Cone beam computed tomography for endodontics: incidental findings and respective significance

BACKGROUND: The aim of this study is to determine the prevalence, distribution, and follow-up recommendations of incidental findings in cone beam computed tomography (CBCT) scans acquired for endodontic treatment. METHODS: This was a retrospective review of limited field-of-view (FOV) CBCT images for endodontic evaluation obtained at the Stony Brook University School of Dental Medicine between 2018 and 2022. All scans were reviewed by 1 oral and maxillofacial radiology (OMR) resident and all incidental findings were corroborated with the radiology report approved by 1 of 2 board-certified OMRs. Data extracted for each case included age, gender, and reason for scan; and location, diagnosis, and recommended follow-up for each incidental finding. The recommended follow-up consisted of 5 categories: no recommendation, radiographic monitoring, dental specialty evaluation, medical evaluation, or immediate evaluation. RESULTS: Data was obtained from 565 CBCT scans with 219 males and 346 females. The mean age was 55.4 ± 18.38. There were 349 maxillary and 216 mandibular scans. The most common incidental finding was mild to moderate mucosal disease (21.4%), then periradicular/periapical odontogenic pathology unrelated to the indication for the scan (15.2%). The most common location for an incidental finding was the gnathic bones (62.2%), then the sino-nasal complex (32.5%). The most common follow-up recommendation was dental specialty evaluation (46.2%). Twenty-five findings (2.3%) were subject to immediate follow-up recommendation. CONCLUSIONS: Incidental findings were found in 90.5% of CBCT scans acquired for endodontic purposes. Medical evaluation or immediate evaluation was recommended for a combined 6.4% of incidental findings. Together, these findings highlight the importance of a thorough review of the entire scan by a trained specialist.