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Fabio Gorni

CBCT: The dark side of the moon

7335 Views - Apr 2016

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Why guessing what we could see?
In comparison with the 2D imaging, 3D technology allows a safer and faster diagnostic process. Analysing the articles related to CBCT technology published in the Literature from 1998 to nowadays, only the 16,3% of papers deals with implantology.
More than the 25% of the studies written from 1998 and dealing with CBCT is about surgery and another 25% is about endodontics, the 11% focuses on orthodontics, while the 4,6% analyses the TMJ. For a correct diagnosis in endo we need a CBCT with an high resolution. Resolution represents the ability to discriminate the smallest particular of an image.
The higher the resolution, the smaller is the thickness of sections and, then, the greater is the possibility to recognize small-size details.
The resolution of a bidimensional image is measured in pixels, the one of a tridimensional image is expressed in voxels.
Which is the relationship between resolution and FOV?
Keeping the FOV constant, high resolution implicates large files and greater doses of X-rays. Generally, it is preferred to associate a small FOV to the best resolution obtainable with each machine.
The CT (“Computed Tomography”) uses a fan beam and a linear sensor that are turned around the patient repeatedly in order to obtain an axial set of sections.
CBCT uses a conical beam and a square sensor in order to acquire a full volume with a single rotation around the patient.

Why does CT emit many more radiations than CBCT?
The dosimetric difference between CT and CBCT depends on their different principle of functioning, contained in the acronym that describes them.
To keep it simple, we could say that CBCT is a conical beam CT that, in a single rotation, is able to acquire all the required volume. From this comes a shorter exposure time, with less radiation absorption.



Img. 1 - The superposition of structures makes it impossible to see the amputation of the buccal root in the 2D image, while it is clearly evidenced in the CBCT
Img. 2 - The presence of an untreated root canal system sustaining the lesion can be found out thanks to the 3D imaging
Img. 3 - The 2D radiograph shows a tooth without any problem, but the patient refers pain. The CBCT permits to see the lesion on the medial root of the molar.
Img. 4 - The 3D image allows seeing the cyst on the central incisor.
Img. 5 - Partial fracture of the root, totally invisible in the normal x-ray
Img. 6 - A huge lesion evidenced thanks to the CBCT has a completely different appearance in the periodical x-ray
Img. 7 - The bidimensional exam does not show the presence of a vertical root fracture which can be seen in the CBCT.
Img. 8 - The complex anatomy of the tooth can be evidence pre-operatively thanks to the CBCT.
Img. 9 - The CBCT helps positioning the lesion in the three dimensions of the space and permits a safer treatment planning. In this case the planning switched from surgery to non surgical pretreatment.
Img. 10 - The size of the lesion cannot be discriminated in the 2D Rx.
Img. 11 - The buccal perforation disappears in the periodical radiographs.

Conclusions


Conclusions

The use of the Cone Beam technology is useful in the endodontics especially in the diagnostic phase and in the decision making process.

Benefits for the profession:
A) Diagnosis:
  • Seeing over superpositions and distortions.

  • Even the most detailed and contrasted 2D image has limits linked to the superposition and distorsion of anatomical structures.

B) Planning:
  • Minimize the risk of unexpected events.

  • Nothing is worse than being caught unprepared while performing a therapy that was considered simple.

C) Communication:
  • Make the patient understand to get his consent and collaboration.

  • Communicating the therapeutic alternatives allows shortening the acceptance times and seconding the enthusiasm generated by a fast and high-quality treatment planning.
 

Bibliography


References

  1. European Society of Endodontology, S. Patel, C. Durack, F. Abella, M. Roig, H. Shemesh, P. Lambrechts and K. Lemberg. European Society of Endodontology position statement: The use of CBCT in Endodontics. Int Endod J. 2014 Jun;47(6):502-4.

  2. Patel S , Kanagasingam S , Mannocci F. Cone beam computed tomography (CBCT) in endodontics. Dent Update. 2010 Jul-Aug;37(6):373-9.

  3. S. Patel, C. Durack, F. Abella, H. Shemesh, M. Roig & K. Lemberg. Cone beam computed tomography in Endodontics – a review. Int Endod J. 2015 Jan;48(1):3-15.

  4. Estrela C, Bueno MR, Leles CR, Azevedo B, Azevedo JR. Accuracy of Cone Beam Computed Tomography and Panoramic and Periapical Radiography for Detection of Apical Periodontitis. J Endod. 2008 Mar;34(3):273-9.

  5. S. Patel, A. Dawood, T. Pitt Ford, and E. Whaites. The potential applications of cone beam computed tomography in the management of endodontic problems. Int Endod J. 2007 Oct;40(10):818-30.

  6. D'Addazio PS, Campos CN, Özcan M, Teixeira HG, Passoni RM, Carvalho AC. A comparative study between cone-beam computed tomography and periapical radiographs in the diagnosis of simulated endodontic complications. Int Endod J. 2011 Mar;44(3):218-24.

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