual or complicated root canal morphology. CBCT also demonstrates considerable diagnostic value in the assessment of periapical pathology, external root resorption, and suspected vertical root fractures. However, diagnostic accuracy may be affected by image artefacts, voxel size, anatomical complexity, and the presence of intracanal or restorative materials.
Despite its diagnostic advantages, CBCT should not be considered a routine replacement for conventional radiography. Its use should be justified on an individual patient basis, particularly when the additional three-dimensional information is expected to influence diagnosis, treatment planning, or prognosis. Appropriate selection of field of view and voxel size is essential to obtain sufficient diagnostic information while minimizing radiation exposure.
CBCT represents a valuable adjunct to conventional endodontic imaging and has the potential to significantly improve the diagnosis and management of complex root canal anatomy. Its greatest clinical value lies in carefully selected cases where three-dimensional information provides clinically relevant information that cannot be obtained adequately through conventional imaging techniques.
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