Use Of Cone-beam Computed Tomography Imaging Research Articles

Guided endodontics a pathbreaking approach to the management of calcified canals: A case report

Abstract Pulp calcification refers to the accumulation of hard tissue in the root canal space as a response to dental trauma. Despite being a common finding in dental practice, access to an obliterated pulp chamber and subsequent canal negotiation remains challenging for clinicians due to the increased likelihood of iatrogenic errors such as gouging, ledging, or perforation. In this current report, a 21-year-old male patient presented with a discolored maxillary central incisor and reported a history of trauma that occurred 15 years ago. The tooth exhibited sensitivity to percussion; with no vestibular obliteration or periodontal pockets. Intraoral periapical radiograph revealed a completely calcified root canal associated with apical widening, suggestive of apical periodontitis. A 3D-printed endodontic guide was fabricated using the cone beam computed tomography (CBCT) images and digital planning software to aid in locating the root canal orifice. The canal was successfully navigated with the help of the endodontic guide, and a 12-month follow-up revealed that the patient remained clinically asymptomatic, with radiographic evidence indicating periapical healing. For conservative, precise, and predictable outcomes, a digital workflow that makes use of CBCT imaging, planning software, and a 3D-printed endodontic guide may be taken into consideration when managing extensively calcified canals.

When Is Cone-Beam Computed Tomography Imaging Appropriate for Diagnostic Inquiry in the Management of Inflammatory Periodontitis? An American Academy of Periodontology Best Evidence Review.

Clinical and radiographic examinations are essential in establishing correct periodontal diagnoses as well as providing appropriate treatment options. Current radiographic examinations, however, do not provide adequate information regarding the severity of periodontal disease, presenting a need to investigate alternative methods. The aim of this best evidence consensus is to determine when cone-beam computed tomography (CBCT) imaging is appropriate for diagnostic inquiry in the management of inflammatory periodontitis. Literature was systematically reviewed to answer three clinically relevant focused questions regarding the role of CBCT in the management of inflammatory periodontitis. 1) Clinical situation: In patients with periodontitis, what (if any) clinical situations/conditions exist where CBCT imaging improves diagnostic acumen and subsequent treatment recommendations compared with two-dimensional radiographic interpretation? 2) Intervention: Does CBCT imaging improve the accuracy of a diagnostic assessment and establishment of a prognosis in the analysis of furcation and/or intrabony defects? Is the execution of therapy improved and facilitated, or is it therapeutically challenged? 3) Outcomes: Does the use of CBCT imaging provide superior short-term or long-term clinical outcomes, more favorable patient-reported outcomes, or more consistent clinical treatment decisions affecting tooth prognosis (as measured by defect fill, improvements in bone anatomy, mobility patterns, and ultimate tooth survival)? An extensive literature search was performed using the MEDLINE database and the most respected journals in the field. An electronic database search identified 885 citations, and a manual search yielded an additional five citations. After screening of article titles and abstracts, studies were excluded if irrelevant to the topic of this systematic review. Of the remaining full-text articles, 74 were obtained and reviewed. Sixty-two articles not meeting inclusion criteria were further excluded. Twelve total references met the inclusion criteria to determine the role of CBCT in diagnosis and treatment of both intrabony and furcation defects. Intrabony and furcation defects were the two most commonly discussed bony defects when comparing efficacy of CBCT versus intraoral radiographs (IRs). After a review of the literature, while diagnostic aspects of intrabony and furcation defects can be improved via the use of CBCT, limited evidence supported the use of CBCT imaging improving the execution of therapy for both types of defects. There was also a lack of literature to support the use of CBCT imaging for superior short-term or long-term clinical outcomes. None of the literature reported patient-reported outcomes when CBCT imaging was used. Currently, limited evidence supports the utilization of CBCT for diagnosis of intrabony and furcation defects. Despite the fact that there is rapidly accruing literature on CBCT, there are still no current evidence-based guidelines on its necessity and use for periodontal treatment planning. In selective cases, however, limited field of view CBCT may be useful for periodontal disease diagnoses due to less radiation dosage to the patient, higher spatial resolution, and shorter volumes to be interpreted.

