![Walter et al. studied the accuracy of conventional assessment, clinical exam with IORs, to conventional
assessment with additional CBCT evaluation for determination of degree of furcation involvement and
appropriateness of treatment planning of maxillary molars with furcation involvement. The degree of
furcation involvement determined by conventional assessment was accurate only 27% of the time; CBCT 41%
of the time.
Nikolic-Jakoba et al. on CBCT for detection of intrabony and furcation defects concluded that insufficient
evidence was available to support the use of CBCT.
Zhao et al. reported CBCT has the ability to assess root concavities of first premolars and associated
pattern of bone loss. They identified five types of roots concavities based on origination of the concavity.
Type I had no concavity, Type II the concavity originated in the enamel, Type II was coincidence with the
CEJ, Type IV below the CEJ (but in the top 2/3 s of the root), and Type V was within the bottom 1/3 of the
root. The associated pattern of bone loss was classified as a Ramp, Plane, or Crater.
Banodkar et al. found that CBCT was highly accurate at both detection of periodontal defects and
determination of type of defect while also very precisely being able to measure the vertical depths of the
defects.
Feijo et al. [21] reported that there was no statistical difference in between measurements of horizontal bone
loss when measured by either CBCT or direct intra-surgical measurements
Although the data is rather limited, it is beginning to highlight some specific clinical situations where
CBCT may be a beneficial adjunct to conventional assessment.](https://image.slidesharecdn.com/8-220307145310/75/CBCT-in-Periodontology-54-2048.jpg)
Uploaded byRinisha Sinha
CBCT in Periodontology
CBCT is a 3D imaging technique using cone-shaped X-rays to produce images of the dental and maxillofacial area. It provides advantages over 2D imaging like panoramic radiographs by allowing evaluation of structures in multiple planes. CBCT has applications in diagnosing periodontal disease due to its ability to accurately measure hard and soft tissue structures. While CBCT reduces imaging errors compared to 2D techniques, it has limitations like higher noise levels and is not optimal for soft tissue imaging. CBCT dose is lower than medical CT but higher than conventional dental radiographs.
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CBCT in Periodontology
- 2. Introduction History and Evolutionof CT and CBCT Components of Image Production Principles of CBCT Processes Technical Aspects of CBCT Image Reconstruction Application of CBCT : Interventional Radiology Justification of referral for CBCT Technical Limitations Quality Assurance Programme Clinical Quality Standards for CBCT Artifacts Strength and Limitations Comparison Role in Periodontology Controversies Doses Conclusion References
- 3. • A medicalimaging technique consisting of X-ray computed tomography where the X-rays are divergent, forming a cone. • Acquires data volumetrically providing three-dimensional (3D) radiographic imaging for the assessment of the dental and maxillofacial complex facilitating dental diagnosis. • Integrated CBCT is also an important tool for patient positioning and
- 6. First - generationCT scanner Second - generation CT scanner Third - generation CT scanner Fourth - generation CT scanner Fifth - generation CT scanner
- 11. Figure: Axial imageobtained from the first Cone-Beam 3D Scan performed on July 1, 1994
- 12. First, compact and high- qualityflat-panel detector arrays were developed. Second, the computer power necessary for cone-beam image reconstruction has become widely available and is relatively inexpensive. Third, x-ray tubes necessary for cone- beam scanning are orders-of- magnitude that are less expensive than those required for conventional CT. Fourth, by focusing on head/neck scanning only, one can eliminate the need for sub-second gantry rotation speeds that are needed for cardiac and thoracic imaging. This significantly reduces the complexity and cost of the gantry. Four technological and application-specific factors have converged to make this possible
- 13.
- 14. Principles of Cone BeamComputed Tomographic Imaging
- 15. Three main processes in CBCT imaging : Image Production Visualization Interpretation CBCT hasbeen described as the gold standard for imaging the oral and maxillofacial area.
- 16.
- 18.
- 19. Supine Equipment required Large surfacearea/ physical footprint Not for physically disabled patients Standing Units Not able to adjust the height in wheelchair bounded patients Seated Units Most comfortable Not for physically disabled
- 20. Patient exposur e depends upon : Presence of pulsedX ray beam Size of the image field Immobilizatio n of head by - Chin cup Bite fork Other head – restraint mechani sm
- 21. Also calledas field of view (FOV) • It is the amount of area to be exposed in a single scan. Shape – cylinder or Spherical Can be selected based on individual requirements Depends on: Detector size Geometry of beam projection Collimation of the beam
- 22. It is desirableto limit the field size to the smallest volume that images the ROI (Region of Interest). This procedure reduces unnecessary exposure to the patient and produces the best image by minimum scattered radiation, which degrade image quality.
