USE OF CBCT IN ENDODONTICSBY

KRISTINA SHAGRAMANOVA, D.D.S

PRACTICE LIMITED TO ENDODONTICS AND MICROSURGERY

410 WEST COLORADO STREET

GLENDLE, CA 91204

24355 LYONS AVE, SUITE #235

SANTA CLARITA, CA 91321

USE OF CBCT IN ENDODONTICS

• CBCT-INTRODUCTION• INTRODUCED IN EUROPE IN 1996, AND IN THE US IN 2001

• FDA approved the first CBCT unit for dental use in the United States in March 2001

• 15 MANUFACTURERS OFFERED 24 CBCT MODELS IN THE USA• OPTIMAL CBCT RESOLUTION for Endodontics <200um (avg width of PDL space)

• FIELD OF VIEW –FOV (Scan Volume)• Depends on the disease presentation and the region to be imaged• The smaller the scan volume

• The higher the resolution of the image• The lower the effective radiation dose to the patient

• USES

USE OF CBCT IN ENDODONTICS

• VOXEL SIZE AND RESOLUTION:• VOXEL-the smallest distinguishable unit of a 3D image/volume

-the size of the voxel is determined by its width, height and length

-the voxel size on CBCT images is isotropic (all equal dimensions)

-This is considered an advantage of the CBCT because the

measurements will be exact in all orthogonal planes (1:1)

VOXEL

-Voxel size needs to be smaller than the desired anatomical structure of interest

-Example: inflammation of PDL will need a CBCT less than 0.2 mm needs to be

visualized

-Structures smaller than the voxel size will not be visualized in the scan

(example, small cracks in the enamel)

-there are different voxel sizes depending on the capabilities of each unit. Small FOV-use small voxel size of 0.076 mm (enables to visualize

very small changes to structures

Other voxel sizes available for CBCT units are 0.2 mm, 0.3 mm, 0.4 mm.

The larger the voxel size, the less resolution the image will have

and less capability to differentiate between small structures

USE OF CBCT IN ENDODONTICS

USE OF CBCT IN ENDODONTICS

USE OF CBCT IN ENDODONTICS

ENDO HD MODE (5 cm X 5 cm) SINGLE JAW MODE (8 cm X 5 cm) DUAL JAW MODE (8cm X 9 cm)

USE OF CBCT IN ENDODONTICS

Background exposures makeabout 50% of annual doze ofionizing radiation

The other 50% come frommedical uses (24% medical CT) With dentistry contributing only2.8% (intra-oral imaging)

USE OF CBCT IN ENDODONTICS

AAE and AAOMR Joint Position Statement

Use of Cone Beam Computed Tomography in Endodontics—2015/2016 Update

Recommendation 1: Intraoral radiographs should be considered the imaging modality of choice in the evaluation of the endodontic patient.

Recommendation 2: Limited FOV CBCT should be considered the imaging modality of choice for diagnosis in patients who present with contradictory or nonspecific clinical signs and symptoms associated with untreated or previously endodontically treated teeth.

Recommendation 3 (Pre-op) Limited FOV CBCT should be considered the imaging modality of choice for initial treatment of teeth with the potential for extra canals and suspected complex morphology, such as mandibular anterior teeth, and maxillary and mandibular premolars and molars, and dental anomalies.

USE OF CBCT IN ENDODONTICS

AAE and AAOMR Joint Position Statement

Use of Cone Beam Computed Tomography in Endodontics—2015/2016 Update

Recommendation 4 (Intra-Op): If a preoperative CBCT has not been taken, limited FOV CBCT should be considered as the imaging modality of choice for intra-appointment identification and localization of calcified canals.

Recommendation 5 (Post-Op): Intraoral radiographs should be considered the imaging modality of choice for immediate postoperative imaging.

Recommendation 6 (Non-sx retx): Limited FOV CBCT should be considered the imaging modality of choice if clinical examination and 2-D intraoral radiography are inconclusive in the detection of vertical root fracture.

USE OF CBCT IN ENDODONTICS

AAE and AAOMR Joint Position Statement

Use of Cone Beam Computed Tomography in Endodontics—2015/2016 Update

Recommendation 7: Limited FOV CBCT should be the imaging modality of choice when evaluating the nonhealing of previous endodontic treatment to help determine the need for further treatment, such as nonsurgical, surgical or extraction.

Recommendation 8: Limited FOV CBCT should be the imaging modality of choice for nonsurgical retreatment to assess endodontic treatment complications, such as overextended root canal

obturation material, separated endodontic instruments, and localization of perforations.

USE OF CBCT IN ENDODONTICS

USE OF CBCT IN ENDODONTICS

USE OF CBCT IN ENDODONTICS

USE OF CBCT IN ENDODONTICS

USE OF CBCT IN ENDODONTICS

USE OF CBCT IN ENDODONTICS

USE OF CBCT IN ENDODONTICS

USE OF CBCT IN ENDODONTICS

USE OF CBCT IN ENDODONTICS

USE OF CBCT IN ENDODONTICS

USE OF CBCT IN ENDODONTICS

USE OF CBCT IN ENDODONTICS

TREATMENT PLAN #4:

1. RETREATMENT 2. APICAL SURGERY3. BOTH

CBCT IS THE ANSWER

USE OF CBCT IN ENDODONTICS

USE OF CBCT INENDODONTICS

USE OF CBCT IN ENDODONTICS