Use of computed tomography in endodontic diagnosis and planning of maxillary premolar with double radicular curvature




Cone Beam Computed Tomography; Endodontics; Endodontic therapy.


Introduction: Imaging exams help in the correct diagnosis and planning of endodontic treatment. Cone beam or cone beam computed tomography (CBCT) is an auxiliary resource in Endodontics, being favorable to the treatment compared to periapical radiography because it allows the evaluation of hard tissues of the maxillofacial region and three-dimensional structures in complex cases, in addition to the possibility of view cut by cut. Objective: To report a clinical case of a patient in need of endodontic treatment in a maxillary premolar with root curvature, being the cone beam computed tomography used as a complementary exam for the evaluation of the root anatomy, diagnosis and planning. Case report: A 37-year-old female patient presents with a fractured tooth with continuous, localized pulsating pain for 6 months. Digital periapical radiographic examination and confirmation by CBCT revealed root dilaceration in the middle third of tooth 15, with double curvature and extensive periapical lesion involving tooth 14. The diagnosis was chronic apical periodontitis in teeth 14 and 15. After 6 months of radiographic and CBCT follow-up, a reduction in the periapical lesion of both teeth submitted to endodontic treatment was observed, with normal clinical characteristics and absence of painful symptoms. Conclusion: CBCT was extremely important for the correct diagnosis, planning and success of endodontic treatment of maxillary second premolars with double root curvature, and should be indicated in the anatomical assessment phase of the patient, as it may be associated with failures in the location, instrumentation and filling of the root canals, compromising the result of the treatment.


Alswilem, R., Abouonq, A., Iqbal, A., Alajlan, S. S., & Alam, M. K. (2018). Three-Dimensional Cone-Beam Computed Tomography Assessment of Additional Canals of Permanent first Molars: A Pinocchio for Successful Root Canal Treatment. J Int Soc Prev Community Dent, 8(3), 259-263. 10.4103/jispcd.JISPCD_3_18

Baruwa, A. O., Martins, J. N. R., Meirinhos, J., Pereira, B., Gouveia, J., Quaresma, S. A., & Ginjeira, A. (2020). The Influence of Missed Canals on the Prevalence of Periapical Lesions in Endodontically Treated Teeth: A Cross-sectional Study. J Endod, 46(1), 34-39 e31. 10.1016/j.joen.2019.10.007

Burklein, S., Heck, R., & Schafer, E. (2017). Evaluation of the Root Canal Anatomy of Maxillary and Mandibular Premolars in a Selected German Population Using Cone-beam Computed Tomographic Data. J Endod, 43(9), 1448-1452. 10.1016/j.joen.2017.03.044

Bürklein, S., Hinschitza, K., Dammaschke, T., & Schäfer, E. (2012). Shaping ability and cleaning effectiveness of two single-file systems in severely curved root canals of extracted teeth: Reciproc and WaveOne versus Mtwo and ProTaper. Int Endod J, 45(5), 449-461. 10.1111/j.1365-2591.2011.01996.x

Cleghorn, B. M., Christie, W. H., & Dong, C. C. (2007). The root and root canal morphology of the human mandibular first premolar: a literature review. J Endod, 33(5), 509-516. 10.1016/j.joen.2006.12.004

Das, S., De Ida, A., Nair, V., Saha, N., & Chattopadhyay, S. (2017). Comparative evaluation of three different rotary instrumentation systems for removal of gutta-percha from root canal during endodontic retreatment: An in vitro study. J Conserv Dent, 20(5), 311-316. 10.4103/jcd.jcd_132_17

Dilaceration among Nigerians: prevalence, distribution, and its relationship with trauma - Udoye - 2009 - Dental Traumatology - Wiley Online Library. (2018). 10.1111/j.1600-9657.2009.00796.x

do Carmo, W. D., Verner, F. S., Aguiar, L. M., Visconti, M. A., Ferreira, M. D., Lacerda, Mfls, & Junqueira, R. B. (2021). Missed canals in endodontically treated maxillary molars of a Brazilian subpopulation: prevalence and association with periapical lesion using cone-beam computed tomography. Clin Oral Investig, 25(4), 2317-2323. 10.1007/s00784-020-03554-4

Hou, B. X. (2018). [Role of the operating microscope in diagnosis and treatment of endodontic diseases]. Zhonghua Kou Qiang Yi Xue Za Zhi, 53(6), 386-391. 10.3760/cma.j.issn.1002-0098.2018.06.005

Jaju, P. P., & Jaju, S. P. (2015). Cone-beam computed tomography: Time to move from ALARA to ALADA. Imaging Sci Dent, 45(4), 263-265. 10.5624/isd.2015.45.4.263

Keine, K. C., Kuga, M. C., Pereira, K. F., Diniz, A. C., Tonetto, M. R., Galoza, M. O., & de Andrade, M. F. (2015). Differential Diagnosis and Treatment Proposal for Acute Endodontic Infection. J Contemp Dent Pract, 16(12), 977-983.

