Successfully reported this slideshow.

3d Imaging

6,224 views

Published on

More 3D imaging info

  • Be the first to comment

3d Imaging

  1. 1. Limited Field Cone Beam Computed Tomography (CBCT) in Dentistry© Martin D. Levin, DMD Diplomate, American Board of Endodontics Chevy Chase, Maryland Adjunct Associate Professor of Endodontics University of Pennsylvania, School of Dental Medicine Philadelphia, Pennsylvania © 2010, EndoNet Consulting, LLC All Rights Reserved.
  2. 2. Agenda* 1. What is CBCT and How Does it Work? 2. Applications of CBCT 3. Summary *Sponsored by Carestream/Henry Schein Software of Excellence
  3. 3. 1.What is CBCT and How Does it Work?
  4. 4. Principals of CBCT: What is it? CBCT utilizes a pyramidal or cone shaped x-ray beam and an area detector that acquires a full volume of images in a single rotation, with no need for patient movement.
  5. 5. Principals of CBCT: VOXEL Imaging Area 50 mm 37mm A voxel (VOlume piXEL), represents the smallest distinguishable box-shaped .076m part of a 3D image, similar .076m m to a pixel representation in m .076m 2D data. m Isotropic Voxel
  6. 6. Principles of CBCT: Optimal voxel size Unpublished ex vivo research investigated the effect of increasing voxel resolution on the detection rate of multiple observers of the MB2 canal on 24 maxillary first molars by CBCT. Compared to the overall prevalence of MB2 canals (92% prevalence), CBCT detection rates increased from 60% to 93.3% with increasing resolution suggesting that if CBCT is to be used, then resolutions in the order of 0.125 mm or less are optimal. Bauman M. The effect of CBCT voxel resolution on the detection of canals in the mesiobuccal roots of permanent maxillary first molars. MS Thesis. University of Louisville School of Dentistry Masters in Oral Biology, Louisville, Kentucky, May, 2009.
  7. 7. This reconstructed view shows the cylindrical volume of data in a CBCT volume of the mandibular anterior teeth of a patient referred for endodontic evaluation. Typically, limited field of view (FOV) is defined as 5 cm x 5 cm or less.
  8. 8. Principals of CBCT: Measurement Simulated bone defects in the human mandible proved that CBCT is an accurate way to measure osseous lesion size and volume. Pinsky H, Dyda S, Pinsky RW, Misch KA, Sarment DP: Accuracy of three-dimensional measurements using CBCT. Dentomaxillofac Radiol 2006:35;410-416.
  9. 9. Principals of CBCT: Field of view (FOV) Large Medium Focused
  10. 10. Principals of CBCT: Field of view (FOV) Large Medium Focused
  11. 11. Principals of CBCT: Field of view (FOV) Large Medium Limited
  12. 12. Principals of CBCT: Field of view (FOV) Large Medium Limited
  13. 13. Principals of CBCT: Field of view (FOV) Large Medium Limited Stitched
  14. 14. Naturally-Occurring “Background” Radiation We are exposed to radiation from natural sources all the time: Average in US is 3 mSv per year from naturally occurring radioactive materials and cosmic radiation from outer space. The added dose from cosmic rays during a 5 hour flight in a commercial airplane is about 0.03 mSv. In the US, the largest source of background radiation comes from radon gas in our homes (about 2 mSv per year). Like other sources of background radiation, exposure to radon varies widely from one part of the country to another.
  15. 15. NCRP Report #160 In 2006, Americans were exposed to 7 times more ionizing radiation than in the early 1980s. The increase was result of growth of medical imaging, especially CTs (67 million) and nuclear medicine (18 million).
  16. 16. Principals of CBCT: Dosimetry CT of maxilla and mandible 243 CBCT large FOV 31 FMX 18.3 Bitewings (4) 4.6 Kodak 9000 3D mand posterior 38.3 µSv 5 Kodak 9000 3D mand anterior 21.7 µSv 3 Kodak 9000 3D panoramic 14.7 µSv 2 Kodak 9000 3D max anterior/posterior… 1 Time period for equivalent effective dose from natural background radiation in days Intraoral periapical 0.61 0 50 100 150 200 250 Ludlow JB: Dosimetry of Kodak 9000 3D Small FOV CBCT and Panoramic Unit, Proceedings of the AAOMR, 2008.
