CONE BEAM COMPUTED TOMOGRAPHY (CBCT) IN DENTISTRY

bsamdrg@unpad.ac.id

Comparison of X-ray Dose

Medical CT Full mouth series Cone Beam CT (EPX-IMPLA) 25 ~ 60 Sv Digital Panoramic 4.7 14.5 Sv Panoramic 10 15 Sv Radiation from other sources Daily background Commercial long haul flight Dr. Sharon Brooks, Dept. of Radiology, University of Michigan Dr. Stuart White, Dept. of Radiology, UCLA Lower limits occupational exposure 8 Sv 6 Sv/hr Highest Film Panoramic 26 Sv 150 Sv 1200 3300 Sv

20,000 Sv/yr

Necessary of CT Diagnosis

If patients move out from the focal trough, image will be changed as extension or reduction. There are much error in panoramic shot.
- Toward to Buccal : Reduction.

- Toward to Lingual : Extension..

Reduction

Extension

Necessary of CT Diagnosis

Define Oral Anatomy

Insufficient bone & invisible canal from the above canal Insufficient bone underneath the sinus
Bone absorption / Ridge shape Nasal cavity / Incisive canal / Sinus

Reference from exact position of impacted teeth

Accurate treatment plan before surgery Saving time from diagnosis to surgery

3 4

Increasing patients agreement of treatment plan

Necessary of CT Diagnosis

Average Distortion Distortion

Panoramic

Maximum

3.0 mm
Periapical

7.5 mm

1.0 mm
Computed Tomography

5.5 mm

0.2 mm

0.5 mm

Necessary of CT Diagnosis

Panorama : 13.5mm , 10.0mm

Panorama vs CT 1st : + 0.54mm

2nd : + 0.40mm

CT : 12.96mm, 9.60mm
Exact Length

* A panorama image must revise as much as about -20% down because of the extension rate.

Necessary of CT Diagnosis

Bone Width
Panoramic

Bone Quality

++++

+ + ++++

Periapical

Computed Tomography

1-5. Necessary of CT Diagnosis

Need to check the depth and position of mandible bone to figure out how to implant.

Looks OK with 2D on Panoramic View

But you can image by using Cross Sectional View on 3D

Necessary of CT Diagnosis

In the view of panorama, mandible darkness is as shown cortical bone. Therefore, even the knife edge area can be measured as same density.

Necessary of CT Diagnosis

Sagittal

Absorption of bone can be diagnosed by using 2D, 3D and 360 rotation.

3D-Zoom

Axial

3D-Rotation

Necessary of CT Diagnosis

Inf. Alveolar N.
Panoramic

Maxillary Sinus

++

++

Periapical

+
++++

+
++++

Computed Tomography

Necessary of CT Diagnosis

When implant operate they can measure exact length of operation area.
Actual Length

Necessary of CT Diagnosis

Only Panoramic view is invisible because palatal bone is overlaid on the maxilla. The position and form of the maxillary will be diagnosed as shown as 3D Image.

CT can figure it out easily, when we use cross sectional view

Necessary of CT Diagnosis

It can show indefinite bone, because of maxillary cyst.

Necessary of CT Diagnosis

Incisive N.
Panoramic

Mylohyoid ridge

Periapical

Computed Tomography

++++

++++

Appearances of CT Models

EPX-IMPLA

Clinical Cases

Impacted Teeth of Mandible

Impacted Teeth of Mandible

Mandible 3rd Molar (Hard case)

Impacted Teeth of Mandible

Buccal

Lingual

3rd molar in the view of axial (check the root direction) It toward to Buccal side unusually

Impacted Teeth of Mandible

Facial

Buccal

Lingual Check the position of 3rd molar with canal

Impacted Teeth of Mandible

Coloring on the mandible canal

Impacted Teeth of Mandible

Check position of canal (Vertical, Horizontal)

Conclusion
What are the advantages of CT equipment

Comprehension of Patients

Increase Acceptance Rate

Having CT is not only modernized treatment. Also, satisfaction of what patient needs.

Enable Predictable Rx.

Endodontics, Surgical Extraction Extract or not, Periodontal Treatment

Increase Income

Happy Implant Dentistry