Medical Research: Emerging Concepts and Applications Vol. 2

Background: Cone-beam computed tomography (CBCT) provides three-dimensional visualisation of periapical tissues, root morphology, resorptive defects, and selected structural abnormalities that may not be evident on conventional periapical radiography. Its greater diagnostic yield, however, does not by itself establish that CBCT-guided decisions improve outcomes after vital pulp therapy (VPT).

Aim: To critically evaluate the diagnostic yield of limited-field-of-view CBCT in clinical situations relevant to VPT, determine how additional three-dimensional findings influence diagnostic thinking and treatment planning, and examine the risk that sensitive imaging may promote overdetection or unnecessary treatment escalation.

Methods: A structured critical narrative review was conducted using PubMed/MEDLINE and Scopus, supplemented by backward and forward citation tracking in Google Scholar. Literature published to 30 June 2026 was considered. Direct VPT evidence was prioritised. Diagnostic-accuracy, decision-impact, outcome, technical, and guidance publications from broader endodontic populations were included when they addressed imaging questions relevant to VPT. Evidence was organised according to diagnostic accuracy, influence on diagnostic thinking, influence on treatment planning, patient-outcome efficacy, and societal considerations.

Results: CBCT is more sensitive than periapical radiography for detecting apical periodontitis and can improve characterisation of resorptive defects, complex root anatomy, and selected structural abnormalities. In a human histopathological study, sensitivity for apical periodontitis was 0.89 for CBCT and 0.27 for a single digital periapical radiograph, with high specificity for both modalities. In the principal VPT-relevant clinical trial, CBCT detected more periapical changes than periapical radiography after indirect pulp treatment; baseline CBCT-detected lesions were associated with a higher observed failure rate, although the subgroup finding was not designed to define an independent treatment threshold. Studies in broader endodontic cohorts show that CBCT can change diagnoses, confidence, and treatment plans, especially in complex and preselected cases. Such changes are not equivalent to improved outcomes and may sometimes shift decisions towards more invasive care. Direct prospective evidence that CBCT-guided treatment selection improves pulp survival, tooth retention, pain, quality of life, or cost-effectiveness after VPT remains insufficient.

Conclusion: Limited-field-of-view CBCT can be valuable when a specific unresolved diagnostic question is likely to change management. It should not be used for routine screening of VPT candidates. Prescription should be individualised, use the smallest appropriate field of view, and integrate symptoms, sensibility testing, periodontal assessment, restorability, conventional imaging, and intraoperative pulp findings. Additional abnormalities should prompt clinical reassessment rather than automatic escalation to root canal treatment or extraction.