The Impact of Cone-beam Computed Tomography on Diagnostic Thinking, Treatment Option, and Confidence in Dental Trauma Cases: A Before and After Study

Abstract

IntroductionThe aim of this study was to identify whether cone-beam computed tomographic (CBCT) imaging affects endodontists' diagnostic thinking, treatment option, and confidence in dental trauma cases. MethodsTwelve endodontists reviewed 15 dental trauma cases with clinical histories and periapical radiography (PR) and answered questions regarding their diagnostic thinking and treatment decisions and their confidence in both. One month later, the same participants reviewed the same cases and answered similar questionnaires with the aid of CBCT imaging. A statistical analysis of their responses was conducted. ResultsDifferences were observed in diagnostic thinking when using PR or CBCT imaging (P < .05), and the use of PR was associated with a higher number of “unsure” answers to questions about diagnoses. After reviewing periapical radiographic images, the approach most frequently endorsed was “don’t start conventional endodontic treatment and order CBCT,” whereas the most common decision made after analyzing the CBCT images was “start conventional endodontic treatment.” Clinical interventions were proposed more often when participants evaluated the clinical case using CBCT imaging than when using PR (P < .05). The participants' degree of confidence in their diagnostic thinking was not different after analysis using PR or CBCT imaging (P > .05). However, there was a difference between PR and CBCT imaging in participants' confidence in their treatment decisions (P < .05). Participants who initially indicated a lack of confidence in their diagnosis or treatment option gained confidence when CBCT images were available. However, the inverse behavior was also observed for participants who were initially confident on the basis of PR (P < .05). Participants who decided to start treatment after CBCT analysis were less confident than when using PR (P < .05). ConclusionsIn dental trauma cases, CBCT imaging influenced participants' diagnostic thinking and choice of treatment modality and affected their confidence in the decision-making process.