Patients selected for Cone beam computed tomography (CBCT) examinations in accordance with European Commission guidelines ( patients with symptomatic vital teeth or with symptomatic root filled teeth; patients with suspected dental fracture; patients with suspected external or internal resorption and for aid in performing any therapeutic intervention ) will be included in the study. Only patients aged above 18 years will be included in the study.~Patients referred to the department of endodontics at Post Graduate Institute of Dental Sciences (PGIDS) Rohtak or any patient from routine opd requiring specialist endodontic consultation will be thoroughly examined .The examination will consist of a proper medical history and clinical examination, such as inspection, palpation, probing and percussion of the area of interest. When appropriate, additional tests such as sensitivity tests (cold and electric pulp tests) and conventional radiography will be performed. After the initial examination, patients judged to be in need of CBCT examination will be referred to the radiology department.~Stages of evaluation~Stage 1(before CBCT examination) Before referral, the examiner will write down the best available diagnosis and therapeutic plan using clinical examination and conventional radiography. The radiographs will be carefully viewed for periapical changes, vertical root fractures, internal or external resorption, perforation or any other radiographic finding.~Stage 2(after CBCT examination)~After the CBCT examination, the previous diagnosis and treatment plan will be considered and, if needed, a new diagnosis and treatment plan will be made by the same examiner, taking into consideration all of the data. The examiners will have access to all image reconstructions performed by the radiologist. These reconstructions will include images in the axial, coronal and sagittal planes throughout the entire volume.~Stage 3(patient dismissal) As per requirement therapy will be performed on the patients. The findings of orthograde treatment, explorative surgery, endodontic microsurgery, or extraction will serve as a gold standard for definitive clinical diagnosis.~Radiological investigation All intraoral periapical radiographs will be done with at least two angled (mesial and distal) views.~CBCT examination (Kodak CS 9300 Care Stream) done with exposure parameters 85 kilovolt and 5ma isotropic voxels with a size of 90*90*90 microns 5 *5 cm volume FOV Slice thickness will vary from .9 to 1.3 mm.~The images will be viewed on a screen with a resolution of 1280*1024pixels (Dell E19135).~Diagnostic decision making The diagnosis with periapical radiograph and CBCT will be made as per following choices~Healthy~Pulp necrosis~Apical periodontitis~External resorption~Root fracture~Non-endodontic diagnosis~Others~Therapeutic decision making~Treatment plans decided by radiographs and CBCT will be divided into following choices~No treatment~Wait and watch~Orthograde endodontics~Retrograde endodontics~Explorative surgery~Extraction~Referral to other specialist~Others
this study will determine the effect of CBCT examinations on diagnostic and therapeutic decision making in endodontics.