Evaluation of the frequency and indications of ordered CBCT in patients referred to a private dental office in Kerman, Iran over three years: A Retrospective Cross-Sectional Study
This retrospective study of 503 patients in a private dental office in Kerman, Iran, found that CBCT was predominantly used as a preoperative diagnostic tool, with the most common indications being the evaluation of previous root canal treatment failures, assessment of treatment quality, and detection of suspected vertical root fractures.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Tooth decay and infection inside a tooth often require a procedure to clean out the damaged nerve and seal the hollow space, a treatment known as a root canal. For decades, dentists have relied on standard two-dimensional X-rays to see inside these teeth. These flat images are useful and safe, but they have a significant blind spot: they flatten a three-dimensional object onto a single plane. This means that complex root structures, hidden cracks, or infections behind other bones can be obscured by overlapping anatomy, much like trying to see the details of a tree by looking at its shadow on a wall. To solve this, dentists now have access to a specialized scanner that creates a three-dimensional picture of the jaw and teeth. This technology, called cone-beam computed tomography, allows a clinician to rotate around a tooth and see every angle, revealing details that flat X-rays simply cannot show. However, because this 3D scan uses more radiation than a standard X-ray and costs more, it is not meant for every single patient. The medical community agrees it should be used only when the flat image is not enough to make a clear diagnosis or plan a safe treatment.
A researcher in Kerman, Iran, decided to look closely at how this powerful tool is actually being used in the real world. They examined the records of patients who visited a private dental office over a three-year period, specifically focusing on every time a 3D scan was ordered. Their goal was not to test the machine itself, but to understand the human decisions behind it: why did the dentist ask for a scan, what did they hope to find, and did the scan change the treatment plan? By reviewing hundreds of patient files, the researcher built a clear picture of how this advanced imaging fits into daily dental practice.
The study reviewed 632 scans, but after removing incomplete records or those ordered for reasons unrelated to root canal therapy, 503 cases remained for analysis. The researcher found that the scans were most frequently requested for patients in their thirties and forties, and slightly more often for women than men. When looking at which teeth were being examined, the upper jaw was the primary focus, with the upper back teeth being the most common subject of the scans. This makes sense, as the roots of upper molars are often twisted and crowded, making them difficult to map out with a flat image.
The reasons for ordering these scans fell into a few clear categories. The most common reason, accounting for nearly one-third of all requests, was to figure out why a previous root canal treatment had failed. When a tooth that was previously treated becomes painful or infected again, a flat X-ray often cannot show whether the failure is due to a missed tiny canal, a crack in the root, or a gap in the filling material. The 3D scan allowed the dentist to peer inside the tooth and identify the exact cause of the problem. The second most common reason was to check the quality of a root canal that had already been done, ensuring the filling material reached the very tip of the root and that no canals were left untreated. The third major reason was to look for suspected vertical cracks in the root, which are notoriously difficult to spot on standard X-rays but can be clearly seen in three dimensions.
Perhaps the most revealing finding was how these scans influenced the final outcome for the patient. In almost 90 percent of the cases, the scan was ordered before any new treatment began, serving as a diagnostic tool to solve a mystery rather than a guide during the procedure itself. More strikingly, in two out of every three cases, no endodontic treatment was initiated after the CBCT evaluation. The researcher noted that several factors could explain this high percentage, such as a poor prognosis for the tooth, the patient choosing not to return for treatment, a preference for extraction, or a referral to another provider. In some instances, such as a confirmed vertical root fracture, extraction might be the only option, while in others, the scan may have helped identify that the tooth could not be saved, potentially preventing unnecessary intervention by providing additional diagnostic information.
The researcher noted that the pattern of use in this private office was driven by specific clinical needs rather than convenience. Because the dentist did not have the machine in the office and had to refer patients to a separate radiology center, the decision to order a scan was deliberate and justified. The scans were used almost exclusively to clarify difficult diagnoses before treatment started, aligning with medical guidelines that recommend using higher-radiation tools only when standard methods are insufficient. The study concludes that while this three-dimensional technology is a vital asset for solving complex dental problems, its greatest value in this setting was in providing a clear answer to difficult questions, often helping to determine whether further intervention was appropriate.
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