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