CBCT is proposed as the imaging modality of choice for comprehensive orthodontic assessment and treatment planning for several reasons:
1) CBCT provides accurate 1:1 geometry which allows for precise measurements and assessments of structures in all three planes of space, unlike 2D imaging.
2) It allows for accurate localization of impacted or ectopic teeth and assessment of root resorption, important factors for developing an effective treatment plan.
3) Features like airway assessment, temporomandibular joint imaging, and periodontal evaluation can be reviewed from CBCT volumes with no additional radiation exposure.
Use of cone beam computed tomography in endodonticsNielsen Pereira
This document reviews the use of cone beam computed tomography (CBCT) in endodontics. It begins with an introduction to the role of imaging in endodontics for preoperative assessment, intraoperative guidance, and postoperative evaluation. It then discusses some limitations of conventional 2D radiography for interpreting complex dental anatomy. The bulk of the document provides a literature review on CBCT as a 3D imaging modality that can help overcome these limitations and aid in endodontic diagnosis, treatment planning, and post-treatment assessment. Key topics covered include the history and approval of CBCT units for dental use, different types of CBCT equipment based on patient positioning and scan volume, and applications of CBCT for endodontic procedures.
This document summarizes the potential applications of cone beam computed tomography (CBCT) in forensic science based on a review of clinical and scientific literature. CBCT can be used for age and sex estimation, frontal sinus analysis for identification, and 3D facial reconstruction. Studies show CBCT allows for more accurate age estimation compared to 2D radiographs. Measurements of bones like the mastoid and mandible from CBCT scans can determine sex with over 80% accuracy. Comparison of frontal sinus patterns through CBCT provides reliable evidence for identification. While CBCT has advantages like portability and accuracy, limitations include artifacts from metals and limited soft tissue contrast. Further research is still needed to improve 3D reconstruction techniques from CBCT data for forensic
A very precise and intimate description on radiographic considerations in dental implants, since the advent of the first radiographic modality in 1905, the dental health care professionals have been striving to achieve clarity & excellence in the development & usage of dental radiographic imaging modalities.
I hope this presentation will make this wonderful topic more understandable and easier to digest in the minds of young and experienced dental health care professionals.
by Dr Ishaan Adhaulia
Cbct is not the imaging technique of choice for comprehensive orthodontic ass...Nielsen Pereira
1) Cone-beam computed tomography (CBCT) is not the imaging technique of choice for comprehensive orthodontic assessment according to current evidence and guidelines.
2) While CBCT provides some benefits over conventional radiographs for certain conditions, it also exposes patients to higher radiation doses. There is little evidence that the additional information provided by CBCT significantly improves treatment outcomes.
3) Existing guidelines from organizations like SEDENTEXCT recommend that CBCT not be used routinely for orthodontic cases and only be used when information cannot be obtained by lower dose conventional radiographs. Overall, the risks of higher radiation exposure from CBCT do not outweigh the limited benefits for most orthodontic patients based on current
Recent advances in radiographic technique /certified fixed orthodontic course...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Use of cone beam computed tomography in endodonticsNielsen Pereira
This document reviews the use of cone beam computed tomography (CBCT) in endodontics. It begins with an introduction to the role of imaging in endodontics for preoperative assessment, intraoperative guidance, and postoperative evaluation. It then discusses some limitations of conventional 2D radiography for interpreting complex dental anatomy. The bulk of the document provides a literature review on CBCT as a 3D imaging modality that can help overcome these limitations and aid in endodontic diagnosis, treatment planning, and post-treatment assessment. Key topics covered include the history and approval of CBCT units for dental use, different types of CBCT equipment based on patient positioning and scan volume, and applications of CBCT for endodontic procedures.
This document summarizes the potential applications of cone beam computed tomography (CBCT) in forensic science based on a review of clinical and scientific literature. CBCT can be used for age and sex estimation, frontal sinus analysis for identification, and 3D facial reconstruction. Studies show CBCT allows for more accurate age estimation compared to 2D radiographs. Measurements of bones like the mastoid and mandible from CBCT scans can determine sex with over 80% accuracy. Comparison of frontal sinus patterns through CBCT provides reliable evidence for identification. While CBCT has advantages like portability and accuracy, limitations include artifacts from metals and limited soft tissue contrast. Further research is still needed to improve 3D reconstruction techniques from CBCT data for forensic
A very precise and intimate description on radiographic considerations in dental implants, since the advent of the first radiographic modality in 1905, the dental health care professionals have been striving to achieve clarity & excellence in the development & usage of dental radiographic imaging modalities.
I hope this presentation will make this wonderful topic more understandable and easier to digest in the minds of young and experienced dental health care professionals.
by Dr Ishaan Adhaulia
Cbct is not the imaging technique of choice for comprehensive orthodontic ass...Nielsen Pereira
1) Cone-beam computed tomography (CBCT) is not the imaging technique of choice for comprehensive orthodontic assessment according to current evidence and guidelines.
2) While CBCT provides some benefits over conventional radiographs for certain conditions, it also exposes patients to higher radiation doses. There is little evidence that the additional information provided by CBCT significantly improves treatment outcomes.
3) Existing guidelines from organizations like SEDENTEXCT recommend that CBCT not be used routinely for orthodontic cases and only be used when information cannot be obtained by lower dose conventional radiographs. Overall, the risks of higher radiation exposure from CBCT do not outweigh the limited benefits for most orthodontic patients based on current
Recent advances in radiographic technique /certified fixed orthodontic course...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Evaluation of Hard and Soft Tissue Dimensions Around Zirconium Oxide Implant–...Dr Ripunjay Tripathi
journal club Evaluation of Hard and Soft Tissue Dimensions Around Zirconium Oxide Implant–Supported Crowns: A 1-Year Retrospective Study
Kniha at el , J Periodontol 2016;87:511-518.
1. There are several methods for predicting surgical outcomes of orthognathic surgery, including manual tracings, computer software programs, and video imaging.
2. Studies have found that current prediction methods tend to be inaccurate, especially in predicting soft tissue changes like lip and chin positions. Predictions often differ from actual outcomes by 2mm or more.