  17. 17. Principals of CBCT: Dosimetry Level “The Kodak 9000 3D provides s doses that are substantially 2 lower than previously reported 3 doses produced by medium and 4 large FOV CBCT units.” 5 The digital panoramic mode 6 provides a low dose alternative 7 for panoramic examinations of the 9 jaws using the same unit. Rando the Radiology Phantom 27 Thermoluminescent Sensors Ludlow JB: Dosimetry of Kodak 9000 3D Small FOV CBCT and Panoramic Unit, University of N Carolina School of Dentistry, Chapel Hill, NC, 2008.
  18. 18. Principals of CBCT – What is it? 2D Planar Imaging 3D Volumetric Imaging With 2D imaging, the letters are With volumetric imaging, it is like superimposed making it difficult removing a particular pane (slice) to to make out detail. examine it clearly and accurately.
  19. 19. Limitations of 2D Imaging Intraoral radiography is based on the transmission, attenuation and recording of X-rays on an analog film or digital receptor, and requires an optimized geometric configuration of the X-ray generator, tooth and sensor to produce an accurate projection. The image produced is a 2D representation of a 3D object. Scarfe WC, Levin MD, Gane D, Farman AG. Use of Cone Beam Computed Tomography in Endodontics. Int J of Dent, 2009.
  20. 20. Limitations of 2D Imaging Intraoral radiography is based on the transmission, attenuation and recording of X-rays on an analog film or digital receptor, and requires an optimized geometric configuration of the X-ray generator, tooth and sensor to produce an accurate projection. The image produced is a 2D representation of a 3D object. Scarfe WC, Levin MD, Gane D, Farman AG. Use of Cone Beam Computed Tomography in Endodontics. Int J of Dent, 2009.
  21. 21. Limitations of 2D Imaging Intraoral radiography is based on the transmission, attenuation and recording of X-rays on an analog film or digital receptor, and requires an optimized geometric configuration of the X-ray generator, tooth and sensor to produce an accurate projection. The image produced is a 2D representation of a 3D object. Scarfe WC, Levin MD, Gane D, Farman AG. Use of Cone Beam Computed Tomography in Endodontics. Int J of Dent, 2009.
  22. 22. Principals of CBCT: Limitations of 2D imaging Goldman et al. showed that in evaluating the healing of periapical lesions using 2D periapical radiographs, there was only 47% agreement between 6 examiners. When those same examiners evaluated the same films at two different times, they only had 19%– 80% agreement between the two evaluations. M. Goldman, A. H. Pearson, and N. Darzenta, ―Endodontic success—who’s reading the radiograph?‖ Oral Surgery, Oral Medicine, Oral Pathology, vol. 33, no. 3, pp. 432–437, 1972.
  23. 23. Principals of CBCT: Limitations of 2D imaging Goldman et al. showed that in evaluating the healing of periapical lesions using 2D periapical radiographs, there was only 47% agreement between 6 examiners. When those same examiners evaluated the same films at two different times, they only had 19%– 80% agreement between the two evaluations. M. Goldman, A. H. Pearson, and N. Darzenta, ―Endodontic success—who’s reading the radiograph?‖ Oral Surgery, Oral Medicine, Oral Pathology, vol. 33, no. 3, pp. 432–437, 1972.
  24. 24. Principals of CBCT: Limitations of 2D imaging Goldman et al. showed that in evaluating the healing of periapical lesions using 2D periapical radiographs, there was only 47% agreement between 6 examiners. When those same examiners evaluated the same films at two different times, they only had 19%– 80% agreement between the two evaluations. M. Goldman, A. H. Pearson, and N. Darzenta, ―Endodontic success—who’s reading the radiograph?‖ Oral Surgery, Oral Medicine, Oral Pathology, vol. 33, no. 3, pp. 432–437, 1972.
  25. 25. Principals of CBCT: Limitations of 2D imaging CBCT is a tomographic scanning technology that allows us understand the maxillofacial complex and the spacial relationship of anatomic structures. Pinsky HM, Dyda S, Pinsky RW, Misch KA, Sarment DP: Accuracy of three-dimensional measurements using CBCT. Dentomaxillofac Radiol 2006. 35;410-416.
