USE OF CONE-BEAM COMPUTED TOMOGRAPHY IN ENDODONTICS

Joint Position Statement of the American Association of Endodontists and the American Academy of Oral and Maxillofacial Radiology

USE OF CONE-BEAM COMPUTED TOMOGRAPHY IN ENDODONTICS 

INTRODUCTION

The American Association of Endodontists (AAE) and the American Academy of Oral and Maxillofacial Radiology (AAOMR) have jointly developed this position statement. It is intended to provide scientifically based guidance to clinicians regarding the use of cone beam computed tomography (CBCT) in endodontic treatment as an adjunct to planar imaging. This document will be periodically revised to reflect new evidence.

Endodontic disease adversely affects quality of life and can produce significant morbidity in afflicted patients. Radiography is essential for the successful diagnosis of odontogenic and non-odontogenic pathoses, treatment of the pulp chamber and canals of a compromised tooth, biomechanical instrumentation, evaluation of final canal obturation, and assessment of healing.

Until recently, radiographic assessments in endodontic treatment have been limited to intraoral and panoramic radiography. These radiographic technologies provide two-dimensional representations of threedimensional tissues. If any element of the geometric configuration is compromised, the image can demonstrate errors¹. In more complex cases, radiographic projections with different beam angulations can allow parallax localization. However, complex anatomy and surrounding structures can make interpretation of planar “shadows” difficult.

CONE BEAM COMPUTED TOMOGRAPHY

The advent of CBCT has made it possible to visualize the dentition, the maxillofacial skeleton, and the relationship of anatomic structures in three-dimensions². Significantly increased use of CBCT is evidenced by a recent Web-based survey of active AAE members in the U.S. and Canada which found that 34.2% of 3,844 respondents indicated that they were utilizing CBCT. The most frequent use of CBCT among the respondents was for diagnosis of pathosis, preparation for endodontic treatment or endodontic surgery, and for assistance in the diagnosis of trauma related injuries³.

CBCT, as with any technology, has known limitations. There are also numerous CBCT equipment manufacturers and models available. In general, CBCT can be categorized into large, medium, and limited volume units based on the size of their “field of view.”

CBCT - Tomografia computerizată cu fascicul conic

CBCT (Cone beam computer tomography / Tomografie computerizată cu fascicul conic) încorporează o tehnologie de ultimă generație în domeniul imagisticii, ce permite vizualizarea în plan tridimensional a zonelor scanate.

Folosind un fascicul conic de raze X, scanerul CBCT are nevoie de o unică rotație în jurul pacientului pentru a prelua sute de imagini ale zonei de interes, ce sunt apoi reconstituite cu ajutorul unui software de imagistică, în vederea obținerii modelului virtual 3D al pacientului. Această imagine 3D permite o mai bună diagnosticare și planificare a tratamentului, în comparație cu radiografiile clasice bidimensionale, oferind maximum de informații cu o doză minimă de radiații.

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The use of cone-beam computed tomography in dentistry : An advisory statement from the American Dental Association Council on Scientific Affairs

The American Dental Association Council on JADA 2012;143(8):899-902 Scientific Affairs

The following resources related to this article are available online at jada.ada.org ( this information is current as of  November 2, 2012):

Updated information and services including high-resolution figures, can be found in the online version of this article at: http://jada.ada.org/content/143/8/899

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http://jada.ada.org/content/143/8/899/#BIBL

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The use of cone-beam computed tomography in dentistry

An advisory statement from the American Dental

Association Council on Scientific Affairs

The American Dental Association Council on Scientific Affairs

    The emergence of cone-beam computed tomography (CBCT) has expanded the field of oral and maxillofacial radiology. CBCT imaging provides three-dimensional volumetric data construction of dental and associated maxillofacial structures with isotropic resolution and high dimensional accuracy.

     A CBCT scanner uses a collimated x-ray source that produces a cone- or pyramid-shaped beam of xradiation, which makes a single full or partial circular revolution around the patient, producing a sequence of discrete planar projection images using a digital detector. These two-dimensional images are reconstructed into a three-dimensional volume that can be viewed in a variety of ways, including cross-sectional images and volume renderings of the oral anatomy.

Metoda imagistica cu fascicul conic – “De ce atata agitatie in legatura cu doza de radiatii?”

Introducere

Cea mai noua metoda imagistica disponibila medicilor dentisti isi exercita rapid impactul. Medicii dentisti generalisti, parodontologii, ortodontii, chirurgii buco-maxilo-faciali si alti specialisti au facut cu entuziasm primii pasi in faza de adoptare a noii metode. 

Evaluarea locului de implantare, a articulatiei temporomandibulare, a problemelor parodontale cu afectarea osului alveolar, a sinusurilor paranazale si aprecierea statusului cailor aeriene sunt doar catev adintre cele mai cunoscute aplicatii curente. Aproape continuu sunt gasite noi aplicatii. Ortodontii folosesc aceasta metoda pentru a identifica „locurile de ancorare” potrivite pentru dispozitivele de ancorare temporara, astfel incat sa li se faciliteze aditional actiunea de deplasare a dintilor sau de captare a dintilor inclusi si aducere a acestora intr-o pozitie favorabila eruptiei. Peste 5 ani, acest tip de metoda imagistica va fi folosit de majoritatea dentistilor. Daca va deveni atat de populara si omniprezenta, ar trebui sa intelegem raportul risc/beneficiu in privinta dozei de radiatii pentru un pacient, in functie de procedura stomatologica pentru care ne este necesara o cantitate atat de mare de informatie radiologica. Prin acest articol imi propun sa clarific cateva „nelamuriri” cu privire la doza de radiatii la care expunem pacientul, pentru a va ajuta pe dumneavoastra, colegii mei, sa luati decizia corecta in legatura cu utilizarea fasciculului conic.

Totul despre radiografiile dentare

Radiografia dentara reprezinta o parte integranta a practicii stomatologice si ii ajuta pe medicii de specialitate sa descopere problemele care nu sunt vizibile la o consultatie obisnuita: carii interdentare sau situate sub obturatii, scaderi in masa osoasa, frecvent intalnite in bolile parodontale, patologii care vizeaza camera pulpara sau canalul radicular, granuloame periapicale, chisturi, tumori beningne sau maligne, pregatirea si fixarea implanturilor, aparatelor ortodontice, precum si alte schimbari asociate cu bolile metabolice sau sistemice.

Cu ajutorul radiografiilor dentare se poate monitoriza eficient starea de sanatate a cavitatii bucale in general, dar, mai ales, la persoane cu lucrari protetice extinse, pacienti cu boala parodontala cronica, persoane care sufera de xerostomie sau uscaciune a gurii, persoane care consuma frecvent bauturi indulcite, fumatori, persoane cu o igiena bucala deficitara, persoane care prezinta modificari de PH a cavitatii bucale, etc.

Asadar, radiografiile dentare conduc medicul de specialitate catre un diagnostic cat mai precis si il  ajuta sa verifice succesul tratamentului, in toate etapele de lucru.

Contrar pacientilor mai putin informati, radiografia dentara nu prezinta riscuri pentru sanatate. In conditiile de siguranta prezentate de aparatura si dotarile suplimentare ale YTS-DENTAL VIEW, cantitatea de raze X (Roentgen) primite in urma unei examinari este foarte mica, iar riscul este neglijabil.