3. While prediction images can help communicate treatment plans to patients, they may also unintentionally create unrealistic expectations that are not always achieved. More accurate prediction methods are still needed.
Wilhelm Roentgen discovered X-rays in 1895 while experimenting with cathode ray tubes. He found that photographic plates were sensitive to these new rays, which he called X-rays. In one experiment, he placed his wife's hand on a photographic plate and saw the bones and rings on her finger clearly after developing the image. Since then, specialized radiography techniques have been developed like panoramic radiography, CT, MRI, and CBCT to provide detailed cross-sectional views of anatomy for diagnostic purposes like dental implant planning. Diagnostic templates can also be used to incorporate proposed treatment plans into radiographic exams.
This document provides an overview of surgical treatment objectives (STO) in orthognathic surgery. It discusses various methods for cephalometric prediction of orthognathic outcomes, including manual acetate tracing methods as well as computerized methods using software. Both traditional manual methods like Cohen's technique and more modern computerized programs are able to simulate orthodontic and surgical movements to predict hard and soft tissue changes and visualize the predicted postoperative profile. Accurate prediction of outcomes is an important part of the orthognathic treatment planning process.
Diagnostic imaging in implants /certified fixed orthodontic courses by Indian...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Changes in Bone Levels Around Mini-Implants in Edentulous ArchesBHU VARANASI
Marginal bone loss around mini-implants used to stabilize complete dentures was evaluated over a mean observation period of 2.3 years. On average, bone loss was higher in the maxilla than mandible but remained below 1.5 mm in both arches. A previous smoking habit and implants with low insertion torque that were delayed in loading showed greater bone loss compared to immediately loaded implants with high insertion torque. While panoramic radiographs have limitations, mean bone loss was comparable to standard-diameter implants and remained clinically insignificant.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This study assessed the agreement between periapical radiographs (PA) and cone-beam computed tomography (CBCT) in evaluating the periapical status of 60 previously root filled maxillary and mandibular molars. The number of canals, periapical lesions, dimensions of lesions, and presence of 'J'-shaped lesions were compared between PA and CBCT. There were statistically significant differences between PA and CBCT for all assessed parameters. The magnitude of differences was greater for maxillary than mandibular molars. Correlation between PA and CBCT was also weaker for maxillary molars. The findings indicate substantial disagreement between PA and CBCT, especially for the maxillary arch, implying implications for periap
Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
for dental professionals who wish to advance in their dental
practice,Offers certified courses in Dental
implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
Dentistry, Periodontics and General Dentistry.
This document discusses the use of CBCT imaging in dental implant treatment planning and assessment. It provides details on how CBCT can be used to evaluate bone quantity and quality, anatomical structures, ridge morphology, and is recommended for pre-operative planning of sinus lift procedures. CBCT allows accurate measurements and 3D visualization to determine suitable implant size, position, and angulation without superimposition. This helps optimize implant placement and outcomes.
This document presents an overview of recent advances in periodontal drug delivery systems. It discusses various drug delivery systems used to treat periodontitis including fibers, strips, films, gels, microparticles, nanoparticles, liposomes, low dose antibiotics, and wafers. It also presents a case study on developing metronidazole-loaded electrospun polycaprolactone nanofibers as a localized drug delivery system for periodontitis. Advanced drug delivery systems can play an important role in treating periodontitis more effectively and conveniently by enhancing drug targeting and patient compliance.
Videocephalometry/certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Estimation of tertiary dentin thickness on pulp capping treatment with digita...IJECEIAES
Dentists usually observe the tertiary dentin formation after pulp capping treatment by comparing periapical radiograph before and after treatment visually. However many dentists find difficulties to observe tertiary dentin and also they can‟t measure exactly the thickness of the tertiary dentin. The aims of this study is to assist the dentists to measure the area of tertiary dentin and calculate the dentin formation using b-spline image processing. The dental radiograph of 38 patients of pulp capping in the Dental Hospital Universitas Muhammadiyah Yogyakarta, Indonesia. Each of patient visited dental hospital 3 times. First, the patient got an application of pulp capping material. Second, after one-week treatment and temporary restoration and the third, after more than one month with the composite as the final restoration. Every visited the patient take a radiograph. Dentist placed the dot from the patient's radiograph. The dots were combined and processed with digital image processing. The b-spline method changed the dot to one area. After the calculation, the dentist can see whether there was dentin formation which means it is one of the treatment success indicators. Dentist has the better view to measure the dentin formation by providing area value of its tertiary dentin thickness calculation. We compare the result to the program calculation using the b-spline method and visual observation from the dentist. This study indicated the thickness of tertiary dentin can be measured by this program with an accuracy of 94.2%. Therefore, dentist can make tertiary dentin thickness prediction from patient‟s radiograph.
Diagnostic imaging /certified fixed orthodontic courses by Indian dental acad...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
CBCT imaging allows for more accurate implant planning compared to traditional 2D radiographs. It provides 3D views of the bone that are crucial for determining implant placement and potential augmentation procedures. For a patient with severe maxillary resorption, CBCT revealed thin bone in the premaxilla requiring grafting and sufficient bone in the molar region but requiring sinus lifts. Implants were successfully placed following the CBCT-based treatment plan with grafts and have sufficient bone support and integration.
Tiwari R, Chakravarthi PS, Kattimani VS, Lingamaneni KP. A Perioral Soft Tissue evaluation after Orthognathic Surgery Using Three-Dimensional Computed Tomography Scan. The Open Dentistry Journal. 2018; 12:366-376. doi:10.2174/1874210601812010366.
Cephalometrics history, evolution, and land marks/orthodontic courses by indi...Indian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
O documento apresenta um caso clínico de um paciente de 20 anos que sofreu um acidente de trânsito e apresenta mobilidade dentária e dor no dente 21. A tomografia computadorizada cônica mostra uma intrusão do dente 21 com inclinação para a palato e aumento do espaço peri-cementário.
