4: JUSTIFICATION AND REFERRAL CRITERIA
As with any X-ray exposure, CBCT
entails a risk to the patient. It is essential that any X-ray examination
should show a net potential benefit to the patient, weighing the total
potential diagnostic benefits it produces against the individual detriment that
the exposure might cause. The efficacy, benefits and risk of available
alternative techniques having the same objective but involving less (or no)
exposure to X-rays should be taken into account. A record of the justification
process must be made in the patient‟s clinical records.
All CBCT examinations
must be justified on an individual basis by demonstrating that the potential
benefits to the patients outweigh the potential risks. CBCT examinations
should potentially add new information to aid the patient‟s management. A
record of the Justification process must be maintained for each patient
ED BP
|
In order that the justification process
can be carried out, it is essential that selection of dental CBCT is based on
the individual patient‟s history and a clinical examination. The “routine” use
of dental CBCT on patients based on a generalised approach rather than
individual prescription is unacceptable. A “routine” (or “screening”)
examination is defined as one in which a radiograph is taken regardless of the
presence or absence of clinical signs and symptoms.
CBCT should not be
selected unless a history and clinical examination have been performed.
“Routine” or “screening” imaging is unacceptable practice
ED BP
|
Societal efficacy
Choosing dental CBCT for a patient
should also be based upon consideration of the prevalence of diseases, their
rates of progression and the diagnostic accuracy of CBCT, compared with
traditional techniques, for the application in question.
“Diagnostic efficacy” of any medical
imaging modality encompasses a spectrum of performance measures. The
hierarchical model presented by Fryback & Thornbury (1991) conceptualised
this into six levels of efficacy:
·
Technical efficacy
·
Diagnostic accuracy efficacy
·
Diagnostic thinking efficacy
·
Therapeutic efficacy
·
Patient outcome efficacy
·
Societal efficacy
In reviewing the literature on dental
CBCT, the Panel recognised that understanding of its diagnostic efficacy was
largely limited to the first two of these levels. Even for these, knowledge is
incomplete. Only a few publications were identified which address higher levels
of diagnostic efficacy. This means that the development of guidelines with high
evidence grades was precluded. It also highlights the need for clinical trials
which will provide information on “higher level” efficacies, notably Patient
Outcome Efficacy (e.g. the proportion of patients improved in a clinical
therapeutic procedure with the use of CBCT compared with the proportion
improved without CBCT).
Consulting guidelines facilitates the
process of selecting radiographs. Such guidelines, called “referral criteria”
or “selection criteria” exist for both medical and traditional dental imaging.
Radiographic referral criteria have been defined as:
“descriptions of clinical conditions
derived from patient signs, symptoms and history that identify patients who are
likely to benefit from a particular radiographic technique".
As with any guideline, these are not
intended to be rigid constraints on clinical practice, but a concept of good
practice against which the needs of the individual patient can be considered.
The term “referral criteria” is appropriate for medical practitioners, where
radiography is usually arranged by referral to a specialist in radiology. With
CBCT, this situation may also apply, with the dentist referring to a hospital
department or to a dentist-colleague. When acting as a referrer, the dentist
should ensure that adequate clinical information about the patient is provided
to the person taking responsibility for the exposure.
When referring a patient
for a CBCT examination, the referring dentist must supply sufficient clinical
information (results of a history and examination) to allow the CBCT
Practitioner to perform the Justification process
ED BP
|
In the Provisional Guideline document
(SEDENTEXCT 2009), referral criteria were devised for a range of uses of dental
CBCT that became apparent during the course of the systematic review, with
priority given to paediatric uses. In the interim period, before publication of
this current document, some European national organizations have presented
indications for the use of dental CBCT (Haute Autorité de Santé, 2009;
Leitlinie der DGZMK, 2009; Advies van de Hoge Gezondheidsraad, 2011); due
account has been taken of these.
