CONE BEAM COMPUTED

TOMOGRAPHY (CBCT) IN
DENTISTRY

bsamdrg@unpad.ac.id
Comparison of X-ray Dose

Medical CT

Full mouth series 1200 – 3300 µSv

Cone Beam CT
150 µSv
(EPX-IMPLA)

25 ~ 60 µSv
Highest Film
Digital Panoramic
Panoramic
26 µSv
4.7 – 14.5 µSv

Panoramic

10 – 15 µSv

● Radiation from other sources

● Daily background 8 µSv

● Commercial long
6 µSv/hr
haul flight
● Lower limits
Dr. Sharon Brooks, Dept. of Radiology, University of Michigan occupational 20,000 µSv/yr
Dr. Stuart White, Dept. of Radiology, UCLA
exposure
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

1 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

2 Accurate treatment plan before surgery

3 Saving time from diagnosis to surgery

4 Increasing patients’ agreement of treatment plan

Necessary of CT Diagnosis

Average Distortion Maximum

Distortion
Panoramic
3.0 mm 7.5 mm

Periapical
1.0 mm 5.5 mm

Computed
Tomography
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 Bone Quality

Panoramic
- +
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

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

rotation.
Sagittal 3D-Zoom

Axial 3D-Rotation
Necessary of CT Diagnosis

Inf. Alveolar N. Maxillary Sinus

Panoramic
++ ++
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. Mylohyoid ridge

Panoramic
- -
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. Enable Predictable Rx.
Also, satisfaction of Endodontics, Surgical Extraction
what patient needs. Extract or not, Periodontal Treatment

Increase Income

Happy Implant Dentistry