Cone Beam Technology in EndodonticsHistory of the Digital Radiograph? Digital or electronic imaging has been available for morethan a decade. The first direct digital imaging system,RadioVisioGraphy (RVG), was invented by Dr. FrancesMouyensand manufactured by Trophy Radiologie(Vincennes,France) in 1984. Described in the U. S. dental literature in1989.Since the discovery of X-rays in 1895, film has been theprimary medium for capturing, displaying, and storingradiographic images.It is a technology that dental practitioners are the mostfamiliar and comfortable with in terms of technique andinterpretation.Digital radiography is the latest advancement in dentalimaging, that is slowly being adopted by the dentalprofession.Digital imaging incorporates computer technology in thecapture, display, enhancement, and storage of directradiographic images.
What is Cone Beam?Also referred to as Computed Tomography/Computed AxialTomography.It is a scan that involved the use of rotating X-Ray equipment,combined with digital computer, to obtain images of thebody and jaws.Cone beam technology has captured the attention of theendodontic community. Some endodontists have likenedCBVI to the introduction of the dental operating microscope.Some see it as the next quantum leap in imaging science inendodontics. With the passage of time some predict that itwill become standard of care for the diagnosis and treatmentof endodontically compromised teeth. Regardless, CBCT ishere to stay. It has clearly been adapted by the dentalcommunity, and even quicker than digital radiography itself.Where is Cone Beam used in Endo?There are four primary areas in today’s endodontic practicethat can implement CBVI on a regular, if not daily, basis.Specifically but not limited to these four areas, is theevaluation and diagnosis of:1. Un-treated teeth2. Non-surgical retreatment3. Surgical retreatment4. Implant treatment planning and placement.
Clinical Case (an example): Figure 1This patient presented with a previously treated upper left first permanent molar. The toothhad been treated endodontically approximately twelve years previously but the patient hadnever been pain free in the maxillary left quadrant. (Figure 1)
The patient was given treatment options and did not elect to have treatment at that timebut returned approximately fourteen months later. An updated periapical digital image wastaken at that time. (Figure 2)
Figure 3 For the first examination consultation appointment we did not have 3D imaging technology in place. At the time of the second consultation the cone beam system had been installed and we were using it regularly beginning to find it especially useful in endodontic retreatment cases. A panoramic and 3D image was taken. (Figure 3).
Advantages of using Cone Beam overConventional X-Rays?1- Enhancement of Images: Superior gray-scale resolution of 256colours of gray incomparison with 16 to 25 shades of gray on a conventionalfilm.2- 3-D Reconstruction: This application can be theoretically used to reconstructintra- and extra-oral images. The uses range from profilingroot canals to visualizing facial fractures in all threedimensions.3- Filtration: The addition of filters to the airspace around the facecan clarify the soft tissue profile if the original soft tissueimage was poor.4- Storage: CD ROM can hold over 30,000 images. This means thatimages can be stored cheaply and indefinitely5- Time: The image is displayed at the chair-side immediatelypost exposure.6- Environmentally Friendly: No processing chemicals are used or disposed.7- Teleradiology: The digital image file can be further sent to colleaguesfor review (e.g: via email).8- Darkroom is no longer needed: So it is economically convenient, now this space can beused for other more useful purposes in the dental office.
9- Dose Reduction: Based on the type of radiograph being taken, radiationcan be reduced by as much as 3 to 4 or more times asconventional.10- Patient Education: Taking a digital radiograph and immediately explainingthe findings as the patient views the condition on anoperatory monitor is extremely useful and practical, and itimproves acceptance of treatment options and plans.Disadvantages of using Cone Beam inEndodontics?1- Cost: it is expensive.2- Medico-legal:The ability to manipulate the images for fraudulent purposes.
Is There Clinical Evidence to Support CBCTUse in Endodontics?Complicated anatomy of both teeth and bone, periapicalpathology, periodontal-endodontic communications, as wellas other treatment planning and diagnostic considerations,make any additional information, 3D imaging in particular,essential to present the best possible treatment options topatients.Initially, case studies appeared in the endodontic literature inwhich patients underwent CBCT imaging for the purposes ofdiagnosis and presurgical treatment planning. Recent reportshave successfully shown the use of CBCT to locate missedcanals, detect the extent of dentoalveolar fractures, identifyresorption patterns, and compare cystic with granulomatousperiapical lesions. It also has he ability to show and diagnosemissed canal that are suggested by periapical radiographs butconfirmed with CBCT.The additional diagnostic information attained from CBCTconfirmed the diagnosis and extent of the root fracture, whichinitially was observed in the periapical radiographs. Notably,the extent of the lingual fracture as well as any alveolarcomplications could be visualized by CBCT only.References:http://cde.dentalaegis.com/courses/12-cone-beam-computed-tomography-in-endodontics-are-we-there-yethttp://www.dentalcompare.com/Featured-Articles/2081-Cone-Beam-Imaging-for-Endodontists-A-Review-of-Clinical-Applications/http://www.conebeam.com/whatishttp://www.slideshare.net/MajdHasanin/digitalradiography