These studies encompassed a good range
of dental CBCT equipment manufacturers and models. The results suggest that
differences between CBCT-derived measurements and the reference standard appear
to be small and are unlikely to be clinically significant. Laboratory studies
do not, however, take account of minor patient movements which, while difficult
to perceive in terms of poorer image quality, might contribute to added
discrepancy between the image dimensions and reality. The methodologies and the
objectives of these studies were usually very different, so that it remains
difficult to make valid comparisons between equipment. Clearly, as new
equipment is introduced, these kinds of efficacy studies should continue to be
performed. It would, however, be valuable if a standard battery of tests using
a commercially available phantom were prospectively adopted so that comparisons
of equipment could be most usefully made.
4.1.1 Dimensional accuracy of CBCT
One aspect of imaging which is
important to all aspects of clinical use of dental CBCT is dimensional
(geometric) accuracy. Clearly, however, this is of particular importance in
certain applications, such as implantology and orthodontics where accurate
quantitative information is required. There are numerous publications on linear
accuracy of dental CBCT and some dealing with angular measurements. Although
these fell outside the strict inclusion criteria of the systematic review of
diagnostic accuracy, the Panel conducted a separate review process for these
studies. While the search methodology for this element of the review may have
omitted some research of relevance, the Panel identified 50 publications where
the primary focus of studies was judged to be aspects of measurement accuracy
(Agbaje et al 2007; Al-Ekrish et al 2011; Al-Rawi et al 2010; Ballrick et al
2008; Baumgaertel et al 2009; Berco et al 2009; Brown et al 2009; Cattaneo et
al 2008; Cevidanes et al 2005; Chen et al 2008; Damstra et al 2010; Eggers et
al 2008; Eggers et al 2009; Fatemitabar et al 2010; Fourie et al 2010; Grauer
et al 2010; Gribel et al. 2011; Hassan et al. 2009; Hilgers et al 2005;
Kamburoğlu et al. 2010; Kobayashi et al 2004; Kumar et al 2007; Kumar et al
2008; Lagravère et al. 2008; Lamichane et al 2009; Lascala et al 2004; Liu et
al 2010; Loubele et al 2008; Ludlow et al 2007; Luk et al 2011; Lund et
al 2009; Marmulla et al 2005; Mischkowski et al 2007; Moerenhout et al 2009;
Moreira et al. 2009; Moshiri et al 2007; Naitoh et al 2009; Peck et al 2006;
Periago et al 2008; Pinsky et al 2006; Razavi et al 2010; Sakabe et al 2007;
Sherrard et al 2010; Stratemann et al 2008; Suomalainen et al 2008; Tsutsumi et
al 2011; Van Assche et al 2007; Van Elslande et al 2010; van Vlijmen et al
2009; Veyre-Goulet et al 2008).
4.1.2 References
Advies van de Hoge Gezondheidsraad nr.
8705. Dentale Cone Beam Computed Tomography. Brussel: Hoge Gezondheidsraad,
2011. www.hgr-css.be
Agbaje
JO, Jacobs R, Maes F, Michiels K, van Steenberghe D.
Volumetric analysis of extraction
sockets using cone beam computed tomography: a pilot study on ex vivo jaw bone.
J Clin Periodontol 2007; 34: 985-990.
Al-Ekrish AA, Ekram M. A comparative
study of the accuracy and reliability of multidetector computed tomography and
cone beam computed tomography in the assessment of dental implant site
dimensions. Dentomaxillofac Radiol. 2011; 40: 67-75.
Al-Rawi
B, Hassan B, Vandenberge B, Jacobs R. Accuracy assessment of three-dimensional
surface reconstructions of teeth from cone beam computed tomography scans. J
Oral Rehabil. 2010; 37: 352-358.
Ballrick
JW, Palomo JM, Ruch E, Amberman BD, Hans MG. Image distortion and spatial
resolution of a commercially available cone-beam computed tomography machine.
Am J Orthod Dentofacial Orthop 2008; 134: 573-582.
Baumgaertel S, Palomo JM, Palomo L,
Hans MG. Reliability and accuracy of cone-beam computed tomography dental
measurements. Am J Orthod Dentofacial Orthop 2009; 136: 19-25; discussion
25-28.
