Clinical
the problem A clear focus on
Cone beam-computed tomography overcomes the limitations of conventional radiographs for endodontics, writes Brian Vaughan
T
he use of cone beam- computed tomography (CBCT) is rapidly increasing in dentistry to aid in diagnosis and
treatment planning for a variety of clinical situations. Implants, endodontics, oral surgery, ortho- dontics, periodontics, treatment of TMD or treatment of sleep apnoea are the main specialties in which CBCT is currently usedı
. At Boyne Dental and Implant
Clinic, as part of the relocation to new premises in October 20ı5, a Sirona XG 3D CBCT scanner was purchased. This new technology has already proved to be invaluable in the practice for the treatment of implant and endodontic patients as will be shown in a recently treated case.
Limitations of radiographs Intra-oral radiographs remain the standard imaging modality for diagnosis, managing and assessing
endodontic disease2. However,
radiographs only provide a 2D image of a 3D structure and therefore have several limitations. These include: l compression of anatomy3
as the
image is only viewed in a mesio- distal (proximal) plane and the bucco-lingual/palatal plane is not observed
l anatomical noise4 l geometric distortion4 produced
by overlying structures such as zygomatic buttress or cortical bone
, for example,
elongation of the image due to a shallow palatal vault
l temporal perspect ive as the positioning of intra- oral radiographs cannot be standardised a slight change in angulation can give a false sign that there is radiographic healing of an apical lesion5
.
Applications in endodontics CBCT overcomes the problems associated with conventional
radiographs. It is always desirable that the field of view (FOV) should be as small as possible and limited to the area of interest thus reducing the radiation exposure to the patient7
.
In endodontics this is usually 5x5cm and the use of a limited volume CBCT scanner, e.g. Sirona XG 3D, makes this achievable. As shown in Table ı, the radiation dose for a 5x5.5cm scan is comparable to between four and eight periapical radiographs. The images produced from the
CBCT are a true 3D representation of the area of interest. The lower radiation dose compared to traditional CT scanners8
and
geometric accuracy of scanned objects9,ı0
treatment planning apical surgeryıı .
makes CBCT ideal for ,
diagnosis of dento-alveolar trauma and in certain cases the diagnosis of radiolucent apical lesionsı2
The European Society of Continued »
Ireland’s Dental magazine 31
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