Use of Cone Beam Computed Tomography in Endodontics

Figure 4

A 79-year-old male was referred for endodontic treatment of the maxillary left central incisor after a palatal sinus tract was noted. CBCT imaging was initially performed with a gutta percha cone marker inserted into the sinus tract to determine the source of the infection. Sagittal images (a) demonstrated that the lesion terminated at the periapex of the maxillary left central incisor after coursing through the incisive canal whereas drainage was visible on the axial image (b). Perioperatively, only the mesiodistal direction could be determined on conventional intraoral periapical radiography (c) and treatment suspended when the explorer reached 17 mm because of the danger of perforation in the facial or palatal direction. Subsequent cross-sectional perioperative CBCT imaging (d) with an intracanal gutta percha marker indicated that the initial access preparation was directed palatally. Correction of the access facially resulted in gaining access to the apical terminus; treatment was completed without complication.