Lecture 14 DENTAL RADIOLOGY ‫ ﻋﻘﻳﻝ ﺍﻟﺳﺎﻋﺩﻱ‬.

‫ﺩ‬
Cone beam computed tomography (or CBCT) is a medical imaging technique consisting of
X‐Ray computed tomography where the X‐rays are divergent, forming a cone.
During a CBCT scan, the scanner rotates around the patient's head, obtaining up to nearly 600
distinct images. The scanning software collects the data and reconstructs it, producing what is
termed a digital volume composed of three‐dimensional voxels of anatomical data that can
then be manipulated and visualized with specialized software
Clinical indications of CBCT
CBCT is used by general dentists and specialists to improve diagnosis and treatment planning
in the following cases:
1‐Dental implants
• Location of anatomic structures: mandibular canal, submandibular fossa, incisive canal,
maxillary sinus
• Size and shape of ridge, quantity and quality of bone
• Number, orientation of implants
• Need for bone graft, sinus lift
• Use of implant planning software
2‐Oral and maxillofacial surgery
• Relationship of third molar roots to mandibular canal
• Localization of impacted teeth, foreign objects
• Evaluation of facial fractures and asymmetry
• Orthognathic surgery planning
3‐Oral and maxillofacial pathology
• Localization and characterization of lesions in the jaws
• Effect of lesion on jaw in 3rd dimension: expansion, cortical erosion, bilateral symmetry
• Relationship of lesion to teeth and other structures
4‐Orthodontics
• Treatment planning for complex cases when 3D information needed to supplement (or
substitute for) other imaging
• Patients with cleft palate
• Impacted teeth
• Root angulation, root resorption
5‐Temporomandibular joint
• Osseous structures of TMJ
• Relationship of condyle and glenoid fossa in 3D
6‐ ENDODONTICS:
1‐ Patients who present with contradictory or nonspecific clinical signs and symptoms associated with untreated
or previously endodontically treated teeth.
2‐ For the initial treatment of teeth with the potential for extra canals and suspected complex morphology.
3‐ For intra‐appointment identification and localization of calcified canals.
4‐ In the detection of vertical root fracture.
5‐When evaluating the nonhealing of previous endodontic treatment .
6‐ For nonsurgical retreatment to assess endodontic treatment complications, such as overextended root canal
obturation material, separated endodontic instruments, and localization of perforations
7‐ For presurgical treatment planning to localize root apex/apices and to evaluate the proximity to adjacent
anatomical structures
8‐ For diagnosis and management of limited dentoalveolar trauma, root fractures, luxation, and/or displacement
of teeth.
9‐ For the localization and differentiation of external and internal resorption .
Advantages of CBCT
• Lower radiation dose than medical CT
• Equivalent to ~1 Full mouth series of radiographs (FMX) or 6‐7 panoramic radiographs
• Thyroid shield can be used in many cases
• Comfortable for patient
• Open environment – no claustrophobia
• Patient seated, facing out
• Only 20 second scan
• Wheelchair accessible
• Images available almost immediately on screen
• Images can be imported into other software
• Size and Cost: smaller size with less cost compared to medical CT
•Submillimeter Resolution: CBCT units are capable of high‐resolution imaging (nominal 0.076‐
to 0.125‐ mm voxel resolution)
Limitations
CBCT images have limitations compared with conventional CT
images.
1‐Image Noise
2‐Poor Soft Tissue Contrast
X‐ray computed tomography (x‐ray CT) is a technology that uses computer‐processed x‐rays to
produce tomographic images (virtual 'slices') of specific areas of the scanned object, allowing
the user to see what is inside it without cutting it open. Digital geometry processing is used to
generate a three‐dimensional image of the inside of an object from a large series of two‐
dimensional radiographic images taken around a single axis of rotation.
How a CT Scan works ?
CT, Computerized Axial Tomography, uses x‐rays to generate images of the body, including
bone. In the CT scanner the x‐ray tube, (source) rotates around the patient laying on the table.
On the opposite side of the patient from the tube is the x‐ray detector. This detector receives
the beam that makes it through the patient. The prepared CT image can be immediately
viewed on a television monitor or recorded for storage and analysis later.
Advantages of CT
There are several advantages that CT has over traditional 2D medical radiography.
1‐ CT completely eliminates the superimposition of images of structures outside the area of
interest.
2‐ The inherent high‐contrast resolution of CT, differences between tissues that differ in
physical density by less than 1% can be distinguished.
3‐ Data from a single CT imaging procedure consisting of either multiple contiguous or one
helical scan can be viewed as images in the axial, coronal, or sagittal planes, depending on the
diagnostic task. This is referred to as multiplanar reformatted imaging
What is the difference between a CBCT scan and a medical CT scan?
The main differences between CBCT and medical (multi‐slice) CT are:
1. Radiation dose: CBCT less than CT
2. Image resolution: For hard tissues and teeth, CBCT offers higher resolution and image
sharpness compared to medical CT (Multi‐Slice CT or MSCT).
3. Metal artifact reduction:
CBCT offers better metal artifact reduction compared to medical CT. This is important because
many patients have metallic crowns or restorations that cause streaking artifacts that may
interfere with the visualization of the region of interest.
4. Soft tissue contrast:
One of the limitations of CBCT is the poor soft tissue contrast compared to medical CT or
Magnetic Resonance Imaging (MRI). While CBCT is appropriate to evaluate osteoarthritic
changes of the temporomandibular joint (TMJ), it is not suited for evaluation of TMJ disc
displacement. Similarly, tumors within the soft tissue cannot be adequately evaluated using
CBCT
Computed tomography applications for dentistry.
1‐CT can be used to image the extent of pathologic conditions
2‐ complex facial fractures.
3‐CT can also be used to assess the temporomandibular joints
4‐ the paranasal sinuses
5‐ presurgical implant treatment planning