The Role of CBCT in Root Resorption
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In this case, a patient presented with diffuse, nonspecific pain in the lower left jaw, having previously undergone tooth extraction with bone grafting. While the intraoral examination appeared normal—no visible issues or periodontal probing abnormalities—there were some signs of recurrent caries. A conventional radiograph suggested an abnormality, but the details were unclear. Suspecting internal or external resorption, a small volume, high-resolution CBCT scan was requested for a more precise diagnosis.
The CBCT scan revealed a significant finding: evidence of internal or external resorption, although it was unclear where it originated. The resorption was below the bone level, and despite probing attempts, the clinician could not reach the affected area. Notably, the scan showed a perforation in the lingual cortex of the tooth's root, confirming the presence of a resorptive lesion. While the conventional X-ray provided minimal information, the CBCT's axial and coronal views clearly illustrated the extent of the resorption and the perforation, allowing for a more accurate diagnosis.
Intraoral probing and examination yielded normal results, as the periodontal attachment seemed intact on the lingual surface, masking the underlying resorptive issue. However, the CBCT scan provided the necessary insights to diagnose the problem as internal or external resorption, leading to a recommendation for tooth extraction, followed by bone grafting and the potential placement of a dental implant. The absence of an active periapical abscess made the patient a candidate for immediate implant placement if primary stability could be achieved.
This case highlights the value of CBCT imaging in diagnosing complex resorption cases that may not be apparent in conventional radiographs or clinical exams. The 3D imaging modality was very important in identifying the resorption and guiding the treatment plan.
Root resorption is a pathological process involving the loss of hard dental tissues, which can be internal, external, or a combination of both. Timely and accurate diagnosis of root resorption is essential for effective management and treatment.
Traditional periapical radiography (PR), although commonly used, has significant limitations in detecting and assessing the full extent of resorptive lesions. Cone beam computed tomography (CBCT) has emerged as a superior diagnostic tool in this regard, providing enhanced visualisation and more detailed information that can guide treatment planning and improve outcomes.
Limitations of PR in Root Resorption Diagnosis
PR is a two-dimensional imaging technique that provides limited information when assessing the three-dimensional nature of resorptive lesions. This limitation often results in an underestimation of the size, location, and severity of root resorption.
Key limitations of PR in diagnosing root resorption include:
- Inability to capture the bucco-palatal extent: PR cannot provide a full view of the internal and external resorptive lesions, leading to incomplete assessments.
- Underestimation of lesion size and severity: PR often fails to capture the true dimensions of the lesion, affecting treatment decisions.
- Risk of misdiagnosis: Inflammatory root resorption, frequently associated with trauma or infection, can be missed or underestimated on PR.
Research has shown that PR detects inflammatory root resorption in only 68.8% of cases, whereas CBCT identifies it in 100% of cases.
This highlights the superiority of CBCT in providing a complete and accurate diagnosis, particularly in cases of external cervical resorption (ECR), where PR is even less reliable. These findings emphasise the importance of CBCT in endodontic diagnostics.
Advantages of CBCT in Diagnosing Root Resorption
CBCT offers significant advantages over PR in diagnosing both internal and external root resorption. Its ability to provide three-dimensional imaging allows for accurate visualisation of the lesion's bucco-palatal extent, which is very important for determining the severity and prognosis of the condition.
This detailed view helps clinicians better understand the nature of the resorptive lesion and its relationship to surrounding structures.
Studies have consistently demonstrated the superior accuracy of CBCT in diagnosing root resorption. For instance, CBCT has been shown to be more effective in identifying internal and external resorptive defects than PR, enabling clinicians to make more informed decisions about treatment.
CBCT also improves the detection of the "portal of entry," or the location where resorption begins, which is often difficult to pinpoint using PR. This enhanced diagnostic capability allows for more precise and targeted treatment planning.
CBCT is a powerful tool in the diagnosis and treatment of root resorption, providing a clearer view of the extent and nature of lesions, which is essential for effective management.