ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Preliminary Evidence Suggests Preexisting Cone Beam Computed Tomography (CBCT) is as Accurate as The Electronic Apex Locator (EAL) in Measuring Endodontic Working Length
Clinical Question How accurate preexisting CBCT in determining Endodontic working length?
Clinical Bottom Line CBCT has a high degree of accuracy in determining the Endodontic working length.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22703648Jeger/201240 anterior root canals in patients had received prior limited CBCT imaging Prospective, Controlled Clinical study.
Key resultsLimited CBCT scans can be used for endodontic working length measurements. A high correlation was found between clinical root length( CRL) and CBCT measurements in both slices (r = 0.97)
#2) 21763892Janner /20118 teeth in Three patients received limited CBCT scans for diagnostics and preoperative treatment planning of cystic jawbone pathologies. Pilot clinical study
Key resultsAll comparisons between clinical measurements and root canal length determination by CBCT scans exhibited Pearson correlation coefficient greater than 0.9 with a high coefficient of 0.968 comparing the RRL with the CRL.
Evidence Search Cone beam computed tomography AND " working length "
Comments on
The Evidence
The studies were not able to statistically analyze the influence of the type of tooth included or the differences between the upper and lower jaw on the correlation between the clinical root length( CRL) values and radiographic root length ( RRL) measurements. Teeth involved in the study were few and single rooted, which indicate further studies should be conducted to multi-rooted teeth.
Applicability All patients who had previous CBCT and need RCT. Cases with inconsistent EAL measurements or cases with metallic restoration in which root length can`t be obtained by EAL.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (Endodontics) (General Dentistry)
Keywords CBCT, working length, root canal therapy, cone beam computed tomography.
ID# 2317
Date of submission: 08/07/2012spacer
E-mail kaaki@livemail.uthscsa.edu
Author Kaaki Muhannad
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Marcel Noujeim, DDS, MS
Faculty mentor/Co-author e-mail Noujeim@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
by Kaaki Muhannad (San Antonio, TX) on 09/19/2012
Endodontists were so dependent on X-ray when determining the working length, and then electronic apex locator took over intra-oral x-ray and became the golden standard in term of determining the working length, years later CBCT was introduced in dentistry and we as a dentist trying our best to get the maximum outcome of the machine since it gives us 3-D and has a ratio of 1:1. But the question is why is it so important to determine the exact working length? Why is it so critical? These questions were answered by Malcolm S. Davis in his classical study titled (Periapical and intracanal healing following incomplete root canal filing in dogs 1971.) He found out after conducting histological slices that the body reacted to the over filling as if they were foreign body as a result of the physical trauma from pushing the filling material against the tissue , and also found out that canal that were filled under the apical constriction had a better success rate and fewer body reaction to those who were over filled, finally those who were filled at the apical constrictions had the best result and the least body reactions and this is why it is important to try the best you can to get the exact working length.
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