  26. 26. Principals of CBCT: Limitations of 2D imaging CBCT is a tomographic scanning technology that allows us understand the maxillofacial complex and the spacial relationship of anatomic structures. Pinsky HM, Dyda S, Pinsky RW, Misch KA, Sarment DP: Accuracy of three-dimensional measurements using CBCT. Dentomaxillofac Radiol 2006. 35;410-416.
  27. 27. Principals of CBCT: Limitations of 2D imaging CBCT is a tomographic scanning technology that allows us understand the maxillofacial complex and the spacial relationship of anatomic structures. Pinsky HM, Dyda S, Pinsky RW, Misch KA, Sarment DP: Accuracy of three-dimensional measurements using CBCT. Dentomaxillofac Radiol 2006. 35;410-416.
  28. 28. Principals of CBCT: Limitations of 2D imaging CBCT is a tomographic scanning technology that allows us understand the maxillofacial complex and the spacial relationship of anatomic structures. Pinsky HM, Dyda S, Pinsky RW, Misch KA, Sarment DP: Accuracy of three-dimensional measurements using CBCT. Dentomaxillofac Radiol 2006. 35;410-416.
  29. 29. Principals of CBCT: Limitations of 2D imaging CBCT is a tomographic scanning technology that allows us understand the maxillofacial complex and the spacial relationship of anatomic structures. Pinsky HM, Dyda S, Pinsky RW, Misch KA, Sarment DP: Accuracy of three-dimensional measurements using CBCT. Dentomaxillofac Radiol 2006. 35;410-416.
  30. 30. Advantages of Limited Field CBCT 1. Higher resolution and diagnostic potential 2. Focused on anatomical area of interest 3. Less radiation exposure 4. Less time required to read the image (4.5 vs 17 min) 5. Smaller area of responsibility Simonton JD, Trevino E, Azevedo: Small v Large Volume CBCT in Endodontics, Table Clinic, AAE, Vancouver, 2008.
  31. 31. Principals of CBCT: Visualization Axial Coronal Sagittal
  32. 32. Principals of CBCT: Visualization Axial Transaxial Coronal Sagittal
  33. 33. What Percentage of Patients Are Scanned? % of All Endodontic Referrals (ALARA) 42 58 Cone beam scan No cone beam scan Offices of Drs. Levin and Mischenko, Chevy Chase, Maryland
  34. 34. What Procedures Are Scanned? 100% 11.3 Mand anterior 15 80% Max anterior 34.6 60% Mand posterior 40% Max posterior 47.3 20% 0% CBCT Data Capture Offices of Drs. Levin and Mischenko, Chevy Chase, Maryland
  35. 35. Principals of CBCT: Radiology Over-Reads “It is the responsibility of the practitioner obtaining the CBCT images to interpret the findings of the examination. Just as a pathology report accompanies a biopsy, an imaging report must accompany a CBCT scan.” American Academy of Oral and Maxillofacial Radiology (AAOMR) Executive opinion statement on performing diagnostic CBCT
  36. 36. 2-D Digital Radiography Systems Odontogenic lesions normally initiate around a specific tooth and spread from the cancellous to cortical bone as the lesion expands.
  37. 37. 2-D Digital Radiography Systems “The Kodak filtered, Schick filtered, Op- Time unfiltered, Schick unfiltered, and Dexis filtered images were significantly better at lesion detection compared with D- speed film.” Hadley DL, Replogle KJ, Kirkam JC, Best AM: A Comparison of five radiographic systems to D-speed film in the detection of artificial bone lesions. J of Endod 34(9):1111-14, 2008.
  38. 38. 2-D Radiography Systems: Comparison “Comparisons of the filtered and unfiltered images in the digital systems revealed differences between the systems. Kodak filtered images had the greatest probability of lesion detection.” Hadley DL, Replogle KJ, Kirkam JC, Best AM: A Comparison of five radiographic systems to D-speed film in the detection of artificial bone lesions. J of Endod 34(9):1111-14, 2008.
  39. 39. 2-D Radiography Systems: Comparison Resolution: 9lp/mm v >20 lp/mm Active Area: 10% more for size 2 sensor Sensor shape: rounded corners Cable attachment: robust
  40. 40. IntraOral Camera: WiFi 1024 x 768 resolution Levin, M: Digital Technology in endodontic practice. Pathways of the Pulp, Ed 10, Elsevier, St. Louis, 2010.
