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