A 3-D Leap Toward Enhanced Patient Outcomes

The ability of cone-beam computed tomography (CBCT) to produce precise, detailed images of the underlying anatomy ensures accurate treatment planning and chairside decision making. The emergence of smaller, more compact CBCT systems is influenced by the advancements in computer processor and X-ray detector technologies from sensors.

As fixed prostheses grow in popularity, dentists must incorporate digital workflows to overcome difficult anatomy and avoid major site development surgery to make these historically impossible solutions, possible. However, CBCT is paramount for presurgical implant assessment, placement, and certain postsurgical evaluation, as endorsed by the International Congress of Oral Implantologists.^1,2 With this advanced imaging technique, practitioners can avoid potential complications such as nerve injuries, sinus perforation, and inaccuracies in placement, which are risks associate with conventional two-dimensional (2-D) imaging.³ Despite these advantages, proper training and experience are crucial for interpreting CBCT images accurately and ensuring successful surgical outcomes.⁴

Medical device companies and manufacturers introduced options to change the field of vision (FOV). Visualization of the path of root canals, root morphology, extent of periapical pathologies, and root fractures are studied by endodontists with limited FOV units.⁵ In orthodontics, CBCT aids in evaluating impacted or supernumerary teeth, determining their orientation for easier removal or surgical exposure.⁶

In surgically-facilitated orthodontic therapy, CBCT imaging helps with precise surgical planning, assessing bone quality, and avoiding vital structures such as nerves and blood vessels. Additionally, posttreatment CBCT scans can even evaluate the potential for bone remodeling after surgically-facilitated orthodontic therapy.⁷

CBCT has had a dramatically positive impact on the field of orthognathic surgery and trauma. Previously, 2-D images were used to estimate bony structures and skeletal morphology. With CBCT, surgeons can accurately produce images and identify the architecture of the bony structures beneath soft tissues.⁸

Preoperative planning can be performed with guides that can be conventionally or digitally prefabricated. Advanced computer-aided manufacturing allow for these guides to be designed from merged CBCT and intraoral scan files. Surgical outcomes can then be assessed by the visualization of plates, implants, and screws.⁹ Although scatter artifacts from metallic materials are present, the resulting CBCT images are still of diagnostic value.

CBCT is also helpful in identifying unlikely sources of pathology. It aids in quicker assessments of odontogenic pain tied to maxillary sinusitis.¹⁰ Pathologies previously diagnosed from panoramic images are better visualized with a CBCT.¹¹ More serious conditions, such as medication-related osteonecrosis of the jaw and squamous cell carcinoma, also benefit from CBCT diagnostics.^12,13

Dentists and radiologists have enjoyed the benefits of CBCT when it comes to temporomandibular joint (TMJ) evaluations. With traditional 2-D imaging, dentists had to interpret a patient’s condyle shape and size by experience.¹⁴ The CBCT rendering dramatically helps in our understanding of condylar interactions but also visualization of the TMJ complex.¹⁵

In conclusion, the emergence and adoption of CBCT in dentistry is not just a technological shift but a leap toward better patient care, sharper diagnostics, and more informed treatment planning.

References

1. Weiss R 2nd, Read-Fuller A. Cone beam computed tomography in oral and maxillofacial surgery: an evidence-based review. DenJ J (Basel). 2019;7:52.
2. Benavides E, Rios HF, Ganz SD, et al. Use of cone beam computed tomography in implant dentistry: the International Congress of Oral Implantologists consensus report. Implant Dent. 2012;21:78–86.
3. Scarfe WC, Farman AG. What is cone-beam ct and how does it work? Dent Clin North Am. 2008;52:707–730.
4. Pauwels R, Jacobs R, Singer SR, Mupparapu M. CBCT-based bone quality assessment: are Hounsfield units applicable? Dentomaxillofac Radiol. 2015;44:20140238.
5. Setzer FC, Lee SM. Radiology in endodontics. Dent Clin North Am. 2021;65:475–486.
6. Zengin AZ, Sumer AP, Ozturk G, Noujeim M. Imaging characteristics of enamel pearls on CBCT and their co-relation with supernumerary tooth. Oral Radiol. 2022;38:370–377.
7. Uribe F, Padala S, Allareddy V, Nanda R. Cone-beam computed tomograpy evaluation of alveolar ridge width and height changes after orthodontic space opening in patients with missing maxillary lateral incisions. Am J Orthod Dentofacial Orthop. 2013;144:649–659.
8. Philip MR, AlFotawi R. The accuracy of soft tissue movement using virtual planning for non-syndromic facial asymmetry cases-a systematic review. Oral Maxillofac Surg. 2023;27:187–200
9. Lonic D, Sundoro A, Lin HH, Lin PJ, Lo LJ. Selection of a horizontal reference plane in 3D evaluation: Identifying facial asymmetry and occlusal cant in orthognathic surgery planning. Sci Rep. 2017;7:2157.
10. Iwata E, Hasegawa T, Kobayashi M, et al. Can CT predict the development of oroantral fistula in patients undergoing maxillary third molar removal? Oral Maxillofac Surg. 2021;25:7–17.
11. Özeren Keşkek C, Aytuğar E, Çene E. Retrospective assessment of the anatomy and dimensions of nasopalatine canal with cone-beam computed tomography. J Oral Maxillofac Res. 2022;13:e4.
12. Ogura I, Minami Y, Ono J, et al. CBCT imaging and histopathological characteristics of osteoradionecrosis and medication-related osteonecrosis of the jaw. Imaging Sci Dent. 2021;51:73–80.
13. Chakraborty D, Natarajan C, Mukherjee A. Advances in oral cancer detection. Adv Clin Chem. 2019;91:181–200.
14. Shi J, Lee S, Pan HC, et al. Association of condylar bone quality with tmJ osteoarthritis. J Dent Res. 2017;96:888–894.
15. Khojastepour L, Vojdani M, Forghani M. The association between condylar bone changes revealed in cone beam computed tomography and clinical dysfunction index in patients with or without temporomandibular joint disorders. Oral Surg Oral Med Oral Pathol Oral Radiol. 2017;123:600–605.

From Decisions in Dentistry.November/December 2023; 9(10):46