Impact of cone beam computed tomography on
periapical assessment and treatment planning ﬁve to
eleven years after surgical endodontic retreatment
, R. Spin-Neto
, A. Wenzel
& L.-L. Kirkevang
Section of Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Aarhus; and
Section for Biostatistics,
Department of Public Health, Aarhus University, Aarhus, Denmark
Kruse C, Spin-Neto R, Wenzel A, Væth M,
Impact of cone beam computed
tomography on periapical assessment and treatment planning
ﬁve to eleven years after surgical endodontic retreatment.
International Endodontic Journal, 51, 729–737, 2018.
Aim To evaluate how additional information from
Cone Beam CT (CBCT) impacts on periapical assess-
ment and treatment planning based on clinical exam-
ination and periapical radiographs (PR) in cases
followed up ﬁve to eleven years after surgical
endodontic retreatment (SER).
Methodology Patients receiving SER during 2004–
2010 were reinvited for follow-up examination includ-
ing clinical examination, PR, and CBCT. In total, 108
patients (119 teeth) were reinvited, 74 patients (83
teeth) accepted to participate. Three observers initially
assessed PR according to the four-scaled, increasing
disease severity criteria by Rud et al. (International Jour-
nal of Oral Surgery, 1, 1972 and 195) and Molven et al.
(International Journal of Oral and Maxillofacial Surgery,
16, 1987 and 432): ‘Radiographic assessment A’. By
including clinical information ‘Treatment plan A’ was
made as follows: 1) no treatment, 2) further
observation, 3) SER reoperation (SER-R), or 4) extrac-
tion. Hereafter, the CBCT volume was assessed and the
information incorporated for ‘Radiographic assessment
B’ followed by ‘Treatment plan B’. Agreement between
radiographic assessments and between treatment plans
was recorded and assessed statistically by Stuart–Max-
well test for marginal homogeneity.
Results Nine teeth had been extracted; thus, the ﬁnal
analysis included 74 teeth (66 patients). The radio-
graphic assessment was changed as a result of the CBCT
evaluation in 38 cases (51.4%), of which 35 (47.3%)
were to a higher Rud & Molven score, P < 0.001. The
treatment plan was changed for 18 teeth (24.3%). For
14 teeth (18.9%), the change was from no treatment or
further observation to a more invasive treatment plan
(SER-R or extraction), P = 0.005.
Conclusion The use of CBCT for long-term follow-up
after SER led to more cases diagnosed with persisting or
recurrent apical periodontitis and hence often to the rec-
ommendation of a more invasive treatment modality.
Keywords: apical periodontitis, cone beam CT, de-
cision making, diagnosis, periapical radiography, sur-
gical endodontic retreatment.
Received 24 October 2017; accepted 11 January 2018
The main goal of root canal treatment is to provide
an optimal biological environment to prevent
development of apical periodontitis (AP), or allow
healing of an existing periapical lesion (Ørstavik &
Pitt Ford 2008).
Surgical endodontic retreatment (SER) is often re-
commended as the treatment of choice in cases of
recurrent periapical disease or persisting periapical
disease not responding to primary root canal treat-
ment or root canal retreatment (Chandler & Koshy
2002, Reit 2003). Traditionally, periapical radio-
graphic imaging (PR) has been used to assess
Correspondence: Casper Kruse, Section of Oral Radiology,
Department of Dentistry and Oral Health, Aarhus University,
Vennelyst Boulevard 9 - 8000 Aarhus, Denmark (e-mail:
International Endodontic Journal
, 51, 729–737, 2018
© 2018 International Endodontic Journal. Published by John Wiley & Sons Ltd