Five New Basics in Root Canal Care | 医療法人社団EPSDC

Introduction

X-ray images are extremely important in root canal treatment.
But regular 2D X-rays are flat images, so structures can overlap and some diseases can be missed.
That’s where CBCT (cone-beam CT) helps. It’s a dental CT that captures a small area in 3D. The latest expert guidelines have updated how to use and think about CBCT properly.

Point 1: Are lead aprons always necessary? Radiation thinking has been updated

In the past, the basic idea was “keep exposure as low as possible” (ALARA).
Now the mainstream view is ALADAIP: “ensure the image quality needed for diagnosis while optimizing for each individual patient.”
In other words, rather than “the same protective gear and the same settings for everyone every time,” it’s important to choose the imaging method that fits the person and the purpose.
Local rules and laws must always be followed, but the latest trend is that it’s no longer simply “lead aprons are always mandatory” as in older policies.

Point 2: 2D alone can miss things; CBCT can change the diagnosis

3D CBCT finds disease more easily than 2D and raises the chance of reaching the correct diagnosis.
For example, invasive cervical resorption and vertical root fractures are classic conditions that are hard to see on 2D. Adding CBCT often leads to a revised treatment plan.
The key idea is not “take it because we want pretty 3D pictures,” but “use it because it truly improves diagnosis and treatment planning.”

Point 3: Keep the scan area to only what’s needed (Limited FOV)

A large FOV (field of view) increases radiation exposure and can lower image quality due to scatter.
Limiting the scan to the area around the tooth of interest (a smaller, Limited FOV) tends to reduce exposure while making fine details easier to see.
Also, making the voxel size smaller improves detail visibility, but may increase dose. The trick is to choose “just-right” settings for the purpose.

Point 4: Watch out for “fake shadows” caused by metal and gutta-percha

Crowns and fillings (metals) and materials inside roots (gutta-percha) can create dark bands or bright streaks (artifacts) on CBCT.
MAR (metal artifact reduction) features can help with metal, but may be less effective for gutta-percha.
Practical tip: Place the region of interest (ROI) in the center—and slightly toward the front—of a narrow FOV to make the image easier to read. When interpreting, scroll through slices gradually.

Point 5: With AI and AR, treatment becomes more precise

AI can help detect lesions at root tips, cracks, and special canal shapes (e.g., MB2, C-shaped canals).
Combined with AR (augmented reality), navigation, or robotic assistance, it can also support removal of separated instruments and highly precise surgical procedures.
The goal is to increase precision so we can treat teeth while “minimizing cutting and avoiding damage.” Even difficult cases may become salvageable.

Summary: The stronger the tool, the more important it is to know when to use it

CBCT is very useful, but it’s not recommended to take it “every time just in case when there are no symptoms.”
For postoperative follow-ups and healing checks, start with 2D X-rays. When 2D is not enough, weigh risks and benefits and then use CBCT.
Going forward, with help from AI and AR, we’ll decide “for whom, when, and with what settings to use CBCT” based on scientific evidence.

Reference

Melo, S. L. S., Fayad, M. I., Gohel, A., Johnson, B. R., Kalathingal, S., Mahdian, M., … & Makins, S. R. (2026). AAE and AAOMR joint position statement: use of cone-beam computed tomography in endodontics 2025 update. Oral surgery, oral medicine, oral pathology and oral radiology, 141(1), 126-135.

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