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Dental CBCT benefits diagnosis – Dr Boota Uhbi

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  Posted by: The Probe      8th March 2019

All dental professionals will be aware that CT scanning provides more thorough diagnostic imaging than regular dental X-rays. However, the radiation exposure is substantially higher as well. Cone Beam CT (CBCT) was developed with the intent of producing similarly high detail imagery, but in a more localised way and with a greatly reduced radiation dose. Whereas traditional CT utilises a high power, rotating anode X-ray tube, CBCT employs a low-power medical fluoroscopy tube. Unlike conventional CT which takes overlapping “slices”, CBCT – as the name suggests – produces a cone-shaped beam to capture the required volume in a single pass. This makes the technology ideal for diagnosing issues in the dental, maxillofacial ear, nose and throat regions.[i]While not quite as sensitive as MRI, the technology is regarded as very viable for this purpose.[ii]

The primary uses of CBCT within dentistry include diagnosis, planning surgeries and implant treatments. While the technology is impressive, a skilled clinician is of course still required to properly examine and evaluate the imagery. CBCT produces 3D images, which can reveal anatomical features that would otherwise be difficult or impossible to discern from 2D X-rays. Two areas where CBCT can be particularly useful is in identifying the thickness of bone at proposed implant sites and accurately mapping the tooth root morphology. Research has shown CBCT detects significantly more periapical lesions and root canals than both single and parallax periapical radiographs.[iii]

CBCT scanning can play a very helpful role in the early diagnosis of maxillary sinus abnormalities and pathologies, which allows for earlier treatment or, where a contraindication is revealed, a potentially invaluable warning. The proximity of dental roots to the maxillary sinus has been shown to make them almost twice as prone to disease as other sinuses.[iv]Even the roots of healthy teeth can provoke an inflammatory response in the sinus membrane and it is believed (though not conclusively proven) that dental procedures may exacerbate this irritation.[v]

CBCT can often reveal asymptomatic sinus pathologies, the prevalence of which has been found to be quite high in orthodontic patients (study findings vary but indicate that around half or more patients are affected).[vi]Frequently occurring abnormalities that can be revealed by CBCT are: mucosal thickening, polyps, sinus size variations, opacification of the sinus, trapped bubbles and retention cysts.[vii]Sinus abnormalities do not necessarily indicate disease, but the volume captured during CBCT imaging can be very useful in the early detection of developing problems in asymptomatic patients.[viii]While there is debate over whether and to what degree periodontal issues cause or exacerbate the above issues and subclinical ear, nose and throat complaints, there is evidence that treating unhealthy teeth can alleviate some of these symptoms, such as sinus membrane thickening.[ix],[x]

The 3D imagery produced by CBCT facilitates more accurate diagnoses. For example, periapical lesions caused by necrotic dental pulp are one of the most common ailments found in alveolar bone after periapical cysts and granulomas. These can often be misdiagnosed resulting in unnecessary surgical interventions instead of non-surgical root canal therapy. CBCT provides a better view of the root morphology, which makes diagnosing this pathology and those like it easier and more accurate.[xi]Likewise, CBCT has been shown to be very helpful in treating dentigerous cysts, a commonly occurring pathology caused by fluid build up from impacted teeth. Because CBCT offers a more precise view of such cysts and the surrounding tissue from multiple viewing angles, surgeons can gain a much more accurate insight into the area in order to better avoid complications.[xii]

The 3D imagery produced can also be used for treatment planning and the fabrication of implant guides, with some immediate placement prosthetic systems dependent on the use of CBCT. For surgical guide fabrication specifically, lower resolution scans may be more efficient both in terms of radiation dose and in avoiding the addition of unnecessary noise to the data.[xiii]

If you feel your patient would benefit from the advanced diagnostic capabilities provided by CBCT but do not possess the technology, consider referring them to Birmingham Periodontal and Implant Centre (BPI Dental). The team can handle complex cases and possess an advanced CBCT machine calibrated specifically for dental use. The scans are taken with the patient sitting upright, as the scanner pans around them completing its work in under 23 seconds, so even for patients inclined to claustrophobia or anxiety, there should little if any disquiet.

CBCT scanning can make a real difference in patient care. High quality 3D diagnostic imagery makes identifying pathologies and potential complications far more achievable and reliable, facilitating better patient care especially in more complex cases.