Cone-Beam Computed Tomography and Interdisciplinary Dentofacial Therapy: An American Academy of Periodontology Best Evidence Review Focusing on Risk Assessment of the Dentoalveolar Bone Changes Influenced by Tooth Movement.

The aim of this systematic review is to evaluate whether cone-beam computed tomography (CBCT) imaging can be used to assess dentoalveolar anatomy critical to the periodontist when determining risk assessment for patients undergoing orthodontic therapy using fixed or removable appliances. Both observational and interventional trials reporting on the use of CBCT imaging assessing the impact of orthodontic/dentofacial orthopedic treatment on periodontal tissues (i.e., alveolar bone) were included. Changes in the alveolar bone thickness and height around natural teeth as well as treatment costs were evaluated. MEDLINE (via PubMed) and EMBASE databases were searched for articles published in the English language, up to and including July 2016, and extracted data were organized into evidence tables. Thirteen studies were included in this systematic review describing the positive or deleterious changes on the alveolar bone surrounding natural teeth undergoing orthodontic tooth movement or influenced by orthopedic forces through fixed appliances. Clinical recommendation summaries presenting the strengths and weaknesses of the evidence in terms of benefits and harms were generated. CBCT imaging can improve the periodontal diagnostic acumen regarding alveolar bone alterations influenced by orthodontic tooth movement and can help determine risk assessment prior to such intervention. Clinicians are also better informed to determine risk assessment and develop preventative or plan interceptive periodontal augmentation (soft tissue and/or bone augmentation) therapies for patients undergoing orthodontic tooth movement. These considerations are recognized as being especially critical for treatment approaches in patients where buccal tooth movement (expansion) is planned in the anterior mandible or involving the maxillary premolars.

Measurement of skin dose from cone-beam computed tomography imaging

ObjectiveTo measure surface skin dose from various cone-beam computed tomography (CBCT) scanners using point-dosimeters.Materials & methodsA head anthropomorphic phantom was used with nanoDOT optically stimulated luminescence (OSL) dosimeters (Landauer Corp., Glenwood, IL) attached to various anatomic landmarks. The phantom was scanned using multiple exposure protocols for craniofacial evaluations in three different CBCT units and a conventional x-ray imaging system. The dosimeters were calibrated for each of the scan protocols on the different imaging systems. Peak skin dose and surface doses at the eye lens, thyroid, submandibular and parotid gland levels were measured.ResultsThe measured skin doses ranged from 0.09 to 4.62 mGy depending on dosimeter positions and imaging systems. The average surface doses to the lens locations were ~4.0 mGy, well below the threshold for cataractogenesis (500 mGy). The results changed accordingly with x-ray tube output (mAs and kV) and also were sensitive to scan field of view (SFOV). As compared to the conventional panoramic and cephalometric imaging system, doses from all three CBCT systems were at least an order of magnitude higher.ConclusionsPeak skin dose and surface doses at the eye lens, thyroid, and salivary gland levels measured from the CBCT imaging systems were lower than the thresholds to induce deterministic effects. However, our findings do not justify the routine use of CBCT imaging in orthodontics considering the lifetime-attributable risk to the individual.

Accuracy and reliability of cone-beam computed tomography for airway volume analysis

The purpose of the present study was to evaluate the accuracy and reliability of airway volume digital measurements of cone-beam computed tomography (CBCT) compared with the manual measurements of an airway model. An acrylic airway model was constructed and attached to a human dry skull in the natural position of the airway passage. The total and internal airway volumes, as well as the most constricted airway area, were measured manually on the model and on the CBCTs taken after the model was attached to the skull. The CBCT images were analysed using the Dolphin3D (Dolphin Imaging & Management solutions, Chatsworth, California, USA) software. Reliability and accuracy were assessed by using intraclass correlation and Student's t-test. A P ≤ 0.05 was considered statistically significant. No significant statistical difference was found between the total, the internal airway volume, and the most constricted airway area measured on CBCTs compared with the manual measurements. The intra-examiner reliability was high for all measurements recorded from both methods (r ≥ 0.90). These results suggested that the three-dimensional CBCT digital measurements of the airway volume and the most constricted area of the airway are reliable and accurate. The use of CBCT imaging for the assessment of the airway can provide clinically useful information in orthodontics.