ABSTRACT
This review provides a comprehensive overview of cone beam computed tomography (CBCT) in dentistry. It covers the basic principles, various applications, advantages, limitations, considerations, and future prospects of CBCT in the field of dentistry.
KEYWORDS: CBCT, dentistry, high-resolution images
INTRODUCTION
Cone beam computed tomography (CBCT) has revolutionized the field of dentistry with its ability to provide three-dimensional (3D), high-resolution images of the oral and maxillofacial structures. This advanced imaging technology offers a comprehensive view of the teeth, bone, nerve pathways, and soft tissues, enabling dentists and maxillofacial surgeons to accurately diagnose and plan various dental treatments.[1]
The applications of CBCT in dentistry are far-reaching, including but not limited to dental implant planning, endodontic assessment, orthodontic evaluations, impacted tooth assessment, and evaluation of pathologies such as cysts and tumors. Moreover, CBCT plays a crucial role in enhancing precision and safety in surgical procedures and in guiding complex dental interventions. Given its clinical significance, CBCT has significantly improved the diagnostic capabilities of dental professionals, leading to more accurate treatment planning and better patient outcomes.[2] This paper aims to delve into the various applications and clinical significance of CBCT in modern dentistry.
BASIC PRINCIPLES BEHIND CBCT
CBCT is an imaging technology that utilizes a cone-shaped X-ray beam to create detailed 3D images of dental structures, soft tissues, and bone. Unlike traditional 2D dental radiography, CBCT provides more comprehensive visualizations that aid in precise diagnosis, treatment planning, and post-treatment assessment. The fundamental principle involves the rotation of the CBCT machine around the patient’s head, capturing multiple X-ray images from different angles, which are then reconstructed into detailed 3D representations using advanced software.[3]
VARIOUS APPLICATIONS OF CBCT
Dental implant planning
CBCT plays a pivotal role in the pre-operative planning of dental implant placements. By providing detailed 3D images of the patient’s oral and maxillofacial structures, CBCT aids in determining the quantity and quality of available bone, identifying vital structures such as nerves and sinuses, and optimizing the implant position and angle for successful outcomes.[2,4]
Orthodontics
CBCT facilitates comprehensive assessment of dentofacial structures, enabling orthodontists to analyze skeletal relationships, temporomandibular joint (TMJ) morphology, and tooth angulation and inclination. This detailed 3D information aids in treatment planning for orthodontic patients, particularly in cases involving complex malocclusions or orthognathic surgeries.[5]
Endodontics
CBCT imaging is invaluable in endodontic practice for visualizing intricate root canal anatomy, detecting the presence of additional canals, evaluating the extent of root resorption, and localizing periapical lesions. This advanced imaging modality assists endodontists in making accurate diagnoses and developing effective treatment strategies.[6]
Temporomandibular joint evaluation
CBCT provides detailed visualization of the TMJ, allowing for the assessment of condylar position, morphology, and pathologies. This is critical in the diagnosis and management of various TMJ disorders, including internal derangements, osteoarthritis, and ankylosis.[7]
Oral and maxillofacial pathology
CBCT aids in the assessment of various hard and soft tissue pathologies within the oral and maxillofacial region. It enables the visualization of osseous lesions, cysts, tumors, and impacted teeth, thereby contributing to accurate diagnosis and treatment planning for such conditions.[1,2]
Pediatric dentistry
CBCT is valuable in pediatric dentistry for assessing dental anomalies, developmental disorders, and trauma. CBCT also plays a crucial role in orthodontic assessment, cleft palate evaluation, and surgical treatment planning for conditions such as supernumerary teeth and impacted canines.[8,9]
Interpretation of CBCT images
Here are key points to consider during the interpretation of CBCT images in dentistry[1,3,6,8]:
Radiographic anatomy
Radiographic landmarks such as the cortical outlines of the mandible and maxilla, the appearance of teeth and their surrounding structures, and the relationship of adjacent anatomical landmarks should be carefully assessed.
Pathological findings
CBCT images may reveal a wide spectrum of pathological conditions, including odontogenic and non-odontogenic tumors, cysts, periapical lesions, and developmental anomalies. Recognition of these conditions involves evaluating changes in bone density, alterations in the shape and size of anatomical structures, and the presence of soft tissue abnormalities.
Three-dimensional analysis
CBCT provides volumetric data, allowing for comprehensive 3D analysis of dental and maxillofacial structures. This includes the assessment of bone quality and quantity, the spatial relationship between teeth and adjacent structures, and the visualization of complex anatomical features such as root canal morphology and TMJ articulation.
Software tools
Utilizing CBCT imaging software, practitioners can employ various tools for image manipulation and analysis. This may involve adjusting the image contrast and brightness, using multi-planar reconstructions to visualize specific anatomical structures from different perspectives, and creating 3D renderings for enhanced spatial understanding.
Patient-specific considerations
Interpretation of CBCT images should take into account the individual patient’s clinical history, presenting symptoms, and specific diagnostic concerns. Integrating clinical and radiographic findings is crucial for formulating a tailored diagnosis and treatment plan that aligns with the patient’s unique circumstances.
ADVANTAGES OF CBCT[2,8,9]
Enhanced diagnostic capabilities
CBCT offers detailed 3D images, enabling precise diagnosis of complex dental conditions that are not adequately visualized in traditional 2D imaging.
Treatment planning precision
CBCT provides detailed anatomical information, facilitating precise treatment planning for procedures such as implant placement, root canal treatment, orthognathic surgery, and more.
Reduced radiation exposure
While CBCT imaging involves higher radiation doses compared to traditional dental radiography, advancements in technology have led to the development of low-dose protocols, minimizing radiation exposure to patients.
Patient comfort
CBCT imaging is relatively quick and non-invasive, offering enhanced patient comfort compared to conventional imaging techniques.
Limitations of CBCT:
Cost
CBCT equipment and imaging procedures are more expensive compared to 2D radiography, limiting its accessibility in certain dental practices and facilities.
Image artifacts
CBCT images can be susceptible to artifacts such as streaking, beam hardening, and scatter, which may impact the overall image quality and diagnostic accuracy.
CONSIDERATIONS TO BE TAKEN[2,8,9]
Justification and referral
It is essential for dental professionals to justify and appropriately refer patients for CBCT imaging, weighing the clinical indications against potential risks and benefits.
Operator training and expertise
Competency in CBCT image acquisition, interpretation, and application is crucial to ensure accurate diagnosis and optimal utilization of this technology.
Radiation safety
Implementing dose optimization techniques, adhering to ALARA principles, and ensuring proper shielding are essential for minimizing radiation exposure during CBCT imaging.
Future prospects
The future of CBCT in dentistry holds promising prospects, with ongoing research and technological advancements focusing on further reducing radiation doses, enhancing image quality, and expanding its applicability in various dental specialties.[2,8,9]
CONCLUSION
CBCT has transformed the landscape of dental imaging and diagnosis, offering advanced 3D visualization capabilities that have revolutionized treatment planning and patient care in various dental specialties. While CBCT presents significant advantages in terms of diagnostic precision and treatment planning, cautious consideration of its limitations, radiation safety, and appropriate utilization is imperative.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acknowledgement
We would like to acknowledge Deanship of scientific research, Prince Sattam Bin Abdul Aziz University, Alkharj KSA, for supporting this review.
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