  41. 41. IntraOral Camera: WiFi 1024 x 768 resolution Levin, M: Digital Technology in endodontic practice. Pathways of the Pulp, Ed 10, Elsevier, St. Louis, 2010.
  42. 42. IntraOral Camera: WiFi 1024 x 768 resolution Levin, M: Digital Technology in endodontic practice. Pathways of the Pulp, Ed 10, Elsevier, St. Louis, 2010.
  43. 43. 2. Endodontic Applications of CBCT
  44. 44. Endodontic Applications of CBCT 1. Diagnosis of endodontic pathosis Canal morphology Assessment of pathosis of non-endodontic origin Evaluation of root fractures and trauma Analysis of external and internal root resorption and extraradicular invasive cervical resorption Pre-surgical planning Implant planning Cotton TP, Geisler TM, Holden DT, Schwartz SA, Schindler WG. Endodontic applications of cone beam volumetric tomography, J Endod 2007;33:1121–1132.
  45. 45. Endodontic Applications of CBCT 1. Diagnosis of endodontic pathosis Canal morphology Assessment of pathosis of non-endodontic origin Evaluation of root fractures and trauma Analysis of external and internal root resorption and extraradicular invasive cervical resorption Pre-surgical planning Implant planning Cotton TP, Geisler TM, Holden DT, Schwartz SA, Schindler WG. Endodontic applications of cone beam volumetric tomography, J Endod 2007;33:1121–1132.
  46. 46. Endodontic Applications of CBCT Diagnosis of endodontic pathosis 2. Canal morphology Assessment of pathosis of non-endodontic origin Evaluation of root fractures and trauma Analysis of external and internal root resorption and extraradicular invasive cervical resorption Pre-surgical planning Implant planning Cotton TP, Geisler TM, Holden DT, Schwartz SA, Schindler WG. Endodontic applications of cone beam volumetric tomography, J Endod 2007;33:1121–1132.
  47. 47. Endodontic Applications of CBCT Diagnosis of endodontic pathosis Canal morphology 3. Assessment of pathosis of non-endodontic origin Evaluation of root fractures and trauma Analysis of external and internal root resorption and extraradicular invasive cervical resorption Pre-surgical planning Implant planning Cotton TP, Geisler TM, Holden DT, Schwartz SA, Schindler WG. Endodontic applications of cone beam volumetric tomography, J Endod 2007;33:1121–1132.
  48. 48. Endodontic Applications of CBCT Diagnosis of endodontic pathosis Canal morphology Assessment of pathosis of non-endodontic origin 4. Evaluation of root fractures and trauma Analysis of external and internal root resorption and extraradicular invasive cervical resorption Pre-surgical planning Implant planning Cotton TP, Geisler TM, Holden DT, Schwartz SA, Schindler WG. Endodontic applications of cone beam volumetric tomography, J Endod 2007;33:1121–1132.
  49. 49. Endodontic Applications of CBCT Diagnosis of endodontic pathosis Canal morphology Assessment of pathosis of non-endodontic origin 4. Evaluation of root fractures and trauma Analysis of external and internal root resorption and extraradicular invasive cervical resorption Pre-surgical planning Implant planning Cotton TP, Geisler TM, Holden DT, Schwartz SA, Schindler WG. Endodontic applications of cone beam volumetric tomography, J Endod 2007;33:1121–1132.
  50. 50. Endodontic Applications of CBCT Diagnosis of endodontic pathosis Canal morphology Assessment of pathosis of non-endodontic origin Evaluation of root fractures and trauma 5. Analysis of external and internal root resorption and extraradicular invasive cervical resorption Pre-surgical planning Implant planning Cotton TP, Geisler TM, Holden DT, Schwartz SA, Schindler WG. Endodontic applications of cone beam volumetric tomography, J Endod 2007;33:1121–1132.
  51. 51. Endodontic Applications of CBCT Diagnosis of endodontic pathosis Canal morphology Assessment of pathosis of non-endodontic origin Evaluation of root fractures and trauma Analysis of external and internal root resorption and extraradicular invasive cervical resorption 6. Pre-surgical planning Implant planning Cotton TP, Geisler TM, Holden DT, Schwartz SA, Schindler WG. Endodontic applications of cone beam volumetric tomography, J Endod 2007;33:1121–1132.
