Cone-beam Computed Tomography Usage Research Articles

Global cone-beam computed tomography adoption, usage and scan interpretation preferences of dentists and endodontists.

This study investigated the adoption of cone-beam computed tomography (CBCT) by dentists and endodontists around the world, including their preferences in endodontic CBCT usage. An online questionnaire surveyed dental association members in Australia and New Zealand, and endodontic association members in Australia, Britain, Canada, Italy, New Zealand and the USA, about their CBCT training history, considerations in acquisition/interpretation, access to and usage of CBCT, preferred scan interpreter, and preferred endodontic scan settings. Data were analysed with Chi-squared, independent sample t-tests, Cochran's Q and McNemar's tests. Responses from 578 endodontic specialists or postgraduates (Group E) and 185 non-endodontic dentists (Group NE) were included. Continuing professional education (CPE) was the most common source of CBCT training (69.2%). Factors considered in CBCT acquisition/interpretation included beam hardening (75.4%), radiation exposure (61.1%) and patient movement (58.3%). Group E reported higher CBCT usage (90.8%) than Group NE (45.4%, p < .001) and greater workplace access to CBCT (81.1% vs. 25.9%, p < .001). Scans were interpreted by the respondent in most workplace scans (83.3%) and externally taken scans (60.5%); Group E were significantly more likely to interpret themselves than Group NE. Small field of view (83.6%) and high resolution (86.6%) were most preferred as settings for endodontic CBCTs; Group NE were less likely to choose these settings. There were some geographic variations within Group E. CBCT training was most commonly acquired via CPE. Endodontic respondents reported very high CBCT usage and access in the workplace. There are educational implications regarding CBCT limitations, appropriate applications and interpretation.

A Survey on Cone-beam Computed Tomography Usage Among Endodontists in the United States

IntroductionThe aim of the study was to investigate the accessibility and frequency of cone-beam computed tomography (CBCT) usage and to assess the economic and logistical factors involved with its usage among active American Association of Endodontists (AAE) members, utilizing a web-based survey. MethodsA survey of 19 questions was sent to 3,071 AAE members addressing participant access to, along with financial and logistical aspects of CBCT imaging. Descriptive analysis was performed and Fisher exact test utilized to test associations between groups (P < .05). ResultsThe overall response rate was 14.7% (n = 544). Ninety-five percent of respondents (n = 486) had an in-office CBCT unit, with those graduating after the year 2000 statistically more likely to have one (P < .05). Utilization of CBCT imaging for every case was reported by 40% of providers. Eighty-nine percent reported taking the scan at the consultation visit and 20% included this charge with the consultation fee. For those who charged for the scan separately, 85% charged more than $100. Providers who paid off their unit did so within 1–2 years (41%), 3–4 years (36%), 4–5 years (12%), and 5+ years (11%). Limited field of view was utilized by 95% of respondents. Fifty-eight percent reported interpreting the scans themselves, 38% send only if pathology is expected, and 3% always send their scans to a radiologist. ConclusionsIn conclusion, accessibility and utilization of CBCT imaging among United States endodontists has increased and acquisition of this equipment has not made a long lasting financial burden on providers.

A Questionnaire of Digital Radiography and CBCT Use and Knowledge among Lithuanian Dentists.

ABSTRACTObjectivesDigital radiography is an increasingly used technology in Lithuania. However, there is no published information about using cone-beam computed tomography. The aims of this cross-sectional study performed in Lithuania were (1) to obtain information about the prevalence and accessibility of digital radiography and cone-beam computed tomography usage, and (2) to estimate dental practitioners’ knowledge about this diagnostic method and their need for education.Material and MethodsQuestionnaires consisting of 31 questions were distributed during the 2019 International Dentist Congress in Lithuania.ResultsThis study analyses the data obtained from 248 respondents. Most of the clinicians use digital radiographic methods in their practice. The institutions usually have a digital dental X-ray machine, less often a digital panoramic X-ray machine, and least often a cone-beam computed tomography (CBCT) unit. Most dental practitioners performed 1 to 10 CBCT scans per month for adult patients and the most frequent reason for its use was implantation planning. Of the practitioners, 81.7% would like to improve their CBCT knowledge and skills.ConclusionsThe number of digital X-ray machines has increased throughout the last decade. Lithuanian dental practitioners do not excessively use cone-beam computed tomography. Some concerns were raised regarding respondents’ knowledge about exposure factors and this diagnostic method’s performance for paediatric patients. Additional training should be provided to Lithuanian dental specialists.

Role of Cone-Beam Computed Tomography in the Management of Periodontal Disease.

The goal of this paper was to review the current literature surrounding the use of cone beam computed tomography (CBCT) related to the diagnosis, prognostic determination, and treatment of periodontal diseases. A literature review was completed to identify peer-reviewed articles related to CBCT and periodontics. The results were filtered to pool only articles specific to CBCT and periodontal diagnosis, prognosis, and treatment/outcomes. The articles were reviewed and findings summarized. Author’s commentary on technological advances and additional potential uses of CBCT in the field of periodontics were included. There is evidence to suggest that CBCT imaging can be more accurate in diagnosing specific periodontal defects (intrabony and furcation defects), and therefore be helpful in the prognostic determination and treatment planning. However, at this time, CBCT cannot be recommended as the standard of care. It is up to the individual clinician to use one’s own judgment as to when the additional information provided by CBCT may be beneficial, while applying the As Low As Reasonably Achievable (ALARA) principle. With continued technological advances in CBCT imaging (higher resolution, reduced imaging artifacts, lower exposure, etc.) the author’s believe that CBCT usage will become more prominent in diagnosis and treatment of periodontal diseases.

