CBCT PRE-SURGICAL ASSESSMENT
With the advent of CBCT, the American Association of Endodontists (in conjunction with AAOR) issued a position statement indicating that CBCT was recommended prior to all surgical treatment. The case below illustrates why. On conventional PA, the tooth appears to have an apical bifurcation that is inadequately cleaned and slightly filled with sealer possibly causing the apical lesion. The post appears well centered. The lesion appears to stay around the root apex with no lateral lesions that might suggest a fracture or crack. CBCT analysis, however, shows that there is a very large lateral lesion on the palatal aspect that has a thin collar of crestal bone which is why periodontal probing defects were not noted during examination. Similarly, what seemed like a well centered post on PA, is actually quite heavily transported to the palatal which puts a lot of strain on that area. Taken together, this tooth very likely has a vertical root fracture on the palatal aspect that is impossible to diagnose without use of CBCT. Before the advent of CBCT, we would have had to start the apicoectomy before noting the fractured root tip clinically.