Why Seek a Provider Who Uses High-Tech Tools Like the Cone Beam CT in Endodontics

When you need a root canal, finding the right provider can make all the difference. While a root canal is a safe, non-toxic, and effective treatment that can save your tooth from extraction, there is such a thing as a good and bad root canal. Therefore, choosing an experienced provider who makes you feel confident and comfortable is crucial not only to your experience during the procedure, but also to the success of your root canal treatment.

While there are a variety of elements to consider when choosing a provider, one of the most important is their use of technology like cone beam CT in endodontic procedures like root canals. Modern tools can play an important role in the overall comfort and success of treatment, so finding a provider who not only has, but feels confident using, these tools should factor into your decision-making process.

I don’t expect you to simply take my word for it, though! Instead, I’d rather show you how important your provider’s skills with endodontic technology are by telling the tooth story of a real-life patient. Knowledge empowers us, so I believe that understanding the why is just as important as understanding the what!

Endodontic Equipment That Saves Teeth

Before we dive into today’s tooth story, let’s talk about the pieces of modern endodontic equipment that have revolutionized how we do root canals! While not every dentist has all of these tools, the more they have—and more importantly, the more confident they are using them—the greater chance you’ll have of experiencing a faster, more comfortable, and more successful root canal.

Endodontic Operating Microscope

The endodontic operating microscope is a specialized microscope that helps your provider see even the tiniest of canals inside the tooth. While it’s not technically required to do a successful root canal, having one around can make the procedure SO much easier for your provider, resulting in a more comfortable and effective treatment.

Cone Beam Computed Tomography (CBCT)

Cone Beam Computed Tomography (also known as cone beam CT in endodontics) is a type of 3-D imaging. This tool, especially when used in conjunction with traditional 2-D radiographs, allows your provider to make faster and more accurate diagnoses and understand the anatomy of your tooth before even going inside. This piece of equipment is absolutely invaluable to doing root canals—and you’ll see why when we get to our tooth story!

GentleWave System

The GentleWave System irrigates the canals of the tooth using sound wave technology that helps break up and remove tissue and debris. It gets into all those tiny, microscopic nooks and crannies, and it even allows the disinfectant to penetrate into the dentinal tubules. This not only makes it incredibly easy for your provider to clean out the tooth’s canals, but also helps reduce your postoperative discomfort. A true win-win!

Fotona Laser

This tool has been the newest to join my practice, and man, does it make all the difference. Like the GentleWave, it helps your provider get into those hard-to-reach places so they can clean all the canals, but it does so using light rather than sound energy. There’s nothing more satisfying than quite literally ZAPPING bacteria right out of the tooth, and who could say no to additional disinfection that can make root canals safer and more effective than ever before?

Cone Beam CT in Endodontics: The Importance of Seeking High-Tech, Experienced Care

Now, let’s dive into today’s tooth story, which demonstrates just how much your provider’s experience with technology can impact the outcome of your root canal treatment. In this particular case, the star of the show is endodontics’ very own cone beam CT! However, it’s important to understand that this lesson applies to any technology that your provider may have in their practice.

Our story begins with a 38-year-old patient who came to see for a dental emergency. She was experiencing intense pain and extreme sensitivity to cold, and it was impacting her ability to go about her everyday activities. As she sat in my chair, I could see how anxious she was, and my heart really went out to her. Having gone through my own dental emergency, I always have empathy for patients in suffering, as I understand just how much it can impact your life—including your ability to interact with others.
After speaking with the patient to find out more about her symptoms and history, the first thing I did as part of my endodontic evaluation was take some pre-operative radiographs so I could take a look at what was going on with the tooth:

Do you see the tooth all lit up in white? That’s tooth #3. It had already undergone root canal treatment, which is why you can see all the canals so clearly on the radiographs. (This will become important later).

When I did my cold and percussion tests to test the sensitivity of the teeth in the area, both #3 and #2 (the tooth to the left) were tender to percussion, and the patient had severe lingering pain to cold on #2 (as well as a small crack). With all that in mind, I diagnosed her with Symptomatic Irreversible Pulpitis and Symptomatic Apical Periodontitis #2. We started emergency root canal therapy at that very moment due to her pain level. We never want to see our patients suffer any longer than they have to!

The procedure went well and the patient was already feeling better by the next day. Here’s what her post-operative radiograph looked like:

The Tooth Story Continues

Unfortunately, that’s not where our story comes to an end. A week later, the patient called our office and told us that “something still didn’t feel right,” so we told her to come back in.

Now, at this point you may have noticed that I didn’t make any mention of using cone beam CT in this endodontic procedure. That’s because, unfortunately, I hadn’t! During the time when this tooth story occurred, I wasn’t taking pre-operative 3-D scans to help me with my diagnosis. As you’ll see in a minute, that turned out to be a BIG problem!

Since there was clearly something going on, I decided to take a cone beam scan this time around, hoping that it would reveal something I hadn’t been able to see on her radiographs. Much to my surprise, I saw this:

All of those red arrows are pointing to an ENORMOUS periapical lesion under tooth #3 extending all the way over to #2. By periapical lesion, I mean bone loss that has occurred as part of an immune response to an infection. It’s the body’s way of protecting itself from the harmful bacteria present inside the tooth.