Kirkevang, L. L., Horsted-Bindslev, P., Orstavik, D., & Wenzel, A. (2001). Frequency and distribution of endodontically treated teeth and apical periodontitis in an urban Danish population. Int Endod J, 34(3), 198-205.

Kirkevang, L. L., Orstavik, D., Horsted-Bindslev, P., & Wenzel, A. (2000). Periapical status and quality of root fillings and coronal restorations in a Danish population. Int Endod J, 33(6), 509-515.

Koc, C., Sonmez, G., Yilmaz, F., Karahan, S., & Kamburoglu, K. (2018). Comparison of the accuracy of periapical radiography with CBCT taken at 3 different voxel sizes in detecting simulated endodontic complications: an ex vivo study. Dentomaxillofac Radiol, 47(4), 20170399. 10.1259/dmfr.20170399

Lopez, F. U., Kopper, P. M., Cucco, C., Della Bona, A., de Figueiredo, J. A., & Vier-Pelisser, F. V. (2014). Accuracy of cone-beam computed tomography and periapical radiography in apical periodontitis diagnosis. J Endod, 40(12), 2057-2060. 10.1016/j.joen.2014.09.003

Matherne, R. P., Angelopoulos, C., Kulild, J. C., & Tira, D. (2008). Use of cone-beam computed tomography to identify root canal systems in vitro. J Endod, 34(1), 87-89. 10.1016/j.joen.2007.10.016

Michetti, J., Maret, D., Mallet, J. P., & Diemer, F. (2010). Validation of cone beam computed tomography as a tool to explore root canal anatomy. J Endod, 36(7), 1187-1190. 10.1016/j.joen.2010.03.029

Mohammadi, Z. (2008). Sodium hypochlorite in endodontics: an update review. Int Dent J, 58(6), 329-341.

Mota de Almeida, F. J., Knutsson, K., & Flygare, L. (2014). The effect of cone beam CT (CBCT) on therapeutic decision-making in endodontics. Dentomaxillofac Radiol, 43(4). 10.1259/dmfr.20130137

Odesjo, B., Hellden, L., Salonen, L., & Langeland, K. (1990). Prevalence of previous endodontic treatment, technical standard and occurrence of periapical lesions in a randomly selected adult, general population. Endod Dent Traumatol, 6(6), 265-272.

Ozyurek, T., Yilmaz, K., & Uslu, G. (2017). Shaping Ability of Reciproc, WaveOne GOLD, and HyFlex EDM Single-file Systems in Simulated S-shaped Canals. J Endod, 43(5), 805-809. 10.1016/j.joen.2016.12.010

Patel, S., Dawood, A., Wilson, R., Horner, K., & Mannocci, F. (2009). The detection and management of root resorption lesions using intraoral radiography and cone beam computed tomography - an in vivo investigation. Int Endod J, 42(9), 831-838. 10.1111/j.1365-2591.2009.01592.x

Patel, S., Durack, C., Abella, F., Shemesh, H., Roig, M., & Lemberg, K. (2015). Cone beam computed tomography in Endodontics - a review. Int Endod J, 48(1), 3-15. 10.1111/iej.12270

Pauwels, R., Beinsberger, J., Collaert, B., Theodorakou, C., Rogers, J., Walker, A., & Horner, K. (2012). Effective dose range for dental cone beam computed tomography scanners. Eur J Radiol, 81(2), 267-271. 10.1016/j.ejrad.2010.11.028

Violich, D. R., & Chandler, N. P. (2010). The smear layer in endodontics - a review. Int Endod J, 43(1), 2-15. 10.1111/j.1365-2591.2009.01627.x



How to Cite

MACHADO, B. S.; SAGUCHI, A. H.; YAMAMOTO, Ângela T. A. .; DINIZ, M. B. Use of computed tomography in endodontic diagnosis and planning of maxillary premolar with double radicular curvature. Research, Society and Development, [S. l.], v. 10, n. 12, p. e488101220668, 2021. DOI: 10.33448/rsd-v10i12.20668. Disponível em: Acesso em: 23 feb. 2024.



Health Sciences