Adult orthodontics /certified fixed orthodontic courses by Indian dental acad...Indian dental academy
The document discusses various aspects of adult orthodontics including biological concepts related to orthodontic treatment in adults, differences between adolescent and adult orthodontic treatment, classifications of adult orthodontic treatment, types of adult orthodontic treatment including adjunctive and comprehensive orthodontics, and case examples. It provides details on topics such as periodontal ligament changes with age, bone changes, tooth changes, objectives of adult orthodontic treatment, and techniques for procedures like molar uprighting, forced eruption, and anterior tooth alignment.
Adult orthodontics /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Evaluation of Hard and Soft Tissue Dimensions Around Zirconium Oxide Implant–...Dr Ripunjay Tripathi
journal club Evaluation of Hard and Soft Tissue Dimensions Around Zirconium Oxide Implant–Supported Crowns: A 1-Year Retrospective Study
Kniha at el , J Periodontol 2016;87:511-518.
1. There are several methods for predicting surgical outcomes of orthognathic surgery, including manual tracings, computer software programs, and video imaging.
2. Studies have found that current prediction methods tend to be inaccurate, especially in predicting soft tissue changes like lip and chin positions. Predictions often differ from actual outcomes by 2mm or more.
3. While prediction images can help communicate treatment plans to patients, they may also unintentionally create unrealistic expectations that are not always achieved. More accurate prediction methods are still needed.
Wilhelm Roentgen discovered X-rays in 1895 while experimenting with cathode ray tubes. He found that photographic plates were sensitive to these new rays, which he called X-rays. In one experiment, he placed his wife's hand on a photographic plate and saw the bones and rings on her finger clearly after developing the image. Since then, specialized radiography techniques have been developed like panoramic radiography, CT, MRI, and CBCT to provide detailed cross-sectional views of anatomy for diagnostic purposes like dental implant planning. Diagnostic templates can also be used to incorporate proposed treatment plans into radiographic exams.
This document provides an overview of surgical treatment objectives (STO) in orthognathic surgery. It discusses various methods for cephalometric prediction of orthognathic outcomes, including manual acetate tracing methods as well as computerized methods using software. Both traditional manual methods like Cohen's technique and more modern computerized programs are able to simulate orthodontic and surgical movements to predict hard and soft tissue changes and visualize the predicted postoperative profile. Accurate prediction of outcomes is an important part of the orthognathic treatment planning process.
Diagnostic imaging in implants /certified fixed orthodontic courses by Indian...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Changes in Bone Levels Around Mini-Implants in Edentulous ArchesBHU VARANASI
Marginal bone loss around mini-implants used to stabilize complete dentures was evaluated over a mean observation period of 2.3 years. On average, bone loss was higher in the maxilla than mandible but remained below 1.5 mm in both arches. A previous smoking habit and implants with low insertion torque that were delayed in loading showed greater bone loss compared to immediately loaded implants with high insertion torque. While panoramic radiographs have limitations, mean bone loss was comparable to standard-diameter implants and remained clinically insignificant.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This study assessed the agreement between periapical radiographs (PA) and cone-beam computed tomography (CBCT) in evaluating the periapical status of 60 previously root filled maxillary and mandibular molars. The number of canals, periapical lesions, dimensions of lesions, and presence of 'J'-shaped lesions were compared between PA and CBCT. There were statistically significant differences between PA and CBCT for all assessed parameters. The magnitude of differences was greater for maxillary than mandibular molars. Correlation between PA and CBCT was also weaker for maxillary molars. The findings indicate substantial disagreement between PA and CBCT, especially for the maxillary arch, implying implications for periap
Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
for dental professionals who wish to advance in their dental
practice,Offers certified courses in Dental
implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
Dentistry, Periodontics and General Dentistry.
This document discusses the use of CBCT imaging in dental implant treatment planning and assessment. It provides details on how CBCT can be used to evaluate bone quantity and quality, anatomical structures, ridge morphology, and is recommended for pre-operative planning of sinus lift procedures. CBCT allows accurate measurements and 3D visualization to determine suitable implant size, position, and angulation without superimposition. This helps optimize implant placement and outcomes.
This document presents an overview of recent advances in periodontal drug delivery systems. It discusses various drug delivery systems used to treat periodontitis including fibers, strips, films, gels, microparticles, nanoparticles, liposomes, low dose antibiotics, and wafers. It also presents a case study on developing metronidazole-loaded electrospun polycaprolactone nanofibers as a localized drug delivery system for periodontitis. Advanced drug delivery systems can play an important role in treating periodontitis more effectively and conveniently by enhancing drug targeting and patient compliance.
Videocephalometry/certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Estimation of tertiary dentin thickness on pulp capping treatment with digita...IJECEIAES
Dentists usually observe the tertiary dentin formation after pulp capping treatment by comparing periapical radiograph before and after treatment visually. However many dentists find difficulties to observe tertiary dentin and also they can‟t measure exactly the thickness of the tertiary dentin. The aims of this study is to assist the dentists to measure the area of tertiary dentin and calculate the dentin formation using b-spline image processing. The dental radiograph of 38 patients of pulp capping in the Dental Hospital Universitas Muhammadiyah Yogyakarta, Indonesia. Each of patient visited dental hospital 3 times. First, the patient got an application of pulp capping material. Second, after one-week treatment and temporary restoration and the third, after more than one month with the composite as the final restoration. Every visited the patient take a radiograph. Dentist placed the dot from the patient's radiograph. The dots were combined and processed with digital image processing. The b-spline method changed the dot to one area. After the calculation, the dentist can see whether there was dentin formation which means it is one of the treatment success indicators. Dentist has the better view to measure the dentin formation by providing area value of its tertiary dentin thickness calculation. We compare the result to the program calculation using the b-spline method and visual observation from the dentist. This study indicated the thickness of tertiary dentin can be measured by this program with an accuracy of 94.2%. Therefore, dentist can make tertiary dentin thickness prediction from patient‟s radiograph.
Diagnostic imaging /certified fixed orthodontic courses by Indian dental acad...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
CBCT imaging allows for more accurate implant planning compared to traditional 2D radiographs. It provides 3D views of the bone that are crucial for determining implant placement and potential augmentation procedures. For a patient with severe maxillary resorption, CBCT revealed thin bone in the premaxilla requiring grafting and sufficient bone in the molar region but requiring sinus lifts. Implants were successfully placed following the CBCT-based treatment plan with grafts and have sufficient bone support and integration.