If you’ve been paying close attention, you will have realized that tooth #3 is NOT the tooth I had just performed a root canal on. Instead, it’s the tooth that had already received a root canal treatment well before I ever saw the patient. What this means is that the patient’s previous provider had missed some bacteria when cleaning out the canals of the tooth (something that can happen if you don’t use cone beam CT in endodontics), and it was left to wreak havoc on her body ever since… leading to a nasty infection, a lot of tooth pain, and the need for a whole other root canal in tooth #2!

In order to treat the infection and finally get the patient out of pain, I would have to find the canal that the other provider had missed in tooth #3 and clean out all that bacteria. The problem was that, due to the excessive buildup of cementum (the layer of tooth material covering the root) and the size of the lesion, a root canal at this stage would be extremely difficult.

Therefore, after explaining the situation to the patient and thoroughly discussing her options, we decided together that, in this case, extracting tooth #3 would actually be the best way forward. So off to the oral surgeon she went.

The Plot Thickens

Here’s where the story really gets good! A few days later, the patient called my office again. She told me that the oral surgeon was suggesting that she get both teeth #3 AND #2 extracted, instead of just tooth #3 like we had discussed. He believed that the area wouldn’t heal unless both teeth were extracted. (This isn’t the case, but we’ll talk about why a bit later!)

Concerned for my anxious patient and in disagreement with the oral surgeon, I decided to give him a call to discuss the case. I asked him if he’d be willing to extract only the one tooth (#3) for now. Then, if we didn’t see any improvement, he could always take out tooth #2 later. (As a provider, I think it’s always best to be conservative in your approach to treatment—why remove two teeth if there’s a chance you only need to remove one?) Although he had some hesitation, he ultimately agreed.

Fast forward to a year later, and the patient was back in my office for her one-year recall. I was anxious to see how she was doing! When I saw her radiograph, I was relieved to see that the oral surgeon had indeed only extracted tooth #3 and placed a bone graft, and all was healing really well.

But it was the 3-D image (Hurrah for cone beam CT in endodontics!) that REALLY amazed me. Look at this miraculous recovery:

The periapical lesion had completely healed and the bone graft looked like it had integrated very well.

A Happy Ending

It was a long time before I heard from this patient again. Then, one day, she turned up in my chair for a toothache in tooth #18.

While she was in the office, I dedicated to check out the upper right side (where tooth #3 had been extracted) and see how it was doing. This is what I saw, almost a WHOLE DECADE LATER:

An implant had been placed in the area and it was still looking great. The lesion was gone for good! (And do you notice how, this time, I used my cone beam CT for my endodontic evaluation? We live and we learn, right?)

What This Tooth Story Teaches Us About Endodontic Technology and Root Canals

I love a happy ending as much as the next person, but that doesn’t mean I don’t see the value in looking back and reflecting on what could have been done differently. So let’s examine this tooth story together and see what lessons it can teach us about endodontic technology and its impact on root canals.

First and foremost, there’s a lot we DON’T know about this patient’s tooth story. Given that she had had a root canal treatment on tooth #3 before coming to my office, I don’t know much for certain about how her provider approached the case. Did they do a thorough endodontic evaluation? Did they do their best to find and clean out every canal in the tooth, with the tools they had at their disposal? How big was the lesion at that point? We’ll never know!

But what I can say for sure is two things:

1. Whether because of a poor job or simply lacking the right resources, the patient’s previous provider did NOT do a successful root canal on tooth #3. One of the canals was missed, and it allowed the remaining bacteria to wreak havoc on the area, leading to a lot of pain and suffering for the patient. I cannot repeat this enough: Good root canals do NOT result in pain and infection!
2. I think it’s highly unlikely that they used cone beam CT for the endodontic procedure, whether pre- or post-operatively. Because had they done so, they probably would have been able to locate ALL of the canals and make sure they were all squeaky clean before sending the patient on their way. 

The previous provider wasn’t the only one with missteps, however. As I already mentioned, I made the mistake of not using cone beam CT either—at least initially! While identifying that huge lesion during my initial evaluation probably wouldn’t have prevented the extraction, it DEFINITELY would have saved the patient from prolonged suffering and additional trips to the dental chair. These days, I’ve updated my workflow to include a pre-operative CBCT on every patient so I can understand their tooth story completely before I continue with evaluation and treatment.

So what can you take away here as a patient? How incredibly impactful it is to find a provider who not only has endodontic technology, but also feels confident using it. As you can see from this tooth story, it can make a world of difference for the outcome of your root canal and your experience as a patient.

If you’re looking for further resources on how to choose a provider, what to expect during a root canal procedure, and even how to handle yours or your child’s tooth trauma, check out my online, self-paced course Tooth Wisdom: The Empowered Patient’s Guide to Oral Health. With quick, easy-to-understand video lessons and a variety of downloadable resources, Tooth Wisdom makes endodontic education extremely accessible and will help you build the confidence to make informed decisions about your oral health.

– Sonia