  52. 52. Endodontic Applications of CBCT Diagnosis of endodontic pathosis Canal morphology Assessment of pathosis of non-endodontic origin Evaluation of root fractures and trauma Analysis of external and internal root resorption and extraradicular invasive cervical resorption Pre-surgical planning 7. Implant planning Cotton TP, Geisler TM, Holden DT, Schwartz SA, Schindler WG. Endodontic applications of cone beam volumetric tomography, J Endod 2007;33:1121–1132.
  53. 53. Pre-Operative Assessment “Imaging achieves visualization of dental and alveolar hard tissue morphology and pathologic alterations to assist correct diagnosis.” Scarfe WC, Levin MD, Gane D, Farman AG. Use of Cone Beam Computed Tomography in Endodontics. Int J of Dent, submitted Jul 29, 2009.
  54. 54. Pre-Operative Assessment Scarfe WC, Levin MD, Gane D, Farman AG. Use of Cone Beam Computed Tomography in Endodontics. Int J of Dent, submitted Jul 29, 2009.
  55. 55. Pre-Operative Assessment Scarfe WC, Levin MD, Gane D, Farman AG. Use of Cone Beam Computed Tomography in Endodontics. Int J of Dent, submitted Jul 29, 2009.
  56. 56. 3 Month Check-Up: CBCT Axial View
  57. 57. 3 Month Check-Up: CBCT Sagittal View
  58. 58. Clinical Decision Making: Missed Lesions “CBCT showed significantly more lesions (34%, p 0.001) than PA radiography.” Low KMT, Dula K, Bürgin W, von Arx T. Comparison of periapical radiography and limited cone-beam tomography in posterior maxillary teeth referred for apical surgery. J Endod 2008;34:557–562.
  59. 59. Clinical Decision Making: Missed Lesions “CBCT showed significantly more lesions (34%, p 0.001) than PA radiography.” Low KMT, Dula K, Bürgin W, von Arx T. Comparison of periapical radiography and limited cone-beam tomography in posterior maxillary teeth referred for apical surgery. J Endod 2008;34:557–562.
  60. 60. Clinical Decision Making: Missed Lesions Low KMT, Dula K, Bürgin W, von Arx T. Comparison of periapical radiography and limited cone-beam tomography in posterior maxillary teeth referred for apical surgery. J Endod 2008;34:557–562.
  61. 61. Clinical Decision Making: Missed Lesions Low KMT, Dula K, Bürgin W, von Arx T. Comparison of periapical radiography and limited cone-beam tomography in posterior maxillary teeth referred for apical surgery. J Endod 2008;34:557–562.
  62. 62. Pre-Operative Assessment “Detecting lesions with PA radiography alone was most difficult in second molars or in roots in close proximity to the maxillary sinus floor.” Low KMT, Dula K, Bürgin W, von Arx T. Comparison of periapical radiography and limited cone-beam tomography in posterior maxillary teeth referred for apical surgery. J Endod 2008;34:557–562.
  63. 63. Pre-Operative Assessment Low KMT, Dula K, Bürgin W, von Arx T. Comparison of periapical radiography and limited cone-beam tomography in posterior maxillary teeth referred for apical surgery. J Endod 2008;34:557–562.
  64. 64. Pre-Operative Assessment “Only 1 out of 14 [artificial] furcation defects in maxillary teeth were seen on PA radiography because of overlapping roots, whereas HR-CT scans were able to identify all furcal defects.” Fuhrmann RA, Bucker A, Diedrich PR. Furcation involvement: comparison of dental radiographs and HR-CT-slices in human specimens. J Periodontal Res 1997;32:409 –18.
  65. 65. Pre-Operative Assessment
  66. 66. Pre-Operative Assessment Fuhrmann compared artificial bone defects in the antral floor (1-2 mm to the denudation of the entire antral surface). PA radiography was unable to detect any of the defects, whereas 62.5% of the defects were detected with CT scans. Fuhrmann RA, Bucker A, Diedrich PR. Furcation involvement: comparison of dental radiographs and HR-CT-slices in human specimens. J Periodontal Res 1997;32:409 –18.
  67. 67. Pre-Operative Assessment Fuhrmann RA, Bucker A, Diedrich PR. Furcation involvement: comparison of dental radiographs and HR-CT-slices in human specimens. J Periodontal Res 1997;32:409 –18.