Tiwari R, Chakravarthi PS, Kattimani VS, Lingamaneni KP. A Perioral Soft Tissue evaluation after Orthognathic Surgery Using Three-Dimensional Computed Tomography Scan. The Open Dentistry Journal. 2018; 12:366-376. doi:10.2174/1874210601812010366.
Cephalometrics history, evolution, and land marks/orthodontic courses by indi...Indian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
O documento apresenta um caso clínico de um paciente de 20 anos que sofreu um acidente de trânsito e apresenta mobilidade dentária e dor no dente 21. A tomografia computadorizada cônica mostra uma intrusão do dente 21 com inclinação para a palato e aumento do espaço peri-cementário.
Adult orthodontics /certified fixed orthodontic courses by Indian dental acad...Indian dental academy
The document discusses various aspects of adult orthodontics including biological concepts related to orthodontic treatment in adults, differences between adolescent and adult orthodontic treatment, classifications of adult orthodontic treatment, types of adult orthodontic treatment including adjunctive and comprehensive orthodontics, and case examples. It provides details on topics such as periodontal ligament changes with age, bone changes, tooth changes, objectives of adult orthodontic treatment, and techniques for procedures like molar uprighting, forced eruption, and anterior tooth alignment.
Adult orthodontics /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Orthodontic treatment modalities include preventive, interceptive, and corrective orthodontics as well as orthognathic surgery. Preventive orthodontics aims to preserve normal occlusion and includes procedures such as space maintainers. Interceptive orthodontics provides early treatment of developing malocclusions through methods like serial extraction. Corrective orthodontics utilizes fixed or removable appliances to fully treat malocclusions and can include orthognathic surgery to correct severe jaw discrepancies.
CBCT has many uses in orthodontics including for impacted teeth, root resorption, and boundary conditions. It provides more accurate 3D information than 2D imaging. CBCT is particularly useful for impacted or transposed teeth to localize them, for root resorption diagnosis, and to understand boundary conditions that may impact treatment planning. CBCT also has applications for craniofacial anomalies, TMJ assessment, and orthognathic surgery planning by providing detailed 3D visualization of structures.
Dental CBCT Evidence Based Guideline 2012 European CommissionNeil Pande
This document provides guidelines for the use of CBCT (cone beam computed tomography) in dentistry based on a 2012 European Union report. It justifies CBCT use on a case-by-case basis by demonstrating benefits outweigh risks. Guidelines are provided for specific clinical scenarios like impacted teeth, orthodontics, endodontics, implants and more. It also outlines protocols to reduce patient radiation dose and ensure quality assurance, staff protection and training.
Components of removable partial denture prosthesis /certified fixed orthodont...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
This document discusses how technology can be used to improve endodontic treatment and restorations. It describes how a dental operating microscope, cone beam computed tomography (CBCT), and CAD/CAM technology allow dentists to perform endodontic treatment and place a restoration in a single visit. The microscope enhances visibility during root canal treatment, while CBCT provides additional diagnostic information. CAD/CAM technology enables same-day fabrication of ceramic restorations with digital impressions. The document provides examples of cases where these technologies were used together from initial endodontic treatment through final restoration.
This article reviews the clinical applications of cone beam computed tomography (CBCT) in dentistry as described in 129 peer-reviewed publications from 1998 to 2010. The literature review found that CBCT has been used for oral and maxillofacial surgery, endodontics, implant dentistry, orthodontics, temporomandibular joint disorders, periodontics, and forensic dentistry. Specifically, CBCT provides advantages over 2D imaging such as a lack of superimposition, accurate measurements, and 3D visualization which has made it useful for applications like dental trauma assessment, implant planning, endodontic diagnosis, and orthognathic surgery planning.
1. This study compared apical root resorption between patients treated with fixed orthodontic appliances versus clear aligners using CBCT scans. 30 patients were divided into 3 groups: fixed appliances, clear aligners, and clear aligners with low-level laser.
2. Root volumes were measured before and after treatment using Mimics software by segmenting the lower incisor roots from CBCT scans.
3. Preliminary results found that root resorption accompanied by aligners was less than fixed appliances, however the difference was not statistically significant. Use of low-level laser also did not reduce root resorption.
CBCT provides high resolution 3D imaging of the maxillofacial region using a low radiation cone-shaped x-ray beam. It acquires full volume data in a single 10 second scan, allowing visualization of hard and some soft tissues from multiple angles. CBCT has numerous applications in dentistry due to its improved accuracy over 2D imaging such as panoramic x-rays. It is useful for implant planning, maxillofacial surgery, orthodontics, temporomandibular joint assessment, trauma cases, and oral pathology diagnosis.
Visualized Treatment Objective (VTO) is a method of orthodontic treatment planning that involves predicting craniofacial growth and tooth movement over the course of treatment. It establishes an "ideal" facial profile and dental arrangement as the treatment goal. Templates and cephalometric analysis are used to predict growth and reposition teeth and soft tissues graphically. VTO helps determine if extractions are needed, which teeth to extract, and guides mechanics to achieve the treatment objectives. Its advantages include establishing clear goals, formulating a specific treatment plan, and allowing for mid-course corrections.
Evaluating spatial and frequency domain enhancement techniques on dental imag...IJECEIAES
Dental imaging provides the patient's anatomical details for the dental implant based on the maxillofacial structure and the two-dimensional geometric projection, helping clinical experts decide whether the implant surgery is suitable for a particular patient. Dental images often suffer from problems associated with random noise and low contrast factors, which need effective preprocessing operations. However, each enhancement technique comes with some advantages and limitations. Therefore, choosing a suitable image enhancement method always a difficult task. In this paper, a universal framework is proposed that integrates the functionality of various enhancement mechanisms so that dentists can select a suitable method of their own choice to improve the quality of dental image for the implant procedure. The proposed framework evaluates the effectiveness of both frequency domain enhancement and spatial domain enhancement techniques on dental images. The selection of the best enhancement method further depends on the output image perceptibility responses, peak signal-to-noise ratio (PSNR), and sharpness. The proposed framework offers a flexible and scalable approach to the dental expert to perform enhancement of a dental image according to visual image features and different enhancement requirements.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
CBCT stands for cone beam computed tomography. It is a 3D imaging technique that uses a cone-shaped X-ray beam to capture volumetric images of the teeth, jaws, and surrounding structures. CBCT provides more detailed views than conventional 2D X-rays and exposes patients to less radiation than traditional medical CT scans. It has various applications in dentistry, including implant planning, endodontics, surgery, and orthodontics by allowing visualization of hard tissues and their relationship to anatomical structures.
