Cone beam CT and orthodontic diagnosis – a personal view

Isaacson, K. G.

doi:10.1179/1465312513z.00000000062

Cited by 6 publications

(3 citation statements)

References 10 publications

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“…Finally, all subjects in this study received 16‐cm field‐of‐view and 0.3‐mm voxel‐size CBCT scans. This may be considered by some investigators a higher radiation exposure than our research focus on the maxillary canine region in this project, especially according to the European guidelines (Isaacson, ). This potential limitation is largely associated with the use of a retrospective sample of orthodontic patients as mentioned above, whose imaging records were used for both treatment planning and research.…”

Section: Discussionmentioning

confidence: 99%

Buccally impacted maxillary canines increase the likelihood of root separation in adjacent first premolars

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Buccally impacted maxillary canines increase the likelihood of root separation in adjacent first premolars

et al. 2016

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“…The ubiquitous and erroneous practice of taking a large volume CBCT for the whole head merely to synthesize panoramic and cephalometric views does not follow the ALADAIP directive, because it does not keep radiation as low as diagnostically acceptable, and it is neither indication-oriented nor patient-specific. If the orthodontic patient requires only two-dimensional panoramic and cephalometric radiographs, these radiographs could be taken without the additional exposure burden that comes with large CBCT volumes [166,167,168]. It also behooves the practitioner to utilize all 3D capabilities of the CBCT scan, and not to be limited to the two-dimensional panoramic and cephalometric views if a large volume is taken.…”

Section: Following the Alara And Aladaip Principlesmentioning

confidence: 99%

Cone-Beam Computed Tomography in Orthodontics

Abdelkarim

2019

Dentistry Journal

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Unlike patients receiving implants or endodontic treatment, most orthodontic patients are children who are particularly sensitive to ionizing radiation. Cone-beam computed tomography (CBCT) carries risks and benefits in orthodontics. The principal risks and limitations include ionizing radiation, the presence of artifacts, higher cost, limited accessibility, and the need for additional training. However, this imaging modality has several recognized indications in orthodontics, such as the assessment of impacted and ectopic teeth, assessment of pharyngeal airway, assessment of mini-implant sites, evaluation of craniofacial abnormalities, evaluation of sinus anatomy or pathology, evaluation of root resorption, evaluation of the cortical bone plate, and orthognathic surgery planning and evaluation. CBCT is particularly justified when it brings a benefit to the patient or changes the outcome of the treatment when compared with conventional imaging techniques. Therefore, CBCT should be considered for clinical orthodontics for selected patients. Prescription of CBCT requires judicious and sound clinical judgment. The central question of this narrative review article is: when does CBCT add value to the practice of orthodontics? To answer this question, this article presents discussion on radiation dosage of CBCT and other imaging techniques used in orthodontics, limitations of CBCT in orthodontics, justifying the use of CBCT in orthodontics, and the benefits and evidence-based indications of CBCT in orthodontics. This review summarizes the central themes and topics in the literature regarding CBCT in orthodontics and presents ten orthodontic cases in which CBCT proved to be valuable.

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“…Alternatively, taking a volume of 16 3 13 cm with the standard setting (85.3 mSv) or high resolution setting (171.1 mSv) merely to synthesize a reliable cephalometric image is not indicated either, because a 2D cephalometric radiograph could have been prescribed without exposing the patient to the additional radiation. 12,13 To do so would be at odds with appropriate radiographic selection criteria and the ALARA directive in radiation protection. 14 To use CBCT in orthodontics appropriately, we must identify its benefits and the reasons for its use.…”

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confidence: 99%

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Abdelkarim

2018

American Journal of Orthodontics and Dentofacial Orthopedics

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publications. Updated studies with recommendations based on the use of ULD CBCT technology vs 2D radiographic techniques would be beneficial. 3. CBCT scans with lower effective doses (ULD) inherently have lower resolution and thus lower image quality than higher resolution scans. Although high-resolution scans may be required for certain periodontic, endodontic, or oral surgical procedures, the quality of ULD CBCT scans is diagnostically acceptable for orthodontic purposes (ALADA) and is improving as the technology advances. 6 4. Concerns over the interpretation of CBCT scans taken for orthodontic diagnostic purposes continue, and the authors have reviewed these in detail. The interpretation of intraoral radiographs has been included in dental school curricula for more than half a century. Today, the interpretation of digital 2D intraoral and panoramic radiographs is taught in dental school. The interpretation and analysis of cephalometric radiographs (lateral and anteroposterior) are taught in our orthodontic residencies. At the 2017 American Association of Orthodontists' Winter Conference in Fort Lauderdale, Chris Bentson reported on a survey of recent (2016) orthodontic residency graduates in the United States: 88% responded that they had used CBCT imaging for diagnosis and treatment planning during their residencies. In my opinion, as ULD CBCT imaging becomes more common in orthodontics, just as it has become more common in orthodontic residency programs, the interpretation and analysis of CBCT scans must become part of orthodontic residency curricula. The availability of continuing education courses on this subject must also increase. Dental education has evolved with advances in technology, and the education in our specialty must evolve as well. The authors' conclusions are well thought out and concise. I agree with them fully, with 1 exception. "4. Consider CBCT imaging only when it is expected to yield a benefit to the patient or change the outcome of treatment over 2D radiographs." When exposure protocols (FOV, voxel size, scan time) are tailored to diagnostic needs, the current generation of ULD CBCT scanners can provide an immediate benefit-more diagnostic information with an effective dose equal to or less than 2D radiographs. My conclusion would be that CBCT imaging is acceptable for radiographic acquisition when its effective dose is less than or equal to comparable FOV 2D radiographs, or when it is expected to yield a benefit to the patient or change the outcome of treatment over 2D radiographs.

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Cone beam CT and orthodontic diagnosis – a personal view

Cited by 6 publications

References 10 publications

Buccally impacted maxillary canines increase the likelihood of root separation in adjacent first premolars

Buccally impacted maxillary canines increase the likelihood of root separation in adjacent first premolars

Cone-Beam Computed Tomography in Orthodontics

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