  68. 68. Pre-Operative Assessment
  69. 69. Pre-Operative Assessment
  70. 70. Pre-Operative Assessment
  71. 71. Lesion Detection Patel, et al. used 2 mm diameter defects placed in the cancellous bone at the apices of 10 first molar teeth on six partially dentate intact human dry mandibles. They found a detection rate of 24.8% for intraoral radiography and 100% CBCT imaging. Patel S, Dawood A, Mannocci F, Wilson R, Pitt Fort T. Detection of periapical bone defects in human jaws using CBCT and intraoral radiogrpahy. Int J Endod 2009;42:507-515.
  72. 72. Pre-Operative Assessment
  73. 73. Clinical Decision Making: Missed Lesions Lofthag-Hansen, et al. compared the accuracy of 3 observers using focused field CBCT to PA radiography. While CBCT and intraoral radiographs identified 53 roots with lesions, CBCT identified an additional 33 roots with lesions (62%). Lofthag-Hansen S, Huumonen S, Grondahl HG. Limited CBCT and intraoral radiography for the diagnosis of periapical pathology. Oral Surg Oral Med Oral Path Oral Radiol Endod 2007;103:114-119.
  74. 74. Clinical Decision Making: Missed Lesions Lofthag-Hansen, et al. compared the accuracy of 3 observers using focused field CBCT to PA radiography. While CBCT and intraoral radiographs identified 53 roots with lesions, CBCT identified an additional 33 roots with lesions (62%). Lofthag-Hansen S, Huumonen S, Grondahl HG. Limited CBCT and intraoral radiography for the diagnosis of periapical pathology. Oral Surg Oral Med Oral Path Oral Radiol Endod 2007;103:114-119.
  75. 75. Clinical Decision Making: Missed Lesions Lofthag-Hansen S, Huumonen S, Grondahl HG. Limited CBCT and intraoral radiography for the diagnosis of periapical pathology. Oral Surg Oral Med Oral Path Oral Radiol Endod 2007;103:114-119.
  76. 76. Maxillary Sinusitis of Dental Origin When a dental infection extends directly through the mucosal floor causing a secondary maxillary sinus infection. Abrahams, et al., infections of maxillary posterior teeth show maxillary sinus pathosis: 60% Matilla found mucosal hyperplasia; 80%. Dental infections cause 10-15% of acute maxillary sinusitis, and is much higher in chronic cases. Ingle JI, Bakland LK: Endodontics. 5th ed. Hamilton, Ont.; BC Decker; 2002.
  77. 77. Clinical Decision Making: Missed Canals
  78. 78. Persistent Idiopathic Facial Pain (PIFP) Pain in face, present daily, persists all or most of day. Poorly localized, unilateral deep ache. Not associated with sensory loss or other physical signs, normal lab and imaging studies. Psychiatric symptoms of depression and anxiety prevalent and compound conundrum. Headache Classification Subcommittee of the International Headache Society, 2004)
  79. 79. Persistent Idiopathic Facial Pain (PIFP)
  80. 80. Ectodermal Dysplasia
  81. 81. Diagnosis and Treatment Planning: Maxillary sinusitis of dental origin
  82. 82. Diagnosis and Treatment Planning: Osteoperiostitis Occasionally, apical periodontitis will not penetrate the antral floor, but will displace the periosteum, which will deposit new bone (periapical osteoperiostitis or “halo”).
  83. 83. Diagnosis and Treatment Planning: Osteoperiostitis
  84. 84. Diagnosis and Treatment Planning: Incidental Findings Mucus retention pseudocyst Antrolith
  85. 85. Diagnosis and Treatment Planning
  86. 86. Diagnosis of Endodontic Pathosis b c d
  87. 87. Diagnosis of Endodontic Pathosis e f
  88. 88. Principals of CBCT: Missed canals Matherne, et al. compared the ability of three board certified endodontists to detect the number of root canals on intraoral digital (both CCD and PSP) images with CBCT in 72 extracted teeth in 3 equal groups of maxillary molars, mandibular premolars, and mandibular incisors. Observers failed to detect at least one root canal in 40% of teeth using 2D imaging. Number of Canals in Number of Canals in Mandibular Number of Canals in Mandibular Maxillary Molars Premolars Incisors CBCT 3.58 1.21 1.5 CCD 3.1 1.0 1.0 PSP 3.0 1.1 1.3 Matherne RP, Angelopoulos C, Kulild JC, Tira D. Use of CBCT to identify root canal systems in vitro. J Endod 2008;34:87-89.