This study analyzed the position and angulation of 300 maxillary central incisors using cone beam imaging to provide data to help clinicians achieve good esthetic results for immediate dental implants. The thickness of buccal and palatal bone and apical bone height were measured. Incisors were classified according to their position (buccal, midline, palatal) and angulation (toward buccal, anterior to A point, parallel to alveolus). Most incisors were positioned buccally. Recommendations for implant placement based on tooth classification aim to maintain adequate buccal bone thickness and prevent complications.
CBCT has become an important tool in clinical orthodontics for providing 3D information. It was developed due to increasing demand for 3D data from conventional CT scans. This article discusses CBCT technology and its various uses in orthodontics such as detection of facial asymmetry, assessment of mandibular shape and growth, localization of impacted teeth, evaluation of root resorption and airway changes. CBCT allows more accurate diagnosis and treatment planning compared to 2D radiographs and has largely replaced conventional records in digital orthodontic records.
Dental CT_ Third Eye in Dental Implants ( PDFDrive ).pdfShounakGhosh10
This document provides an overview of the use of dental CT, or cone-beam CT, in dental implant planning and placement. It contains chapters on the history and working of dental CT, anatomical landmarks visible on dental CT images, and the use of dental CT specifically for implantology. The document serves as an introductory textbook on this important imaging modality for dental applications such as implant planning and assessment of anatomical structures.
This document discusses diagnostic aids used in implant dentistry. It begins with an introduction and history of diagnostic aids, highlighting the advances in dental imaging over time. It then covers various diagnostic tools used in implant planning including case history, dental casts, photographs, radiographs, and computed tomography (CT). Specifically, it details different types of radiographs like panoramic, cephalometric, and CT imaging. It emphasizes the importance of a thorough medical history and radiographic evaluation in implant treatment planning to assess bone quality and quantity at potential implant sites. In conclusion, using diagnostic aids helps obtain important information for accurate presurgical implant planning and placement.
This document describes a case study of a 28-year old female patient who underwent full-mouth dental implant rehabilitation using a flapless surgical technique with computer-assisted planning. The patient had lost all her teeth due to aggressive periodontal disease, resulting in severe bone loss. A total of 13 dental implants were placed in both jaws using CT-based planning and surgical guides. Immediate loading of the implants was done, and the patient received maxillary and mandibular implant-supported fixed dentures. The CT-based planning and surgical guides helped ensure accurate placement of the implants flapless, and resulted in a successful treatment outcome for the patient.
Cephalometric analysis has evolved from traditional 2D radiographs to 3D digital techniques. Broadbent is considered the father of radiographic cephalometry for developing the technique in 1937. While conventional cephalometry is useful for diagnosis, treatment planning and evaluation, it has disadvantages like errors and manual processing. Photocephalometry introduced in 1970s allowed measuring soft tissue changes but was complex. Digital cephalometry since 1980s has advantages like dose reduction and storage. 3D modeling using CT, stereophotogrammetry and laser scans now allows accurate anatomical models for pre-operative simulation and custom implants. Stereolithography is used to produce 3D printed models but has limitations of cost and radiation dose. 3D navigation during
This document discusses the principles of cone beam computed tomography (CBCT). It describes how CBCT uses an x-ray source and detector that rotate around the patient to acquire multiple 2D projections, which are then used to reconstruct 3D volumetric images using computational algorithms. Key aspects of CBCT imaging discussed include the hardware components involved in image acquisition, technical parameters that influence image quality and radiation dose, and different scan modes available. The document emphasizes that clinicians should understand how various acquisition factors impact the diagnostic value and radiation exposure of CBCT exams.
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1. There are several methods for predicting outcomes of orthognathic surgery, including manual tracings, computer programs, and 3D modeling.
2. Accuracy of prediction varies depending on the method and software used, with 3D modeling generally providing the most accurate predictions but manual methods still common.
3. Studies have found most software to be reasonably accurate for hard tissue predictions but with more variability for soft tissues like lips and less ability to account for individual patient differences.
This document discusses the debate around whether orthodontists should mount dental casts on an articulator. While articulators are useful for other dental specialties, their validity in orthodontics is equivocal. Supporters argue that articulators allow detection of minor occlusal discrepancies and aid in achieving ideal condyle position. However, others argue that articulators are unnecessary given tolerance for occlusal discrepancies and lack of evidence that they improve outcomes. The document examines evidence on both sides but ultimately argues against the routine use of articulators in orthodontics.
Digital signature of electronic dental recordsNielsen Pereira
This document discusses the use of digital signature technology to authenticate electronic dental records and provide them with the same legal validity as conventional paper records. It examines how digital signatures can be applied to each component of the electronic dental record, which may be produced by different parties. The technology guarantees authenticity by ensuring only the genuine signer could have created the signature attached to a document. While electronic records can potentially be manipulated, principles of good faith and burden of proof mean digitally signed records are assumed authentic unless proven otherwise, matching the legal standard for paper records. Widespread use of digital signatures may soon allow full implementation of this proposal to validate electronic dental records legally.
Uma paciente de 32 anos apresentou mobilidade no dente 21. Exame de tomografia computadorizada mostrou fratura radicular diagonal no dente 21, com reabsorção interna e perfuração na raiz. O relatório descreve os achados do exame realizado na paciente.
O documento descreve um caso clínico de um paciente de 44 anos com dor no dente 36. O exame de imagem CBCT mostrou que o dente 36 tinha tratamento endodôntico com reabsorção dos ápices radiculares, lesão endo-periodontal, lesão de furca e perfuração do assoalho da câmara pulpar. Também havia uma fratura transversal na raiz mesial e perfuração na raiz distal.
