Sometimes The Old is Still Gold

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I am writing concerning your publication of the article by Quereshey and associates, “Applications of Cone Beam Computed Tomography in the Practice of Oral and Maxillofacial Surgery.” 1 Quereshey F. Savell T.A. Palomo J.M. Applications of cone beam computed tomography in the practice of oral and maxillofacial surgery. J Oral Maxillofac Surg. 2008; 66: 791 Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar First of all, I agree with the authors that several clinical applications for CBCT, such as diagnosis of impacted teeth, assessment of airway, and TMJ morphology, have been identified to be relatively more helpful than other diagnostic modalities. 2 Kau H. Richmond S. Palomo J.M. et al. Three-dimensional cone beam computerized tomography in orthodontics. J Orthod. 2005; 32: 282 Crossref PubMed Scopus (211) Google Scholar For diagnostic purposes, the lack of high precision in landmark identification does not seem to be as important as in practice as it is in research because the ability to reliably identify landmarks in the maxillofacial region before and after a specific study is of significant importance since the research results will have an impact on the effectiveness of treatment modalities and outcomes. It is interesting to note that the accuracy results obtained with CBCT in the study by Lascala et al 3 Lascala C.A. Panella J. Marques M.M. Analysis of the accuracy of linear measurements obtained by cone beam computed tomography (CBCT-NewTom). Dentomaxillofac Radiol. 2004; 33: 291 Crossref PubMed Scopus (380) Google Scholar have shown to be far different from the study results using spiral CT. 4 Cavalcanti M.G. Rocha S.S. Vannier M.W. Craniofacial measurements based on 3D-CT volume rendering: Implications for clinical applications. Dentomaxillofac Radiol. 2004; 33: 170 Crossref PubMed Scopus (143) Google Scholar Spiral CT has been in use since late 1970, and researchers and clinicians have gained much experience and knowledge working with spiral CT using different parameters, while software for manipulating spiral CT images and 3-dimensional reformatting is quite helpful for the clinicians throughout the globe. Unlike spiral CT, CBCT is a relatively new imaging technique for the maxillofacial region, where the most effective scanning protocol is still being researched. A study by Marmulla et al 5 Marmulla R. Wörtch R. Mühling J. et al. Geometric accuracy of the NewTom 9000 cone beam CT. Dentomaxillofac Radiol. 2005; 34: 28 Crossref PubMed Scopus (162) Google Scholar using CBCT on a 12 × 12 × 12 cm phantom geometric cube has shown an absolute measurement error of 0.13 mm and a standard deviation of 0.09 mm. Considering the fact that CBCT cuts are as fine as 0.3 mm, this would suggest that the potential for far more improved measurement accuracy exists when CBCT is compared with medical CT. Further research regarding accuracy of the CBCT units will be required. Software tools for accurate identification of anatomic structures and quantitative measurements and software to facilitate segmentation of anatomic areas of interests in individual slice sections for volumetric measures must be developed and refined. 6 Lou L. Lagravere M.O. Compton S. et al. Accuracy of measurements and reliability of landmark identification with computed tomography (CT) techniques in the maxillofacial area A systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 10: 1016 Google Scholar For me, an oral and maxillofacial surgeon practicing in this part of the world, though accepting the CBCT advantage of lower radiation received by the patient, the conventional CT and its features remain the “gold standard.”