Endodontic Applications of Cone-Beam VolumetricTomography
Taylor P. Cotton, DDS, Todd M. Geisler, DDS, David T. Holden, DMD, Scott A. Schwartz, DDS,and William G. Schindler, DDS, MS
The ability to assess an area of interest in 3 dimensionsmight benefit both novice and experienced cliniciansalike. High-resolution limited cone-beam volumetric to-mography (CBVT) has been designed for dental appli-cations. As opposed to sliced-image data of conven-tional computed tomography (CT) imaging, CBVTcaptures a cylindrical volume of data in one acquisitionand thus offers distinct advantages over conventionalmedical CT. These advantages include increased accu-racy, higher resolution, scan-time reduction, and dosereduction. Specific endodontic applications of CBVT arebeing identified as the technology becomes more prev-alent. CBVT has great potential to become a valuabletool in the modern endodontic practice. The objectivesof this article are to briefly review cone-beam technol-ogy and its advantages over medical CT and conven-tional radiography, to illustrate current and futureclinical applications of cone-beam technology in endo-dontic practice, and to discuss medicolegal consider-ations pertaining to the acquisition and interpretationof 3-dimensional data.
(J Endod 2007;33:1121–1132)
CBCT, CBVT, cone-beam computed tomography, cone-beam volumetric tomography, digital volume tomogra-phy, DVT, endodontics
adiographic examination is essential in diagnosis and treatment planning in endo-dontics. The interpretation of an image can be confounded by the anatomy of boththe teeth and surrounding structures. Having the ability to assess an area of interest in3dimensionsmightbenefitbothnoviceandexperiencedcliniciansalike.Theobjectivesof this article are to review 3-dimensional (3-D) imaging, specifically cone-beam tech-nology and its advantages over traditional medical computed tomography (CT) andconventional radiography, to illustrate current and future clinical applications of cone-beam technology in endodontic practice, and to discuss medicolegal considerationspertaining to the acquisition and interpretation of 3-D dat a.Cone-beamtechnologyhasexistedsincethe1980s(1).However,theconvergenceof technology and its applications has only recently made cone-beam volumetric to-mography (CBVT) (2, 3)or cone-beam computed tomography (CBCT) a viable option
for the dental office (4).Twomaininnovationshavedrivendevelopmentoftheseimagingsystems.Thefirst is the change from analog to digital imaging. Second, advances in imaging theory andvolume-acquisition data have allowed for increasingly detailed 3-D imaging (5). Pow-erful low-cost computers, less expensive cone-beam x-ray tubes, and the development ofhigh-qualityflat-paneldetectors(6–8)haveincreasedtheaffordabilityandqualityof these imaging systems and made CBVT imaging in the dental office a reality (4).Cone-beamtechnologyusesacone-shapedbeamofradiationtoacquireavolumein a single 360-degree rotation, similar to panoramic radiography (2, 3). Just as a digital picture is subdivided into pixels, the volume acquired by a CBVT is composed of voxels. Essentially, a voxel is a 3-D pixel. Because the data are captured in a volume asopposed to slices, all the voxels are isotropic, which enables objects within the volumetobeaccuratelymeasuredindifferentdirections.TheaxialheightofamedicalCTvoxel,however,isdeterminedbytheslicethicknessorpitch(1–2mmthick)andresultsinananisotropic voxel (9). In other words, unlike the CBVT voxel, a medical CT voxel is not
aperfectcube,andmeasurementsmadeinmultipleplanesarenotaccurate.Inadditionto increased accuracy and higher resolution, CBVT offers significant scan-time reduc-tion, radiation dosereduction, and reduced cost for the patient (9–11). With the help
of viewer software (12), the clinician is able to scroll through the entire volume and
simultaneouslyviewaxial,coronal,andsagittal2-Dsectionsthatrangefrom0.125–2.0mm thick. The axial and proximal (sagittal in the anterior, coronal in the posterior)views are of particular value, because they are generally not seen with conventionalperiapical radiography. The ability to reduce or eliminate superimposition of the sur-roundingstructuresmakesCBVTsuperiortoconventionalperiapicalradiography(13).
In addition to the 2-D slices, 3-D reconstruction enables further assessment of the area of interest.In the year 2000, the Food and Drug Administration approved the first CBVT unit for dental use in the United States (14). As of 2007, there are at least 12 cone-beamsystems specifically designed for dental use. The majority of these machines scan thepatientinaseatedposition,whereasafewscanthepatientineitheranuprightorsupineposition. CBVT systems can be classified into 2 categories, limited (dental or regional)CBVT or full (ortho or facial) CBVT. The field of view (FOV) of limited CBVT ranges indiameter from 40–100 mm, whereas the FOV of full CBVT ranges from 100–200 mm.Another difference between the limited CBVT and full CBVT is that a voxel is generally smaller for the limited version (0.1–0.2 mm vs 0.3–0.4 mm). Thus, limited CBVTsystems offer higher resolution and are better suited for endodontic applications.
From the Department of Endodontics, University of TexasHealth Science Center at San Antonio, San Antonio, Texas.Address requests for reprints to Taylor P. Cotton, DDS,Department of Endodontics, UTHSCSA School of Dentistry,7703 Floyd Curl Dr, Mail Code 7892, San Antonio, TX 78229-3900. E-mail address: email@example.com/$0 - see front matterCopyright © 2007 by the American Association of Endodontists.doi:10.1016/j.joen.2007.06.011
Case Report/Clinical Techniques
Volume 33, Number 9, September 2007 Endodontic Applications of CBVT