O documento descreve um caso de um menor de 11 anos que sofreu acidente doméstico resultando em fratura e intrusão no dente 11 e luxação no dente 21. Exames de tomografia computadorizada mostraram detalhes das lesões, incluindo fratura na borda mesial do dente 11 e aumento do espaço peri-cementário no dente 21.
This study evaluated the accuracy and reproducibility of linear measurements made on 3D digital models created with a surface laser scanner compared to direct measurements on dental casts.
Fifteen anatomic points were identified on 20 dental casts and their corresponding 3D digital models. Eleven linear measurements of arch width and length were made directly on each cast and digitally. There were no statistically significant differences found between the direct and digital measurements.
The study concluded that linear measurements of arch width and length on 3D digital models created with this particular surface laser scanner are accurate and reproducible compared to direct measurements on the original dental casts.
A new method to mesure mesiodistal angulation and faciolingual with cbctNielsen Pereira
This document describes a new method for measuring the mesiodistal angulation and faciolingual inclination of whole teeth using cone-beam computed tomography (CBCT) images. The method involves digitizing reference points on a typodont's teeth and archwires to define coordinate systems for measuring tooth angles. Measurements using this new CBCT-based method were compared to measurements from a coordinate measuring machine, showing the new method can accurately measure tooth angles. The ability to measure whole tooth angles in 3D from CBCT images could improve orthodontic diagnosis and treatment planning.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
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Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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Cbct is the imaging technique of choice for comprehensive orthodontic assesment
1. POINT/COUNTERPOINT
Cone-beam computed tomography is the
imaging technique of choice for comprehensive
orthodontic assessment
Brent E. Larson
Minneapolis, Minn
I
t is interesting to observe the adoption of new BENEFITS OF CBCT FOR ORTHODONTIC
technology in dentistry and orthodontics. Of par- ASSESSMENT
ticular interest is the use of cone-beam computed The benefits of CBCT for orthodontic assessment
tomography (CBCT) as the imaging protocol of choice include accuracy of image geometry. Clinicians have
for comprehensive orthodontic treatment. A concise learned to deal with the inherent image magnification
review of the diffusion of innovation in dentistry and distortion that is part of 2-dimensional radiogra-
was published by Parashos and Messer,1 who con- phy. With lateral cephalograms, structures on the left
cluded that the adoption of technology is affected side are magnified less than the same structures on
by factors that “include a complex interplay of per- the right because of proximity to the film. With pano-
ceived benefits and advantages, and psychosocial ramic imaging, the amounts of horizontal and vertical
and behavioral factors, in decision-making.” Lateral magnification vary at different rates as objects are dis-
and posteroanterior cephalograms were introduced placed from the focal trough. However, CBCT offers the
to orthodontics in the early 1930s by Broadbent; distinct advantage of 1:1 geometry, which allows accu-
yet, adoption of this technology, which is an ac- rate measurements of objects and dimensions. The ac-
cepted standard today, was still being resisted when curacy and reliability of measurements from CBCT
Steiner2 wrote in 1953 about the use of cephalogram images have been demonstrated, allowing precise as-
films: “It has been claimed by many that it is a tool sessment of unerupted tooth sizes, bony dimensions
of the research laboratory and that the difficulties in all 3 planes of space, and even soft-tissue anthropo-
and expense of its use in clinical practice are not jus- metric measurements—things that are all important in
tified. Many have argued that the information gained orthodontic diagnosis and treatment planning.4-6 Ad-
from cephalometric films, when used with present ditionally, to allow use of our historic growth and nor-
methods of assessment, do not contribute sufficient mative data, it has been shown that landmarks can be
information to change, or influence, their plans of located reliably on cephalometric images that are gen-
treatment.” erated from the CBCT volumes.7
Steiner’s statement could easily be applied to the Other benefits include the localization of ectopic
use of CBCT today. A recent review suggested that teeth and the assessment of root resorption. The
CBCT should be used as an adjunct imaging technique accurate localization of ectopic, impacted, and super-
in orthodontics.3 I propose that, although we still have numerary teeth is vital to the development of a pa-
much to learn about how to best use CBCT imaging to tient-specific treatment plan with the best chance of
improve the outcomes of orthodontic treatment, we success. There seems to be little debate in the literature
know enough about its application to consider it the that CBCT is superior for localization compared
imaging of choice for comprehensive orthodontic with conventional imaging methods.8,9 One study indi-
treatment. cated that this improved localization and space estima-
tion does result in changes in diagnosis and treatment
recommendations.10 Another study analyzed the
Associate professor and director, Division of Orthodontics, University of
Minnesota, Minneapolis.
“failed” treatment of 37 impacted canines, successfully
Reprint requests to: Brent E. Larson, Division of Orthodontics, University delivering the canine in about 70% of these cases be-
of Minnesota, 6-320 Moos Tower, 515 Delaware St SE, Minneapolis, cause of careful diagnosis and 3-dimensional imaging.
MN 55455; e-mail, larso121@umn.edu.
Am J Orthod Dentofacial Orthop 2012;141:402-11
Initially, failure occurred because of mistaken localiza-
0889-5406/$36.00 tion and directional traction in 40.5% of the patients. 11
Copyright Ó 2012 by the American Association of Orthodontists. There is also increasing evidence that assessment of
doi:10.1016/j.ajodo.2012.02.009
402
2. 404 Point
root resorption, both from ectopically erupting teeth has primary biologic importance and that significant
and as a side effect of orthodontic treatment, can postural adaptations to airway problems can cause un-
best be done with CBCT, since much resorption occurs desirable growth changes. This is another item that was
in a slanted direction that is not readily imaged without frequently noted by the radiologist in our study of inci-
the use of a tomographic technique.12 dental findings in orthodontic patients. Nearly half our
In orthodontics, an asymmetric malocclusion is one patient population had sinus or airway findings noted,
of the most difficult problems to diagnose and treat. ranging from relatively minor sinusitis or polyps to
Before CBCT, the skeletal and dental contributions to complete opacification of the maxillary sinuses. 18
the problem were assessed from clinical examinations, The need to assess the periodontal bone levels be-
study models, and perhaps a posteroanterior cephalo- fore orthodontic treatment has always been important
gram. Although these provided meaningful insight for and has been emphasized with the American Board of
a diagnosis, the CBCT volume allows direct measure- Orthodontics’ requirement to include a formal peri-
ment of the transverse dimensions and the relative po- odontal evaluation for all patients over the age of 18
sitions of the teeth within the skeletal components, and years or for those with signs of periodontal disease.
