Introduction

Cone Beam Computed Tomography, involves a transition from two dimensional to three dimensional visualisation. The quality of imaging has improved the diagnostic accuracy, with regard to patient exposure and time consumption (Durack, Patel, Davies, Wilson, & Mannocci, 2011).

Conventional radiographic techniques show some limitations such as anatomic 3D compression (Giudice, Nigrone, Longo, & Cicciù, 2008; Velvart, Hecker, & Tillinger, 2001), geometric alteration (Cicciù, Giudice, Lipari, Lizio, & Cervino, 2012; Forsberg & Halse, 1994), anatomic obstacles (Giudice et al., 2017; Paurazas, Geist, Pink, Hoen, & Steiman, 2000). Ex Vivo and In Vivo studies have confirmed the two dimensional radiology presents clear limits in periapical lesion diagnosis (Jorge, Tanomaru-Filho, Gonçalves, & Tanomaru, 2008; Paula-Silva, Wu, Leonardo, Silva, & Wesselink, 2009).CBCT in endodontics not only gives a three dimensional evaluation of the region of interest but also an appropriate resolution of images that help give a detailed analysis of the tooth and the surrounding alveolar anatomy.

Success of endodontic treatment depends on the diagnosis and treatment planning. Regarding root canal therapy, a major difficulty in achieving root canal disinfection involves removal of the bacterial biofilm (Noor & Pradeep, 2016; Teja & Ramesh, 2019). Intracanal medicaments have been used to disinfect root canals between appointments and reduce interappointment pain (Manohar & Sharma, 2018). However, pain perception is a highly subjective and variable experience modulated by various physical and psychological factors (Ramamoorthi, Nivedhitha, & Divyanand, 2015). Success of root canal treatment requires proper knowledge of the root canal anatomy and the variations that can be seen in it (Kumar & Antony, 2018). Microorganisms have been established as the sole entity responsible for initiating pulpal and periapical pathologies (Siddique, 2019). MMPs in adult tissues tend to increase in cases of chronic inflammation and destructive bone lesions (Teja, Ramesh, & Priya, 2018). Efficiency of the diagnostic aids plays an important role in the treatment plan. Pulp vitality tests are the valuable diagnostic tool which aids the clinician towards the accurate diagnosis and appropriate treatment planning (Janani, Palanivelu, & Sandhya, 2020). Remineralizing agents such as fluorides, Casein phosphopeptide - Amorphous calcium phosphate (CPP-ACP), xylitol, and bioactive glass can be used to reduce demineralization and enhance remineralization (Nasim & Nandakumar, 2018). CPP-ACP can be considered as the materials of choice in remineralizing early enamel carious lesions (Rajendran et al., 2019). It is very important to be able to properly diagnose a case as it has a huge impact on the success of the treatment.CBCT also plays an important role in identification of cracks, and to visualize any fracture in dento alveolar segment as in case of traumatic injuries (Jose, P, & Subbaiyan, 2020; Rajakeerthi & Nivedhitha, 2019).CBCT has proved to be a useful tool for evaluation of root canal preparation (Ramanathan & Solete, 2015). Another important aspect of the success of endodontic therapy is the role of Coronal restoration. Composites have been preferred for coronal restoration and to prevent coronal microleakage due to their improved esthetic properties, improved adhesive capacity, modern dentin adhesives, and increased mechanical properties (Hussainy, 2018; Ravinthar & Jayalakshmi, 2018).

European Society of Endodontology suggests usage of CBCT in endodontics for periapical pathology diagnosis in the presence of contradictory signs /symptoms to confirm causes of non odontogenic pathology, maxillofacial evaluation, extremely complex root canal anatomy evaluation before endodontic treatment, evaluation of cases of endodontic failure in surgical endodontic treatment planning and evaluation /management of radicular resorption (Patel et al., 2014).

CBCT can be a powerful tooth for endodontic diagnosis as well as in treatment planning and follow up. This survey aimed to evaluate the knowledge, attitude and practice of dentists in diagnosing and interpreting endodontic treatment with the help of cone beam computed tomography.

Materials and Methods

This survey was conducted in May 2020 among dentists, including general dentists, Endodontists,and postgraduates to assess their knowledge, attitude and practice towards the usage of CBCT in endodontics. This questionnaire-based survey consisted of 19 multiple choice questions. Overall, 307 dentists took part in the survey. The questionnaire consisted of demographic details of the participants and questions related to the knowledge, awareness of interpretation of CBCT for endodontic treatment procedures. In this Questionnaire based survey, all the questions were circulated through online forms.

Statistical Analysis

The collected data was converted into excel sheets. SPSS 23.0. Chi square test was used for statistical analysis and Bar graphs were used for a pictorial representation of the results of the study.

Results and Discussion

Among 307 responses received from the participants who participated in the survey,55.5% consisted of females and 44.6% males. About 71% of the participants of the survey were of the age group of 20-30 years. Most of the participants were general dentists (46.9%) followed by Endodontic postgraduates (31.3%) and undergraduates (21.1%). 75% of the participants had professional experience of more than 5 years and 25% of the participants had a professional experience within 5 years (Table 1).