- 23. CBCT Image Intensifier + Charge Coupled Device Flat Panel Area Detectors Largerand bulkier Circular basis image area Spherical volume Lighter in weight Rectangular Cylindrical volume Cesium iodide scintillator
- 27. When a lownumber of projections is used, the object is under sampled, and images exhibit streaks along the direction of back projected rays. An improved reconstruction is possible when the number of projection angles is increased.
- 31. Localized applications ofCBCT for the developing dentition Generalized application of CBCT for the developing dentition Dental caries diagnosis Periodontal assessment, Assessment of periapical disease Endodontics, Dental trauma, Exodontia, Implant dentistry Bony pathosis, Facial trauma, Orthognathic surgery, Temporomandibular joint
- 32. Compared to multidetectorcomputed tomography (MDCT), the wider collimation in CBCT leads to increased scatter radiation and degradation of image quality as demonstrated by artifacts and decreased contrast-to-noise ratio. The temporal resolution of Cesium Iodide detectors in CBCT slows data acquisition time to approximately 5 to 20 seconds, which increases motion artifacts. The time required for image reconstruction takes longer for CBCT (1 minute) compared to MDCT (real time) due to the computationally demanding cone beam reconstruction algorithms. Hounsfield Units is inaccurate in CBCT scans because different areas in the scan appear with different greyscale values depending on their relative positions in the organ being scanned, despite possessing identical densities, because the image value of a voxel of an organ depends on the position clarification in the image volume.
- 33. Performance of theX-ray tube and generator Quantitative assessment of image quality Display screen performance Patient dose assessment Clinical image quality assessment Clinical audit
- 35. Acquisition artifacts Cupping artifact and Streakand dark bands due to beam hardening of high dense objects Patient related artifacts Misregistration and bluntness and blurriness in image due to motion. Scanner related artifacts Circular or ring artifacts due to lack of detector calibration Cone beam related artifacts Partial volume averaging, Under sampling and Cone beam effect.
- 38.
- 39. Image noise – •Because radiation from the source transmitted through tissue in the body, the receptor receives non uniform information from radiation scattered in many directions termed as noise. Noise is 0.05 to 0.15 with conventional CT and can be as large as 0.4 to 2 in CBCT Poor soft tissue contrast - • Scattered radiation contributes to increased noise of the image which reduces the contrast of the cone DISADVANTAGE S ADVANTAGES
- 42. CBCT in DiagnosingFurcations, Caters, and Bony Defects CBCT in Measuring Alveolar Bone Density CBCT in the Visualization of Periodontal Ligament Space Soft tissue CBCT for the measurement of gingival tissue and the dimensions of the dentogingival unit CBCT for diagnostic imaging for the implant patient Other Periodontal Applications of CBCT
- 43. Reference : Tyndall DA, Rathore S. Cone-beam CT diagnostic applications: Caries, periodontal bone assessment, and endodontic applications. Dent Clin North Am 2008; Ito K, Yoshinuma N, Goke E, Arai Y, Shinoda K. Clinical application of a new compact computed tomography system for evaluating the outcome of regenerative therapy: A case report. J Periodontol 2001 soft tissue and alveolar bone levels in three dimensions, imaging of periodontal intrabony defects, dehiscence and fenestration defects, diagnosis of furcation-involved molars, and implant site imaging
- 44. Reference : WalterC, Weiger R, Zitzmann NU. Accuracy of three - dimensional imaging in assessing maxillary molar furcation involvement. J Clin Periodontol 2010
- 45. Reference : OzmericN, Kostioutchenko I, Hägler G, Frentzen M, Jervøe- Storm PM. Cone-beam computed tomography in assessment of periodontal ligament space: In vitro study on artificial tooth model. Clin Oral Investig 2008;12:233-9.
- 46. Reference : MischKA, Yi ES, Sarment DP. Accuracy of cone beam computed tomography for periodontal defect measurements. J Periodontol 2006
- 48. to visualize andprecisely measure distances corresponding to the hard and soft tissues of the periodontium and dentogingival attachment apparatus Clinicians are able to determine the relationships between Gingival margin and the facial bone crest, Gingival margin and the cemento- enamel junction (CEJ), CEJ and facial bone crest.
- 50. Persson et al.reported that conventional radiographic images provided a better resolution of the bone levels than what can be achieved from computer screen images Mol and Balasundaram found that CBCT provided slightly better diagnostic and quantitative information on periodontal bone levels in three dimensions than conventional radiography. They found that the accuracy in the anterior aspect of the jaws is limited in both imaging techniques, obtained with traditional means.