Berco M, Rigali PH Jr, Miner RM, DeLuca
S, Anderson NK, Will LA. Accuracy and reliability of linear cephalometric
measurements from cone-beam computed tomography scans of a dry human skull. Am
J Orthod Dentofacial Orthop. 2009; 136: 17.e1-9; discussion 17-8.
Brown AA, Scarfe WC, Scheetz JP,
Silveira AM, Farman AG. Linear accuracy of cone beam CT derived 3D images.
Angle Orthod. 2009 Jan;79(1):150-7.
Cattaneo PM, Bloch CB, Calmar D,
Hjortshoj M, Melsen B. Comparison between conventional and cone-beam computed
tomography-generated cephalograms. Am J Orthod Dentofacial Orthop 2008; 134:
798-802.
Cevidanes LHS, Bailey LJ, Tucker GR,
Jr., Styner MA, Mol A, Phillips CL, Proffit WR, Turvey T. Superimposition of 3D
cone-beam CT models of orthognathic surgery patients. Dentomaxillofac Radiol
2005; 34: 369-375.
Chen L-C, Lundgren T, Hallstrom H,
Cherel F. Comparison of different methods of assessing alveolar ridge dimensions
prior to dental implant placement. J Periodontol 2008; 79: 401-405.
Damstra J, Fourie Z, Huddleston Slater
JJR, Ren Y. Accuracy of linear measurements from cone-beam computed
tomography-derived surface models of different voxel sizes. Am J Orthod
Dentofacial Orthop 2010; 137: 16.e1-6; discussion 16-17.
Eggers G, Klein J, Welzel T, Muhling J.
Geometric accuracy of digital volume tomography and conventional computed
tomography. Br J Oral Maxillofac Surg 2008; 46: 639-644.
Eggers G, Senoo H, Kane G, Muhling J.
The accuracy of image guided surgery based on cone beam computer tomography
image data. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107: e41-48.
Fatemitabar SA, Nikgoo A. Multichannel
computed tomography versus cone-beam computed tomography: linear accuracy of in
vitro measurements of the maxilla for implant placement. Int J Oral Maxillofac
Implants. 2010 May-Jun;25(3):499-505.
Fourie Z, Damstra J, Gerrits PO, Ren Y.
Evaluation of anthropometric accuracy and reliability using different
three-dimensional scanning systems. Forensic Sci Int 2010; Oct 14. [Epub ahead
of print]
Fryback DG, Thornbury JR. The efficacy
of diagnostic imaging. Med Decis Making 1991; 11: 88-94.
Grauer D, Cevidanes LSH, Styner MA, Heulfe
I, Harmon ET, Zhu H, Proffit WR. Accuracy and landmark error calculation using
cone-beam computed tomography-generated cephalograms. Angle Orthod 2010; 80:
286-294.
Gribel BF, Gribel MN, Manzi FR, Brooks
SL, McNamara JA Jr.
Accuracy and reliability of
craniometric measurements on lateral cephalometry and 3D measurements on CBCT
scans. Angle Orthod. 2011; 81: 3-10.
Haute Autorité de Santé. Tomographie
Volumique a Faisceau Conique de la Face (Cone Beam Computerized Tomography).
Rapport d‟évaluation Technologique. Service évaluation des actes
professionnels. Saint-Denis La Plaine: Haute Autorité de Santé, 2009.
http://www.has-sante.fr
Hassan B, van der Stelt P, Sanderink G.
Accuracy of three-dimensional measurements obtained from cone beam computed
tomography surface-rendered images for cephalometric analysis: influence of
patient scanning position. Eur J Orthod. 2009 Apr;31(2):129-34.
Hilgers ML, Scarfe WC, Scheetz JP,
Farman AG. Accuracy of linear temporomandibular joint measurements with cone
beam computed tomography and digital cephalometric radiography. Am J Orthod
Dentofacial Orthop 2005; 128: 803-811.
Kamburoğlu K, Kolsuz E, Kurt H, Kılıç
C, Ozen T, Semra Paksoy C.