has been judged to be supe- Imaging suggestions for this
rior to previous methods.13 evaluation include a pano-
We recently conducted a study Although we still have much to learn ramic image supplemented
using CBCT to objectively as- about how to best use CBCT with bitewing and anterior
sess asymmetry and found imaging to improve the outcomes of periapical radiographs, or
that this method is potentially a full-mouth series of radio-
orthodontic treatment, we know
useful for clinicians.14 graphs including periapicals
Imaging of the temporo- enough about its application to and bitewings, or images
mandibular joint has not consider it the imaging of choice for taken from a CBCT volume.22
been common practice for comprehensive orthodontic The first 2 are supplemental
asymptomatic orthodontic treatment. images that require additional
patients. The view of the con- exposure, whereas the images
dyle and the fossa on a pano- from the CBCT are recon-
ramic film has been used as a screening tool with structed as needed from the acquired volume with no
subsequent specific imaging ordered for the temporo- additional exposure required. Misch et al23 reported
mandibular joint if bony changes are noted. The that CBCT imaging provides a significant advantage
CBCT volume used for orthodontic assessment will over conventional radiographs for periodontal assess-
generally include the right and left temporomandibular ment because it allows for the measurement of buccal
joints, and therefore they are available for routine re- and lingual defects as well as interproximal defects.
view. The orthodontist can screen for bony changes Other investigators have also found that CBCT-
and get an indication of condylar position from this re- derived images offer advantages for periodontal assess-
view.15-17 A recent review of nearly 200 consecutive or- ment.24,25
thodontic patients at the University of Minnesota A truly unexpected result from our study of CBCT
showed that 18% had incidental temporomandibular incidental findings in orthodontic patients was the
joint findings noted by a radiologist that were signifi- 10% frequency of significant endodontic findings: api-
cant enough for further follow-up or referral.18 A sim- cal periodontitis, apical radiolucency, internal or exter-
ilar result for incidental temporomandibular joint nal root resorption, or retained root tips.18 These are
findings was reported by researchers in North Carolina important items to assess before final orthodontic
in an older, nonorthodontic population.19 planning—items that could dramatically alter the treat-
Traditional 2-dimensional cephalometric imaging ment plan. I was convinced that this high degree of
has been limited in its ability to assess airway dimen- endodontic involvement was most likely a statistical
sions, and our view of the sinuses has been limited to anomaly since it did not correspond with my clinical
the tomographic slice on the panoramic image. With experience; however, Price et al19 recently reported
CBCT imaging, 3-dimensional views of the airway and a similar prevalence of endodontic findings in a differ-
the sinuses are clearly visible and measurable. 20,21 Al- ent population, lending additional support to the
though as a specialty we still struggle to understand result.
the impact of the airway on the growth and develop- Recent reports have suggested that certain regions
ment of our patients, we all understand that breathing are more desirable as placement sites for temporary
April 2012 Vol 141 Issue 4 American Journal of Orthodontics and Dentofacial Orthopedics
3. 406 Point
skeletal anchorage devices.26-28 These recommen- various imaging protocols and machines should be
dations are based on average cortical bone thickness done by using those guidelines and not the previous
and bone depth determined from CBCT images of 1990 guidelines.
skulls or patients. Although these general recommen- The question of primary importance is the radiation
dations are helpful, they do not provide patient- burden of a CBCT image relative to a conventional lat-
specific information. When patients have CBCT eral cephalogram, a panoramic radiograph, and any
imaging as part of their initial record set, areas that supplemental films that are required. To answer this
might be considered as placement sites for temporary question specifically for our facilities at the University
skeletal anchorage devices can be individually assessed of Minnesota, we conducted dosimetry testing of our
for bone quality without the cost or the inconvenience CBCT machine and our conventional 2-dimensional
of additional imaging. digital radiography equipment. We found that the
In addition to the items listed above, there are re- CBCT imaging normally used for comprehensive ortho-
ports that suggest future benefits of CBCT imaging dontic patients was about 65 mSv compared with about
related to risk management. The bone density mea- 26 mSv for a lateral cephalogram and a panoramic
sured on CT imaging has been correlated with the image taken on our digital machine.33 Subsequent to
risk of neurosensory disturbance after sagittal split our testing, a new low-dose scan protocol has been
mandibular advancement.29 Although 1 limitation of added to the CBCT machine that provides the needed
CBCT is that bone density in Hounsfield units is not orthodontic diagnostic information for an estimated
as standardized as medical computed tomography, 35 to 40 mSv (based on our data adjusted for reduced
the use of fractal dimension analysis of CBCT images milliampere-second exposure).
has recently been described as a promising tool for These rapid advances in CBCT technology have re-
detecting bone changes caused by bisphosphonates.30 sulted in 3-dimensional images that have about 2%
Recently, the fabrication of custom lingual ortho- or less of annual background radiation, with only
dontic appliances has been demonstrated by using slightly more than conventional orthodontic imaging
CBCT image data with existing technology to virtually without any supplemental radiographs. 33 If full-
plan a patient’s treatment and manufacture the custom mouth intraoral radiographs are taken to assess the
appliances with 3-dimensional printing technology.31 periodontal status of adults, CBCT imaging typically re-
Such advances appear to be rapid, and promise efficient duces the patient dose.
