With digital technologies becoming more prevalent within dentistry, clinicians are able to better diagnose, treat and ensure the success of many dental procedures.
Cone-beam computed tomography (CBCT) provides clinicians with a non-invasive system to deliver diagnostics, develop treatment plans and assess risks. These CBCT scanners offer a more comprehensive view of the mouth, including teeth, gingiva and other oral structures, giving clinicians more valuable 3D information than the 2D images afforded by a computerised tomography (CT) scan.
There are different reasons as to why clinicians may choose to purchase a CBCT scanner – there are also reasons why they may not. Perhaps they feel that concerns regarding radiation would dissuade patients, or they believe they simply cannot justify the price. However, the CBCT scanner can be a prominent, state-of-the-art and cost-effective addition to any dental practice, and its benefits should not be understated.
CBCT scanning has allowed clinicians to treat their patients more effectively. Within the area of orthodontics, this system has demonstrated exceptional efficacy.[i] In orthodontic patients, several factors can impact treatment, such as temporomandibular joint disorders (TMD). Temporomandibular joint (TMJ) pathologies that alter, for example, the size, form and quality of the osseous joint components could lead to issues such as progressive bite changes and changes in tooth position and occlusion. These alterations could lead to unpredictable orthodontic outcomes,[ii] therefore visualising the TMJ morphology may be necessary. CBCT has been used in studies[iii] to assess TMJ morphology, with researchers showing a preference over CT, due to the higher resolution and visualisation.
Children make up a large number of patients seeking orthodontic treatment – because they are more sensitive to radiation than adults,[iv] CBCT can pose some risks. Therefore, scanners that provide a smaller field-of-view (FOV) option may be favourable to clinicians, as they will minimise radiation exposure whilst continuing to provide sufficient visualisation of the area of interest.[v] Due to emerging technologies, scanning with CBCT can be done with lower doses at all FOVs than has historically been possible. This is useful as it alleviates the issue of excessive dosage.[vi]
This can also be valuable during adult clear aligner treatment, as the clinician can receive a detailed and comprehensive view of the patient’s teeth and jawbones. Due to the lower radiation dose, clinicians can safely use a CBCT scanner to ensure highly effective treatment planning, better diagnostics and more successful identification of any pathologies. Images can also be merged with intraoral scans, simplifying the treatment planning even further. This will encourage peace of mind for clinicians and patients alike, as the use of a CBCT scan for removable aligner treatment demonstrates that all possible steps to ensure safe treatment and reduce the risk of complications have been taken. This provides medicolegal protection should a patient raise a complaint further down the line.
In addition, a range of literature[vii] [viii] has explored the effectiveness of CBCT in diagnosing and treatment planning for complex endodontic cases that involve root fractures, due to the higher-quality 3D images and sensitivity compared to conventional dental radiography. CBCT has also been shown to be effective and reliable in the detection of canals, as opposed to the use of a loupe and microscope.[ix]
It’s your call…
CBCT can be applied in many situations to gain a more comprehensive understanding of the area of interest. However, in all situations, the justification for a CBCT scan must be clinically judged and the benefits weighed against the risks. Even if the clinician deems CBCT suitable for the case, the patient may feel concerned about the exposure to radiation. Thus, a clinician may consider sourcing a CBCT scanner that can provide an ample range of benefits with the lowest possible radiation dose.
Clark Dental supplies a vast range of CBCT systems, including the top-of-the-range Axeos 2D/3D specialist system. The Axeos boasts one of the largest FOV options on the market, offering from 5cm x 5.5cm up to 17cm x 13cm; the 17x 13 FOV mode is unique from other brands in that it is also non-stitched, giving clinicians an unrivalled degree of accuracy. With the intelligent 3D Low Dose mode, clinicians can scan with exceptionally high visibility even at a low radiation dose, for a wide range of indications. Plus, the Axeos is seamlessly compatible with SureSmile orthodontic software, enabling clinicians to expand their orthodontic services with confidence and highly efficient diagnostics and treatment. This innovative and ground-breaking investment will prove a beneficial addition to many dental practices.
As dentistry is propelled into the digital world, solutions and systems are constantly being improved and adapted to simplify dental treatments, increase patient comfort and ensure treatment success. These are the ultimate goals of every clinician, so sourcing equipment that facilitates these aims is a no-brainer.
[i] Abdelkarim, A. (2019). Cone-Beam Computed Tomography in Orthodontics. [online] Available at: https://www.mdpi.com/2304-6767/7/3/89/htm [Accessed 13 Jan. 2022].
[ii] The Journal of Professional Excellence: Dimensions of Dental Hygiene. Indications for CBCT use. Available online. https://dimensionsofdentalhygiene.com/article/indications-for-cbct-use/. Accessed 25 Oct. 21.
[iii] US National Library of Medicine. Association of temporomandibular joint morphology in patients with and without temporomandibular joint dysfunction: A cone-beam computed tomography-based study. Available online. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7737818/. Accessed 26 Oct. 21.
[iv] National Library of Medicine. Paediatric exposures to ionizing radiation: carcinogenic considerations. Available online. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5129267/. Accessed 27 Oct. 21.
[v] US National Library of Medicine. New evolution of cone-beam computed tomography in dentistry: combining digital technologies. Available online. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761063/#B57. Accessed 26 Oct. 21.
[vi] Song, Y., Zhang, W., Zhang, H., Wang, Q., Xiao, Q., Li, Z., Wei, X., Lai, J., Wang, X., Li, W., Zhong, Q., Gong, P., Zhong, R. and Zhao, J. (2020). Low-dose cone-beam CT (LD-CBCT) reconstruction for image-guided radiation therapy (IGRT) by three-dimensional dual-dictionary learning. Radiation Oncology, [online] Available at: https://ro-journal.biomedcentral.com/articles/10.1186/s13014-020-01630-3 [Accessed 13 Jan. 2022].
[vii] Quintessence Publishing. Use of cone-beam computed tomography (CBCT) in the assessment of a complex horizontal root fracture: long-term follow-up. Available online. http://www.quintpub.com/index.php3. Accessed 25 Oct. 21.
[viii] US National Library of Medicine. Detection of dental root fractures by using cone-beam computed tomography. Available online. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520261/. Accessed 25 Oct. 21.
[ix] US National Library of Medicine. Diagnostic efficacy of four methods for locating the second mesiobuccal canal in maxillary molars. Available online. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5911295/. Accessed 26 Oct. 21.