  89. 89. Acute Periradicular Periodontitis In a 150 patients, 17 accessory mental foramina were located in the area of the, area of mesial root of the mandibular first molar. Katakami K, Mishima AT, Shiozaki K, Shimoda S, Hamada Y, Kobayashi K. Characteristics of accessory mental foramina observed on limited CBCT images, published online 13 Oct 2008. AAE, Elsevier, Inc.
  90. 90. Revision Therapy
  91. 91. Revision Therapy
  92. 92. Revision Therapy
  93. 93. Root Fracture, Horizontal Bernardes, et al. [65] retrospectively compared conventional periapical radiographs and CBCT images for 20 patients with suspected root fractures. They found that CBCT was able to detect fractures in 90% of patients whereas PAs could only detect fractures in 30% to 40% of cases. Bernardes RA, de Moraes IG, Duarte MA, Azevedo BC, de Azevedo JR, Bramante CM. Use of cone-beam volumetric tomography in the diagnosis of root fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009 Mar 7.[Epub ahead of print]..
  94. 94. Root Fracture, Vertical Hassan, et al. compared the accuracy of 4 observers in detecting ex vivo vertical root fractures (VRFs) on CBCT and periapical images. They found an overall higher accuracy for CBCT because mesio-distal fractures are almost impossible to detect with 2D imaging - the x-ray beam must be within 4 of the fracture plane. Hassan B, Metska ME, Ozok AR, van der Stelt P, Wesselink PR. Detection of vertical root fractures in endodontically treated teeth by a cone beam computed tomography scan. J Endod 2009;35:719-722.
  95. 95. Root Fracture, Vertical Hassan B, Metska ME, Ozok AR, van der Stelt P, Wesselink PR. Detection of vertical root fractures in endodontically treated teeth by a cone beam computed tomography scan. J Endod 2009;35:719-722.
  96. 96. Resorption Common complications of trauma are pulp necrosis, pulp canal obliteration, periapical pathosis and root resorption. Types of root resorption: repair-related (surface), infection-related (inflammatory), ankylosis-related (osseous replacement) or extraradicular invasive cervical resorption are among the most common.
  97. 97. Resorption: External
  98. 98. Resorption, External c d b a e
  99. 99. Extraradicular Invasive Cervical Resorption “CBCT has been used successfully to confirm the presence of IRR and differentiate it from ERR.” Scarfe WC, Levin MD, Gane D, Farman AG. Use of Cone Beam Computed Tomography in Endodontics. Int J of Dent, submitted Jul 29, 2009.
  100. 100. “CBCT has been used successfully to confirm the presence of IRR and differentiate it from ERR.” Scarfe WC, Levin MD, Gane D, Farman AG. Use of Cone Beam Computed Tomography in Endodontics. Int J of Dent, submitted Jul 29, 2009.
  101. 101. Extraradicular Invasive Cervical Resorption “CBCT has been used successfully to confirm the presence of IRR and differentiate it from ERR.” Scarfe WC, Levin MD, Gane D, Farman AG. Use of Cone Beam Computed Tomography in Endodontics. Int J of Dent, submitted Jul 29, 2009.
  102. 102. Resorption, Cervical
  103. 103. Resorption, Cervical
  104. 104. Intra-Operative
  105. 105. Intra-Operative
  106. 106. Surgical Assessment
  107. 107. 3. Why Embrace 3D?
  108. 108. Periradicular Pathosis Estrela, et al. compared the accuracy of CBCT, panoramic and periapical radiographs from 888 imaging exams showing periapical pathosis. 3 observers reviewed a total of 1,014 images taken from 596 patients. They found that CBCT imaging detected 54.2% more periradicular lesions than intraoral radiography alone. Estrela C, Bueno MR, Leles CR, Azevedo B, Azevedo JR. Accuracy of CBCT and panoramic and periapical radiography for detection of apical periodontitis. J Endod 2008;34:273-279.
  109. 109. Why Embrace 3D? “Diagnostic information directly influences clinical decisions. Accurate data lead to better treatment planning decisions and potentially more predictable outcomes.” Cotton TP, Geisler TM, Holden DT, Schwartz SA, Schindler WG. Endodontic applications of cone beam volumetric tomography, J Endod 2007;33:1121–1132.
  110. 110. Summary

×