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From the AAE Colleagues of Excellence
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Cone Beam-Computed Tomography and Endodontics
Principles of CBCT -What is it?
Anatomically accurate 3-D informationBetter understanding of “the patient” as opposed to “the tooth”Identify possibilities and limitations of treatmentPowerful communication with patients and colleagues
Why 3-D?
Large Medium Focused
Principles of CBCT -Field of View
Large Medium Focused
Principles of CBCT -Field of View
Large Medium Focused
Principles of CBCT -Field of View
Radiation Dose Considerations
ALARA Principle
Following appropriate radiograph selection criteria
Using properly trained and credentialed personnel
Using optimal technique factors
Using the fastest x-ray detector
Judicious Use of CBCT
Clinicians should use CBCT only when the need for imaging cannot be answered adequately by lower dose radiography.
Imaging Area50
mm
.38 mm
.076mm.076
mm
.076mm
Cubic Voxel
Voxel (VOlume piXEL) is the smallest building block of a 3-D image
Simulated bone defects in acrylic blocks and the human mandible proved that CBCT is an accurate way to measure osseous lesion and volume
Principles of CBCT -Voxel
Advantages of CBCT
Transverseor Axial
Coronal Sagittal
Advantages of CBCT
Differentiation of pathosis from normal anatomy Relationships with important anatomical
structures Management of aberrant anatomy (i.e. Dens, C-
shapes) External and internal resorption defects Diagnosis of root perforations Identification of missed canals, additional anatomy Management of fractured instruments
Potential Endodontic Applications of CBCT
Potential Endodontic Applications of CBCT
Aiding surgical planningRetreatments- treatment planningTraumatic injuries - diagnosis and treatment planningIntra-operative (i.e. finding canals)Maxillary sinusitis of dental origin Calcified casesFacial pain cases to rule out odontogenic etiology
Detection and Extent of PA Lesions
Detection of Apical Periodontitis
CBCT is significantly more sensitive than conventional x-rays for demonstrating ‘AP’
Estrela C et al, JOE 2009
Cotton TP et al, JOE 2007
Lofthag-Hansen S et al, OOOE 2007
CBCT: What Are We Missing?
CBCT showed significantly more lesions (34%, p< .001) than PA’s
Low KMT, et al, JOE 2008Low KMT, et al, JOE 2008
Detection of Apical Periodontitis
Detection of Apical Periodontitis
Detection of Apical Periodontitis
Enhanced Visualization of Anatomy and Pathosis
Pathosis
Pathosis
Mental Foramen?
Mental Foramen?
Diagnosis of Missed Canalsand Retreatment
Is there a lesion?
Is there a lesion?
Is there a missed canal?
Detection of Canals
MB2
Missed Root
Trauma
CBCT and Trauma
CBCT and Trauma
Detection of Luxations
Detection of Luxations
Trauma
Trauma
Diagnosis of Complications
Complications
Strip peroration is now observed
Complications
Complications
Detection of Resorption
Resorption was detected in 69% of radiographs and 100% of CBCT scans
Estrela C et al JOE 2009
Detection of Resorption
?
Detection of Resorption
?
Conclusions
CBCT is perfectly positioned for endodontics– Focused FOV
– Minimal radiation
– Highest resolution
– Real-time analysis