I was among the first endodontists in Europe and the first in the UK in 2006 to use cone beam computed tomography (CBCT) in everyday specialist practice. CBCT is a three-dimensional X-ray that shows a tooth and the surrounding bone in detail that ordinary dental X-rays simply cannot. It has been shown to improve diagnostic accuracy and clinician confidence, as well as treatment effectiveness
Twenty years on, I take a CBCT scan before every treatment. I have been invited to provide bespoke CBCT workshops for dentists and endodontists across 5 continents helping them to integrate CBCT effectively into their everyday clinical practice.
I published the first clinical study showing that CBCT enables the early and accurate diagnosis of root resorption, and I am the lead author of the European Society of Endodontology (ESE) position statements on the use of CBCT in Endodontics (2014 and 2019) — the international guidance on the use of CBCT scans in endodontics (root canal treatment). I am also the lead author of the textbook Cone Beam Computed Tomography in Endodontics (Quintessence Publishing), now a standard international reference for the field.
What is a CBCT scan?
A CBCT scan is a quick scan that produces detailed three-dimensional X-ray images of your tooth and the surrounding jawbone. You simply sit still while the scanner gently rotates around your head once, taking around 15–20 seconds. I use a high resolution, focused (small field of view) scan that captures the area of interest in 3 dimensions with a low radiation dose.
Good imaging is one of the foundations of a good result, for a simple reason: a problem that is seen clearly from the outset is a problem that can be treated more efficiently and effectively.
Research that changed how teeth are treated
My translational research is centred on a simple but important question: Do CBCT scans improve diagnosis, increase clinician confidence, and/or ultimately lead to better patient outcomes?
Together with my research team, I have published some of the most highly cited papers on CBCT in endodontics. This body of work has influenced international clinical practice and modified the way root canal treatment is performed.
Why use CBCT in endodontics?
A regular dental X-ray compresses your tooth and the surrounding, complex bone into a flat, two-dimensional image, rather like a photograph. This commonly leads to loss of detail due to overlapping structures masking exactly what is going on. A 3D CBCT can remove that guesswork. CBCT is particularly useful for:
- Finding hidden or extra root canals that a 2D X-ray misses — a common reason root canal treatment fails.
- Diagnosing signs of cracks and vertical root fractures, which are notoriously difficult to see on ordinary X-rays.
- Managing root resorption, especially external cervical resorption, where 3D imaging allows the defect to be graded using the Patel classification and treated appropriately.
- Confirming the presence/absence of dental infections when regular assessment and dental X-rays are giving equivocal results.
- Managing dental trauma.
A 3D scan lets me appreciate the true nature of your (potential) root canal problem. This makes treatment more accurate, efficient and predictable.
The pros and cons — an honest summary
Advantages
- A true 3D view of the tooth and bone, revealing detail 2D X-rays cannot show.
- More accurate diagnosis of cracks, resorption, extra canals and infection.
- Better treatment planning and fewer surprises during treatment.
- Often allows diagnosis, planning and treatment to be completed in fewer visits.
- A small-field scan focuses only on the teeth of interest, keeping the dose low.
Limitations
- A higher radiation dose than a single conventional dental X-ray (though still low).
- Metal posts, crowns and fillings can create artefacts that obscure the image.
- It does not replace a careful clinical examination — it complements it.
- There is an additional cost, which I will always discuss with you in advance.
What about the radiation?
A focused endodontic CBCT scan delivers a radiation dose broadly in the same order of magnitude as three to four routine, small dental X-rays, which is roughly equivalent to a few days of the natural background radiation we are all exposed to every day from the soil, air and cosmic sources around us. It is more than a single ordinary X-ray but is still a very low dose.
I follow the ALARA principle — keeping radiation ‘as low as reasonably achievable’. In practice that means using the smallest field of view that answers the clinical question.
Does a scan really improve treatment?
Yes. By revealing the full anatomy of your tooth and the true extent of any infection or complexities beforehand, a 3D CBCT scan helps me diagnose accurately and advise on the most appropriate approach. This is especially important when a tooth has a suspected crack or is affected by root resorption (such as external cervical or internal resorption), where a problem left undiagnosed can cause the tooth to fail years later.
Do I need to go elsewhere for the scan?
No. The CBCT scanner is in-house, so your scan is carried out by one of our team of experienced radiographers prior to treatment. There is no need for a separate imaging referral before treatment can begin.
Do I need a referral to be seen?
You can ask your dentist to refer you. Alternatively, you are welcome to book an appointment directly if you think you may have a dental problem — I can assess you and, if appropriate, take a CBCT scan at the same visit.