Dental Tribune USA

CBCT: changing diagnosis and treatment planning

By Dan McEowen
September 15, 2009

Since the introduction of cone-beam computed tomography in 1999 in the U.S. market, there has been a gradual shift in radiography paradigms. Many of the early adopters were unfairly accused of overuse of this radiology technology with comments such as, “If you have a hammer, everything looks like a nail,” or, “It’s way too much radiation compared to a panoramic, and the information isn’t that valuable.”

Others in the specialty fields or general dentists who had placed many implants over the years said, “It wasn’t needed and with enough experience no one would need it.” Interestingly enough, I had not met one of those doctors who had actually used the technology, much less purchased one to use in their own office.

As technology has improved in the last 10 years, we now have CBCT machines that rival periapical radiographs in clarity and diagnostic capability. The days of using 2-D images as the only diagnostic tool are fast approaching an end. As this technology progresses, dentists and patients will demand the best quality 2-D and 3-D images to diagnose and treatment plan their dental needs.

There are more than 17 manufacturers in the CBCT market today, offering a wide variety of machines. Some manufacturers offer machines that perform a multitude of tasks from a very large full head view to reconstructed panoramic, 2-D and 3-D images of every size with moderate to good resolution. Other manufacturers have chosen to use a smaller, flat-panel detector to give extremely high-resolution images for accurate diagnosis.

PreXion 3D is one of those machines with an 8x8 cm and 5x5 cm field-of-view (FOV). When performing surgical procedures, the multiplaner views (slices) can be viewed in any plane and thickness. Three-dimensional views allow the doctor to do virtual surgery before doing any invasive procedures on the patients.

I have found that when showing patients their own scan and explaining it in the 3-D mode, there is greater acceptance and understanding of the treatment you have planned. It is true — “a picture is worth a thousand words.”

Another factor that cannot be ignored is the identification of defects not visible on panoramic or pericapical films. This eliminates adding procedures during surgery that patients had not planned on.

CBCT will change the way you view endodontics from the initial diagnosis to retreatments. The ability to look at a tooth from virtually any angle eliminates surprises.

The high-quality images show MB2 canal, split root systems and multiple root exits and makes treatment success more certain. Impacted teeth from third molars to canines are easily treatment planned in both the multiplaner and 3-D views.

Periodontal defects can be visualized from any angle, and patient understanding of “pockets” is dramatically increased. The hygiene department will love the diagnostic value when treating deep defects.

All of these valuable tools are available in high-resolution PreXion scans. You will never look at radiographs the same way once you adopt CBCT technology. Your diagnosis will be spot on, and your treatment planning will be accurate based on sound knowledge using CBCT.
 

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