Introduction: The integration of clinical inspection and diagnostic imaging forms the basis for endodontic diagnosis, decision making, treatment planning, and outcome assessments. In recent years, CBCT imaging has become a common diagnostic tool in endodontics. CBCT should only be used to ensure that the benefits to the patient exceed the risks. As such, our aim in this study was to evaluate the high level diagnostic efficacy studies and their risk of bias. Methods: A systematic search of the literature was conducted to identify studies evaluating the use of CBCT imaging in endodontics. The following databases were searched: Medline (PubMed), Scopus, and Cochrane Central. The identified studies were subjected to rigorous inclusion criteria. Studies considered as having a high efficacy level were then subjected to a risk of bias assessment using the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Results: Initially, 1568 articles were identified for possible inclusion in the review. Following title and abstract assessment, duplicate removal, and a full-text evaluation, 22 studies were included. Of those studies, 2 had a low risk of bias and 20 had a high risk of bias. Six studies investigated non-surgical treatment, eight investigated surgical treatment, two investigated both non-surgical and surgical treatment, and six studies investigated diagnostic thinking or decision making. Conclusion: The evidence for the influence of CBCT on decision making and treatment outcomes in endodontics is predominantly based on studies with a high risk of bias.

This study aimed to determine the bactericidal efficacy of sequential use of NaOCl pH 12 followed by acidified NaOCl pH 6.5, and compare it to that of either of these NaOCl solutions alone. E. faecalis biofilm was grown on standardized dentine specimens for four weeks. The specimens were randomly divided into four groups: (A) 4 min exposure to 0.9% saline solution (control); (B) 4 min exposure to 4% NaOCl pH 12; (C) 4 min exposure to 4% NaOCl pH 6.5; and (D) 2 min exposure to 4% NaOCl pH 12 followed by 2 min exposure to 4% NaOCl pH 6.5. The bactericidal activity was evaluated after the 4 min of contact time using confocal laser scanning microscopy. The volume ratio of red fluorescence to green and red fluorescence indicated the proportion of dead cells in the biofilm. The percent of dead cells in the saline solution group was significantly lower than those in the other groups. There was no significant difference between NaOCl pH 12 compared to NaOCl pH 6.5. The sequential use of NaOCl pH 12 followed by pH 6.5 significantly increased the percent of dead cells compared to both the samples exposed to either NaOCl pH 12 or pH 6.5. These results show that sequential irrigation protocol had a stronger bactericidal effect than the commonly used NaOCl pH 12.