cbct-scan in dentistry

CONE BEAM COMPUTED TOMOGRAPHY (CBCT) IN

DENTISTRY

bsamdrg@unpad.ac.id

Comparison of X-ray Dose

Digital Digital PanoramicPanoramic

4.7 4.7 –– 14.5 14.5 µSv

PanoramicPanoramic

10 10 –– 15 15 µSv

Highest Film Highest Film PanoramicPanoramic

26 26 µSv

Full mouth seriesFull mouth series

150 150 µSv

Medical CTMedical CT

1200 1200 –– 3300 3300 µSv

● Radiation from other sources

● Daily background 8 µSv

● Commercial long haul flight

6 µSv/hr

● Lower limits occupational

exposure 20,000 µSv/yr

Cone Beam CTCone Beam CT((EPX-IMPLAEPX-IMPLA))

25 ~ 60 25 ~ 60 µSv

Dr. Sharon Brooks, Dept. of Radiology, University of MichiganDr. Stuart White, Dept. of Radiology, UCLA

Necessary of CT Diagnosis

If patients move out from the focal trough, image will be changed as extension

or reduction. There are much error in panoramic shot. - Toward to Buccal : Reduction.

- Toward to Lingual : Extension.. ReductionReduction

ExtensionExtension

Necessary of CT Diagnosis

● Insufficient bone & invisible canal from the above canal

● Insufficient bone underneath the sinus

● Bone absorption / Ridge shape

● Nasal cavity / Incisive canal / Sinus

Define Oral Anatomy11

Accurate treatment plan before surgery22

Increasing patients’ agreement of treatment plan44

● Reference from exact position of impacted teeth

33 Saving time from diagnosis to surgery

Average Distortion Maximum Distortion

3.0 mm 7.5 mm

1.0 mm 5.5 mm

0.2 mm 0.5 mm

PanoramicPanoramic

PeriapicalPeriapical

CComputedomputedTTomographyomography

Necessary of CT Diagnosis

Necessary of CT Diagnosis

Panorama : 13.5mm , 10.0mm

CT : 12.96mm, 9.60mm Exact Length

Panorama vs CT

1st : + 0.54mm

2nd : + 0.40mm

* A panorama image must revise as much as about -20% down because of the extension rate.

Bone Width Bone Quality

- +

- +

++++ ++++

PanoramicPanoramic

PeriapicalPeriapical

CComputed omputed TTomographyomography

Necessary of CT Diagnosis

1-5. Necessary of CT Diagnosis

Need to check the depth and position of mandible bone to figure out how to implant.

Looks OK with 2D on Panoramic View Looks OK with 2D on Panoramic View But you can image by using Cross Sectional View on 3D But you can image by using Cross Sectional View on 3D

Necessary of CT Diagnosis

In the view of panorama, mandible darkness is as shown cortical bone.

Therefore, even the knife edge area can be measured as same density.

Necessary of CT Diagnosis

Absorption of bone can be diagnosed by using 2D, 3D and 360˚ rotation.

SagittalSagittal 3D-Zoom3D-Zoom

AxialAxial 3D-Rotation3D-Rotation

Inf. Alveolar N. Maxillary Sinus

++ ++

+ +

++++ ++++

PanoramicPanoramic

PeriapicalPeriapical

CComputed omputed TTomographyomography

Necessary of CT Diagnosis

Necessary of CT Diagnosis

When implant operate they can measure exact length of operation area.

Actual LengthActual Length

Necessary of CT Diagnosis

Only Panoramic view is invisible because palatal bone is overlaid on the maxilla.

The position and form of the maxillary will be diagnosed as shown as 3D Image.

CT can figure it out easily,

when we use cross sectional view

It can show indefinite bone, because of maxillary cyst.

Necessary of CT Diagnosis

Incisive N. Mylohyoid ridge

- -

- -

++++ ++++

PanoramicPanoramic

PeriapicalPeriapical

CComputed omputed TTomographyomography

Necessary of CT Diagnosis

Appearances of CT Models

EPX-IMPLAEPX-IMPLA

Clinical Cases

Impacted Teeth of Mandible

Impacted Teeth of Mandible

Mandible 3rd Molar (Hard case)

Impacted Teeth of Mandible

3rd molar in the view of axial (check the root direction)It toward to Buccal side unusually

LingualLingual

BuccalBuccal

Impacted Teeth of Mandible

Check the position of 3rd molar with canal

BuccalBuccal

FacialFacial

LingualLingual

Impacted Teeth of Mandible

Coloring on the mandible canal

Impacted Teeth of Mandible

Check position of canal (Vertical, Horizontal)

What are the advantages of CT equipment

Having CT is not only modernized treatment. Also,

satisfaction of what patient

needs.

Having CT is not only modernized treatment. Also,

satisfaction of what patient

needs.

Comprehension of PatientsComprehension of Patients

Increase Acceptance RateIncrease Acceptance Rate

Enable Predictable Rx.Endodontics, Surgical Extraction

Extract or not, Periodontal Treatment

Enable Predictable Rx.Endodontics, Surgical Extraction

Extract or not, Periodontal Treatment

Happy Implant Dentistry

Increase IncomeIncrease Income

Conclusion