Cone‑beam computed tomography in endodontics: Historical development, technical principles, clinical applications and operative outcomes (Review)

Cone-beam computed tomography (CBCT) has transformed diagnostic and therapeutic approaches within endodontics by providing practitioner-accessible three-dimensional visualization of dentoalveolar anatomy with high spatial resolution and comparatively low radiation dose.Conventional two-dimensional radiography, while essential and routinely used, suffers from inherently limited perspectives caused by projection, geometric distortion, and anatomical superimposition; these limitations can obscure complex root canal systems, periapical pathology and subtle fractures.CBCT fills these diagnostic gaps by producing isotropic voxel datasets that permit multiplanar reconstructions, accurate measurement, and volumetric assessment of osseous and dental structures.The present review traces the historical development of dental radiology leading to dental CBCT, summarizes fundamental technical considerations including voxel size, field of view and reconstruction algorithms, and discusses the principal advantages and limitations of CBCT relative to conventional imaging.Emphasis is placed on endodontic indications: The pre-operative evaluation of canal morphology and anomalous anatomy, the detection of vertical and horizontal root fractures, assessment of internal and external resorption, intra-operative localization of separated instruments and perforations, and objective postoperative outcome appraisal.Practical considerations, such as radiation dose, artifact generation and interpretation challenges are discussed, and suggested practice guidelines for appropriate use are provided.The intent is to present an integrated, evidence-informed perspective that assists clinicians in selecting and applying CBCT appropriately to enhance diagnostic accuracy and treatment outcomes in endodontic care.Contents 1. Introduction 2. History of dental radiology and CBCT development 3. Limitations of conventional radiographic imaging 4. CBCT: Technical considerations 5. Advantages of CBCT in dentistry and endodontics 6. Pre-operative assessment using CBCT 7. Intra-operative and post-operative assessment 8. CBCT in pediatric endodontics 9. Limitations, artifacts and radiation considerations 10.Practical recommendations and appropriate use criteria 11.