Depending on the knowledge of the participants based on the usage of CBCT in Endodontics, About 83% of the participants were aware that CBCT can be used for diagnosis and management in endodontics. Regarding the field of view, 75% of the participants recommended usage of a small field of view of CBCT for diagnosis and management in Endodontics. Most of the participants of the survey did not have access to CBCT for their clinical practice (88.6%). About 74.3% of the participants had good knowledge about the general usage of CBCT. About 83% of the participants of the survey were aware that CBCT can be used for evaluation of calcified canals, missing canals, Internal and External resorption and in identifying periradicular lesions. 74% of the participants preferred usage of CBCT in endodontics, chi square test showed responses of the participants to be statistically significant (p<0.05) (Figure 5; Figure 4; Figure 3; Figure 2; Figure 1).

Depending on the attitude of the participants on the usage on CBCT in Endodontics,58% of the participants preferred usage of CBCT for detection of the middle mesial, second mesiobuccal canal and distolingual canals while 22% of the participants preferred usage of panoramic radiographs. Most of the participants preferred usage of CBCT for detection of maxillary sinus before periapical surgery (56%). About 23.8% of the participants preferred usage of panoramic radiographs.68% of the participants preferred usage of CBCT for diagnosis of cervical resorption. Most of the participants used a limited field of view of CBCT for their practice (56%), chi square test showed responses of the participants to be statistically significant (p<0.05) (Figure 10; Figure 9; Figure 8; Figure 7; Figure 6). The objective of this study was to analyse the skill of CBCT interpretation among dentists for endodontic treatment procedures. Accurate diagnosis is of utmost importance in dental practice. Based on professional experience, it was found that about 74% of the dentists who participated in the survey had more than 5 years of professional experience (Figure 15; Figure 14; Figure 13; Figure 12; Figure 11). This study discusses the ability of CBCT to detect the presence of resorption, root fractures, treatment of root canal system and detection of missing canals. According to the literature review, more periapical lesions were detected before and after primary root canal treatment using CBCT compared with periapical radiography (Durack et al., 2011). Previous reports showed that the size of the periapical lesion is often underestimated using periapical radiograph (Schwartz & Foster, 1971). Another study compared CBCT with a panoramic radiograph and reported that usage of CBCT can lead to the detection of more periapical lesions than PAN (Estrela et al., 2009).

On the assessment of tooth morphology and its complication, it was stated that CBCT accurately detected presence /absence of mesiobuccal canals compared with the gold standard of the clinical section in the presence of untreated /missed canals in intraoral periapical radiography (Abella, Patel, Durán-Sindreu, Mercadé, & Roig, 2012). In another study, Tu et al., investigated the prevalence of distolingual roots identified with periapical radiograph and CBCT showed a prevalence of 21% and 23% respectively. They concluded that multiple periapical radiographs (25-degree mesial tube shift )to CBCT is required to assess the presence of distolingual roots (Kamburoğlu, Kurşun, Yüksel, & Öztaş, 2011; Tu et al., 2007).

Bornstein et al. confirmed that limited CBCT imaging is a valuable diagnostic tool to evaluate anatomically certain areas like maxillary sinus before periapical surgery (Bornstein, Lauber, Sendi, & Arx, 2011). These findings are in agreement to the results of the survey. Upon detection of external, internal, invasive root resorption, Ex Vivo studies have reported on the superior diagnostic accuracy of CBCT over periapical radiography in the detection of simulated external resorption (Bernardes et al., 2012; Eskandarloo, Mirshekari, Poorolajal, Mohammadi, & Shokri, 2012). This survey is in agreement with these findings. True size, location and extent of periapical lesions can be detected with the help of CBCT (Bornstein et al., 2011; Ren et al., 2013).

This survey was done to assess knowledge on CBCT technology for better diagnosis and treatment planning in endodontics.

Conclusion

CBCT has been proved as an essential diagnostic aid for endodontic practice. Since the use of ionizing radiation involves the patient's and clinician's safety, adequate knowledge about the appropriate usage of CBCT usage should be considered as a necessity. This survey was done to assess knowledge, attitude and practice on the usage of CBCT technology among dentists. This research showed that the majority of the participants had a good level of knowledge, attitude towards usage of CBCT and were well versed regarding usage of CBCT in endodontics. This survey provides the reader with a clearer understanding in the appropriate and unwarranted usage of CBCT for endodontic practice. With growing technology collecting all necessary records from a single low radiation CBCT scan instead of subjecting the patients to different modalities should be considered. Proper knowledge combined with appropriate use and easy cost efficient access to CBCT would benefit endodontic diagnosis and treatment planning efficiency. It is recommended that CDE programs can be conducted for dentists to increase their awareness to gain more knowledge about the indications and contraindications regarding usage of CBCT in endodontics.

Funding Support

The authors declare that they have no funding support for this study.

Conflict of Interest

The authors declare that they have no conflict of interest for this study.