Cone-beam computed tomography usage: An alert to the field of dentistry.

Sir, Cone-beam computed tomography (CBCT) is a relatively novel technique for visualizing an individual tooth or dentition in relation to the surrounding skeletal tissues and for generating a three-dimensional image of the area to be studied.1,2 Since CBCT is extensively used in dental and maxillofacial imaging for the treatment planning of dental implants, endodontics, maxillofacial surgery, and orthodontics, it is imperative for operators and referring practitioners to comprehend the basic concepts of this imaging modality.3 Its widespread use and the fact that it involves greater radiation doses has given rise to numerous concerns regarding the rationalization and optimization of CBCT exposure, the training of CBCT operators, quality assurance for CBCT scanners, variations in image quality, differences in radiation doses in equipment made by different manufacturers, the inappropriate referral of patients for CBCT, and the need to safeguard staff from radiation exposure.4,5 Therefore, we absolutely agree with Jaju and Jaju's article6 entitled Cone-beam computed tomography: time to move from ALARA to ALADA, that is, moving from a paradigm of low as reasonably achievable to the goal of low as diagnostically acceptable. However, due to the absence of strict guidelines and the lack of experience regarding the role of CBCT in dentistry, CBCT has become an alternative to conventional radiography, including periapical, bitewing, and panoramic radiographs. The dosage delivered by CBCT results from several factors, such as the region of the jaw that is scanned, the exposure settings of the CBCT scanner, the size of the field of view (FOV), the exposure time (s), the tube current (mA), and the energy/potential (kV).7,8,9,10 Bearing in mind the greater radiation dose in comparison to conventional radiographs, it is essential that the potential benefits of CBCT outweigh the risks incurred through exposure to ionizing radiation.11 Dentists must respect their principal ethical obligation to protect patients, and therefore indications for CBCT should be justified appropriately and its usage for screening purposes alone should be strictly avoided. Essentially, CBCT should be considered as an adjunct to standard oral imaging modalities rather than as an alternative. Unfortunately, guidelines on the clinical usage of CBCT are frequently poorly presented. Prospectively, guideline development panels must aim to carry out and report their work using the AGREE II tool as a means of raising standards and avoiding bias.5 Guideline creators should be certain to bring together a multidisciplinary team of stakeholders to frame strategies. They should carry out systematic reviews and critically assess the evidence, characterize the limitations of the presented evidence, and clearly link their commendations to the evidence. Guidelines should be methodically reviewed prior to publication. Clear implementation approaches as well as tools for monitoring and clinical assessment should be presented. CBCT imaging should only be recommended by a clinician who has undergone appropriate training in CBCT radiology and exhibits an acceptable knowledge concerning the applications of CBCT, along with experience in the interpretation of CBCT images and an appreciation of the limitations of CBCT.12,13 It is imperative for dentists to know and communicate the doses and the associated risks of specific examinations to their patients and referring practitioners. The American Dental Association Council on Scientific Affairs Council has encouraged CBCT operators to contribute to continuing education courses in order to ensure that practitioners have a satisfactory understanding of radiation safety in the dental care setting.14 Although the danger from dentomaxillofacial imaging is not especially high for an individual, when multiplied by the enormous number of patients who are exposed to diagnostic imaging, the radiation hazard becomes a noteworthy public health issue. As imaging experts, we should educate our coworkers about the difference in risk between diagnostically acceptable and attractive pictures.6 Since CBCT is a fundamental tool in innovative advanced dentistry, we strongly feel it must be taught rigorously in the undergraduate dental curriculum. Such a step forward will enrich the knowledge of our young graduates, enabling them to correctly understand its implications and its appropriate usage.

Trends in maxillofacial cone-beam computed tomography usage

Cone-beam computed tomography (CBCT) is making inroads into dental practice worldwide, both in terms of adding the third dimension to diagnosis, and also in terms of enabling image-guided treatment strategies. This article reports trends in the early referral pattern of patients to a CBCT facility in the United States. With institutional review board approval, a retrospective study was made of sequential CBCT radiographic reports made by a specialist oral and maxillofacial radiology service from May 2004 through January 2006 (n = 329). Demographic and referral data were extracted from the reports. Descriptive statistics identified referral patterns, trends, and indications for CBCT. Comparisons were made with the Rogers' Product Innovation Adoption curve. The mean age of referred patients was 45 ± 21 years, and there was a predominance of women (62%). Oral and maxillofacial surgeons (51%) and periodontology specialists (17%) made most patient referrals. The listed reasons for CBCT referrals were dental implant planning (40%), suspected surgical pathology (24%), and temporomandibular joint analysis (16%). Other uses included planning extraction of impacted teeth and orthodontic assessment. Over the period of the study, the numbers of pathology diagnosis cases remained relatively constant, while adoption of CBCT for dental implant planning followed closely the first three stages of the Rogers' Product Innovation Adoption curve. Alongside this increased CBCT adoption for dental implant planning, there was an associated increased demand for use of DICOM image sets for laser modeling and provision of surgical guides. Diagnosis will probably remain a constant source of referral for CBCT examination by oral and maxillofacial radiologists. Nevertheless, more specialized applications such as laser-guided model fabrication and image-guided surgery are expanding indications for CBCT referrals by dentists and also expanding the horizons of clinical dental practice.