and effective treatment that is specific for each patient. There is little published information regarding the
Orametrix (Richardson, Tex) has been using CBCT tech- financial cost of CBCT technology used for orthodon-
nology for the last several years to provide the data nec- tics. From my personal experience, the transition to
essary for planning and executing technology-assisted CBCT imaging for orthodontic assessment did not
treatment through its SureSmile system. add to the patient cost of treatment in our university
clinic or our private practice. Obviously, an investment
COSTS OF CBCT FOR ORTHODONTIC must be made in the equipment, and many practi-
ASSESSMENT tioners have difficulty justifying the return on this in-
The general argument against using CBCT as a stan- vestment, since efficiency and income are not directly
dard imaging protocol for comprehensive orthodontic affected. However, in my opinion, the confidence
treatment centers on the radiation burden to patients. gained in treatment decisions and the greater ability
Most current recommendations are that CBCT should for patients to visualize problems dramatically im-
be used as an adjunct imaging technique when con- proves my practice.
ventional 2-dimensional imaging proves to be inade-
quate. Comparison of effective radiation dose levels is CONCLUSIONS
difficult because of the many CBCT machines now The assessment of available information, as well as
available and the fact that new scanning protocols my clinical experience, has led me to believe that CBCT
for the machines are constantly being implemented imaging for comprehensive orthodontic patients has
based on software modifications. In addition, the Inter- substantial advantages. The ability to measure accu-
national Commission on Radiological Protection re- rately, improve localization, identify and quantify
leased updated guidelines in 2007 that added salivary asymmetry, visualize airway abnormalities, assess peri-
glands, oral mucosa, and airway tissues to the dose odontal structures, identify endodontic problems, view
equation, and this raised effective dose calculations condylar positions and temporomandibular joint bony
from 32% to 422%.32 Therefore, comparisons of structures, and plan placement sites for temporary
April 2012 Vol 141 Issue 4 American Journal of Orthodontics and Dentofacial Orthopedics
4. 408 Point
skeletal anchorage devices adds to the practitioner’s 6. Lagravere MO, Carey J, Toogood RW, Major PW. Three-dimen-
knowledge base at the time of orthodontic diagnosis. sional accuracy of measurements made with software on cone-
beam computed tomography images. Am J Orthod Dentofacial
Looking forward, CBCT might help us with risk assess-
Orthop 2008;134:112-6.
ment by assessing bone density, visualizing root 7. Chang ZC, Hu FC, Lai E, Yao CC, Chen MH, Chen YJ. Landmark
proximity and resorption, and even providing the imag- identification errors on cone-beam computed tomography-
ing data to support treatment simulation and derived cephalograms and conventional digital cephalograms.
technology-aided treatment. Am J Orthod Dentofacial Orthop 2011;140:e289-97.
8. Becker A, Chaushu S, Casap-Caspi N. Cone-beam computed to-
All of these advantages are currently available with
mography and the orthosurgical management of impacted teeth.
little increase in radiation dose relative to a modern J Am Dent Assoc 2010;141(Suppl 3):14-8S.
digital panoramic and single cephalometric film. In 9. Alqerban A, Jacobs R, Fieuws S, Willems G. Comparison of two
fact, compared with the standard record set I used 15 cone beam computed tomographic systems versus panoramic
years ago (lateral and posteroanterior cephalograms, imaging for localization of impacted maxillary canines and de-
tection of root resorption. Eur J Orthod 2011;33:93-102.
panoramic film, and full-mouth set of radiographs
10. Botticelli S, Verna C, Cattaneo PM, Heidmann J, Melsen B. Two-
with round collimation), the radiation burden of a sin- versus three-dimensional imaging in subjects with unerupted
gle CBCT image represents more than an 80% reduc- maxillary canines. Eur J Orthod 2011;33:344-9.
tion in dose—a remarkable technologic achievement! 11. Becker A, Chaushu G, Chaushu S. Analysis of failure in the treat-
According to the writings of Steiner2 in 1953, he chal- ment of impacted maxillary canines. Am J Orthod Dentofacial
Orthop 2010;137:743-54.
lenged orthodontists with the following words: “The
12. Alqerban A, Jacobs R, Fieuws S, Nackaerts O, , SEDENTEXCT Pro-
cephalometer is here to stay, and those of you who are ject Consortium, Willems G. Comparison of 6 cone-beam com-
not using cephalometrics in your everyday clinical prac- puted tomography systems for image quality and detection of
tices must soon bow to its importance, accept the added simulated canine impaction-induced external root resorption in
burden it imposes, and master its mysteries if you are to maxillary lateral incisors. Am J Orthod Dentofacial Orthop
2011;140:e129-39.
discharge your full obligation to your patients.”
13. Damstra J, Fourie Z, Ren Y. Evaluation and comparison of
If you substitute CBCT for cephalometer and ceph- postero-anterior cephalograms and cone-beam computed to-
alometrics in Steiner’s comment, it would summarize mography images for the detection of mandibular asymmetry.
my feelings on the adoption of this technology in or- Eur J Orthod 2011 Mar 31 [Epub ahead of print].
thodontics. With the understanding that each patient 14. Sievers MM, Larson BE, Gaillard PR, Wey A. Asymmetry assess-
ment using cone-beam CT A Class I and Class II patient compar-
is assessed before imaging and that patient-specific im-
ison. Angle Orthod 2011 Oct 6 [Epub ahead of print].
aging decisions are made, CBCT has replaced conven- 15. Alkhader M, Kuribayashi A, Ohbayashi N, Nakamura S,
tional lateral cephalograms and panoramic images as Kurabayashi T. Usefulness of cone beam computed tomography
the most commonly ordered imaging for comprehen- in temporomandibular joints with soft tissue pathology. Dento-
sive orthodontic patients, in both our university clinic maxillofac Radiol 2010;39:343-8.
16. Cevidanes LH, Hajati AK, Paniagua B, Lim PF, Walker DG,
and my private practice. Although better scientific evi-
Palconet G, et al. Quantification of condylar resorption in tempo-
dence of improved outcomes is desired, I truly believe romandibular joint osteoarthritis. Oral Surg Oral Med Oral Pathol
its use results in better patient care. Oral Radiol Endod 2010;110:110-7.
17. Chandrasekhara D, Tahir F, Kaliaperumal G, Balasubramanian S.
A protocol for evaluating condylar position in symptomatic TMD
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