 

For more information on the referral services available from Birmingham Periodontal & Implant (BPI) Dental, visit www.bpidental.co.uk,

call 0121 427 3210 or email info@bpidental.co.uk

 

 

REFERENCES

[i]Bulard R., Clampet L., Bruning H., Ultra cone beam CT imaging. Dentistry iQ.2005. Link: https://www.dentistryiq.com/articles/dem/print/volume-10/issue-4/focus/ultra-cone-beam-ct-imaging.htmlAccessed November 22, 2018.

[ii]Nazri M., Bux S., Tengku-Kamalden T., Ng K., Sun Z. Incidental detection of sinus mucosal abnormalities on CT and MRI imaging of the head. Quantitative Imaging in Medicine and Surgery.2013; 3(2): 82-88. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636478/Accessed November 16, 2018. 

[iii]Davies A., Mannocci F., Mitchell P., Andiappan M., Patel S. The detection of periapical pathoses in root filled teeth using single and parallax periapical radiographs versus cone beam computed tomography – a clinical study. International Endodontic Journal. 2014; 48(6): 582-592. Link https://www.ncbi.nlm.nih.gov/pubmed/25074727Accessed November 22, 2018.

[iv]Roque-Torres G., Ramirez-Sotelo L., de Azevedo Vaz S., de Almeida de Bóscolo S., Bóscolo F. Association between maxillary sinus pathologies and healthy teeth. Brazilian Journal of Otorhinolaryngology. 2016; 82(1): 33-38. Link:https://www.sciencedirect.com/science/article/pii/S180886941500227XAccessed November 16, 2018.

[v]Roque-Torres G., Ramirez-Sotelo L., de Azevedo Vaz S., de Almeida de Bóscolo S., Bóscolo F. Association between maxillary sinus pathologies and healthy teeth. Brazilian Journal of Otorhinolaryngology. 2016; 82(1): 33-38. Link:https://www.sciencedirect.com/science/article/pii/S180886941500227XAccessed November 16, 2018.

[vi]Raghav M., Karjodkar F., Sontakke S., Sansare K. Prevalence of incidental maxillary sinus pathologies in dental patients on cone-beam computed tomographic images. Contemporary Clinical Dentistry. 2014; 5(3): 361-365. Link https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147814/Accessed November 16, 2018.

[vii]Elwakeel E., Ingle E., Elkamail Y., Alfadel H., Alshehri N., Madin i, K. Maxillary sinus abnormalities detected by dental cone-beam computed tomography. Anatomy & Physiology.2017; 7(2): 252. Link https://www.omicsonline.org/open-access/maxillary-sinus-abnormalities-detected-by-dental-conebeam-computedtomography-2161-0940-1000252.php?aid=85574Accessed November 22, 2018.

[viii]Raghav M., Karjodkar F., Sontakke S., Sansare K. Prevalence of incidental maxillary sinus pathologies in dental patients on cone-beam computed tomographic images. Contemporary Clinical Dentistry. 2014; 5(3): 361-365. Link https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147814/Accessed November 16, 2018.

[ix]Berkun H., Polak D., Shapira L., Eliashar R. Association of dental and maxillary sinus pathologies with ear, nose, and throat symptoms. Oral Diseases.2017; 24(4): 650-656. Link: https://onlinelibrary.wiley.com/doi/pdf/10.1111/odi.12805Accessed November 22, 2018.

[x]Block M., Dastoury K. Prevalence of sinus membrane thickening and association with unhealthy teeth: a retrospective review of 831 consecutive patients with 1,662 cone-beam scans. Journal of Oral and Maxillofacial Surgery. 2014; 72(12): 2454-2460. Link: https://www.sciencedirect.com/science/article/pii/S027823911401101XAccessed November 22, 2018.

[xi]Gbadebo S., Akinyamoju A., Sulaiman A. Periapical pathology: comparison of clinical diagnosis and histopathological findings. Journal of the West African College of Surgeons. 2014; 4(3): 74-88. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553234/Accessed November 16, 2018.

[xii]Vidya L., Kannan R., Praveen B, Gunaseelan R., Shanmugasundaram S. Cone-beam computed tomography in the management of dentigerous cyst of the jaws: a report of two cases. The Indian Journal of Radiology & Imaging. 2013; 23(4): 342-346. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3932577/Accessed November 22, 2018.

[xiii]Jacobs R., Salmon B., Codari M., Hassan B., Bornstein M. Cone beam computed tomography in implant dentistry: recommendations for clinical use. BMC Oral Health.2018; 18: 88. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5952365/Accessed November 22, 2018.


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