- 53. Advanced Radiographic Diagnosis Post- surgical Evaluation Braun et al. have reported that CBCT is superior to Intraoral Radiograph in the detection of intrabony defects and furcation involvement. Overall, correct identification of intrabony defects occurred 82.7% using IOR and 99.7% with CBCT. Brags et al. had similar findings regarding the detection of dehiscence (46.8% versus 78.2%) and fenestration (25.7% versus 89.1%) when comparing IOR versus CBCT. Padmanabhan et al. determined that there was no statistical significance between CBCT and direct intra- surgical measurements regarding furcation height, width, and depth.
- 54. Walter et al.studied the accuracy of conventional assessment, clinical exam with IORs, to conventional assessment with additional CBCT evaluation for determination of degree of furcation involvement and appropriateness of treatment planning of maxillary molars with furcation involvement. The degree of furcation involvement determined by conventional assessment was accurate only 27% of the time; CBCT 41% of the time. Nikolic-Jakoba et al. on CBCT for detection of intrabony and furcation defects concluded that insufficient evidence was available to support the use of CBCT. Zhao et al. reported CBCT has the ability to assess root concavities of first premolars and associated pattern of bone loss. They identified five types of roots concavities based on origination of the concavity. Type I had no concavity, Type II the concavity originated in the enamel, Type II was coincidence with the CEJ, Type IV below the CEJ (but in the top 2/3 s of the root), and Type V was within the bottom 1/3 of the root. The associated pattern of bone loss was classified as a Ramp, Plane, or Crater. Banodkar et al. found that CBCT was highly accurate at both detection of periodontal defects and determination of type of defect while also very precisely being able to measure the vertical depths of the defects. Feijo et al. [21] reported that there was no statistical difference in between measurements of horizontal bone loss when measured by either CBCT or direct intra-surgical measurements Although the data is rather limited, it is beginning to highlight some specific clinical situations where CBCT may be a beneficial adjunct to conventional assessment.
- 55. CBCT can allowa clinician to locate and map vital structures, such as the inferior alveolar, lingual, mental, or greater palatine nerves when planning surgical therapies. Utilized for evaluation of biotype by measuring hard and soft tissue thickness of the alveolar process. Used to detect facial plate thickness and for identification of a dehiscence or fenestrations over root surfaces. This information can aid in diagnosing altered passive eruption (based on crestal bone level in relationship with the CEJ of the teeth) and surgical planning, especially for advanced soft and/or hard tissue augmentation. One of the most useful applications of CBCT assessment is for post treatment evaluation. Reference: Yilmaz H.G.; Boke F.; Ayali A. Cone-beam computed tomography evaluation of the soft tissue thickness and greater palatine foramen location in the palate. J. Clin. Periodontol. 2015 Reference: Gambarini G.; Miccoli G.; Gaimari G.; Pompei D.; Pilloni A. Detection of Bone Defects Using CBCT Exam in an Italian Population. Int. J. Dent. 2017
- 58. Reference: Mandelaris, G.A.;Scheyer, E.T.; Evans, M.; Kim, D.; McAllister, B.; Nevins, M.L.; Rios, H.F.; Sarment, D. American Academy of Periodontology Best Evidence Consensus Statement on Selected Oral Applications for Cone-Beam Computed Tomography. J. Periodontol. 2017 Reference: McAllister, B.S.; Eshraghi, V.T. Commentary: Cone-Beam Computed Tomography: An Essential Technology for Management of Complex Periodontal and Implant Cases. J. Periodontol. 2017
- 60. Intra-oral = 0.001mSv up to 0.004 mSv Full-mouth set = 0.080 mSv Lateral cephalogram = 0.002 mSv Dental panoramic technique = 0.015 mSv CBCT (both jaws) = 0.068 mSv Hospital CT scan (both jaws) = 0.6 mSv
- 62. White and Pharoah’sOral Radiology : Principles and Interpretation – 8th edition Dental Applications of Computerized Tomography. Stephen L . G. Rothman Fundamentals of Special Radiographic Procedures - 5th ed. Albert M. Snopek. CBCT : A guide to Periodontologist; K. Tarun et al. 2020 Three-dimensional imaging in periodontal diagnosis – Utilization of cone beam computed tomography; S. Archana et al. 2020 Role of Cone-Beam Computed Tomography in the Management of Periodontal Disease – A Review; V. Thomas Eshraghi et al. 2019 Role of cone beam computed tomography in periodontics - A review; J. Asish 2018 Diagnostic Applications of Cone-Beam CT for Periodontal Diseases – A Review; Yousef A. AlJehani 2014 Scott R. Makins,Artifacts Interfering with Interpretation of Cone Beam Computed Tomography Images.2014 Use of cone beam computed tomography in periodontology; Buket Acar et al. 2014