The impact of cone beam CT on outcomes associated with endodontic access cavity preparation: a controlled human analogue study using 3D-printed first maxillary molars

Objectives: To identify if supplemental preoperative cone beam CT (CBCT) imaging could improve outcomes related to endodontic access cavity preparation, using 3D-printed maxillary first molars (M1Ms) in a rigorously simulated, controlled human analogue study.

Methods: Eighteen operators with 3 experience-levels took part in 2 simulated clinical sessions, 1 with and 1 without the availability of CBCT imaging, in a randomized order and with an intervening 8-week washout period. Operators attempted the location of all 4 root canals in each of 3 custom-made M1Ms (2 non-complex and 1 complex mesiobuccal [MB] canal anatomy). The primary outcome was tooth volume removed. Secondary outcomes were linear cavity dimensions, canals located, and procedural time. Operator confidence and "helpfulness" of available imaging were recorded. Statistical analysis of data included: paired t-tests, Fisher's exact test, linear mixed-effect modelling, and Mann-Whitney U test, with an alpha level of .05 for all.

Results: When supplemental preoperative CBCT was available, there were significant reductions in volume of the access cavity and procedural times, with significantly increased MB2 canal location, but only for teeth with non-complex anatomies and for more experienced operators. Linear mixed-effect modelling identified image type and operator experience as significant predictors of tooth volume removed and procedural time. There was significantly lower confidence in canal location and perceived "helpfulness" (all Experience Groups) when conventional imaging only was used compared with when CBCT was available.

Conclusions: Supplemental preoperative CBCT had several beneficial impacts on access cavity preparation, although this only applied to teeth with non-complex anatomy and for more experienced operators.