Accuracy of CBCT Measurements of a
Human Skull. J Digit Imaging. 2010 Sep 21. [Epub ahead of print]
Kobayashi K, Shimoda S, Nakagawa Y,
Yamamoto A. Accuracy in measurement of distance using limited cone-beam
computerized tomography. Int J Oral Maxillofac Implants 2004; 19: 228-231.
Kumar V, Ludlow J, Soares Cevidanes LH,
Mol A. In vivo comparison of conventional and cone beam CT synthesized
cephalograms. Angle Orthod 2008; 78: 873-879.
Kumar V, Ludlow JB, Mol A, Cevidanes L.
Comparison of conventional and cone beam CT synthesized cephalograms.
Dentomaxillofacl Radiol 2007; 36: 263-269.
Lagravère MO, Carey J, Toogood RW,
Major PW. Three-dimensional accuracy of measurements made with software on
cone-beam computed tomography images. Am J Orthod Dentofacial Orthop. 2008;
134: 112-116.
Lamichane M, Anderson NK, Rigali PH,
Seldin EB, Will LA. Accuracy of reconstructed images from cone-beam computed
tomography scans. Am J Orthod Dentofacial Orthop. 2009; 136: 156.e1-6;
discussion 156-7.
Lascala CA, Panella J, Marques MM.
Analysis of the accuracy of linear measurements obtained by cone beam computed
tomography (CBCT-NewTom). Dentomaxillofac Radiol 2004; 33: 291-294.
Leitlinie der DGZMK. Dentale
Volumentomographie (DVT) - S1 Empfehlung. Deutsche Zahnärztliche Zeitschrift
64, 2009: 490 - 496.
Liu Y, Olszewski R, Alexandroni ES,
Enciso R, Xu T, Mah JK. The validity of in vivo tooth volume determinations
from cone-beam computed tomography. Angle Orthod. 2010; 80:160-166.
Loubele M, Van Assche N, Carpentier K,
Maes F, Jacobs R, van Steenberghe D, Suetens P. Comparative localized linear
accuracy of small-field cone-beam CT and multislice CT for alveolar bone
measurements. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 105:
512-518.
Ludlow JB, Laster WS, See M, Bailey LTJ,
Hershey HG. Accuracy of measurements of mandibular anatomy in cone beam
computed tomography images. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2007; 103: 534-542.
Luk LC, Pow EH, Li TK, Chow TW.
Comparison of ridge mapping and cone beam computed tomography for planning
dental implant therapy. Int J Oral Maxillofac Implants 2011; 26: 70-74.
Lund H, Grondahl K, Grondahl HG.
Accuracy and precision of linear measurements in cone beam computed tomography
Accuitomo tomograms obtained with different reconstruction techniques.
Dentomaxillofac Radiol 2009; 38: 379-386.
Marmulla R, Wortche R, Muhling J,
Hassfeld S. Geometric accuracy of the NewTom 9000 Cone Beam CT. Dentomaxillofac
Radiol 2005; 34: 28-31.
Mischkowski RA, Pulsfort R, Ritter L,
Neugebauer J, Brochhagen HG, Keeve E, Zoller J E. Geometric accuracy of a newly
developed cone-beam device for maxillofacial imaging. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 2007; 104: 551-559.
Moerenhout BA, Gelaude F, Swennen GR, Casselman
JW, Van Der Sloten J, Mommaerts MY. Accuracy and repeatability of cone-beam
computed tomography (CBCT) measurements used in the determination of facial
indices in the laboratory setup. J Craniomaxillofac Surg. 2009; 37: 18-23.
Moreira CR, Sales MA, Lopes PM,
Cavalcanti MG. Assessment of linear and angular measurements on
three-dimensional cone-beam computed tomographic images. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod. 2009; 108: 430-436.
Moshiri M, Scarfe WC, Hilgers ML,
Scheetz JP, Silveira AM, Farman AG. Accuracy of linear measurements from
imaging plate and lateral cephalometric images derived from cone-beam computed
tomography. Am J Orthod Dentofacial Orthop 2007; 132: 550-560.
Naitoh M, Hirukawa A, Katsumata A,
Ariji E. Evaluation of voxel values in mandibular cancellous bone: relationship
between cone-beam computed tomography and multislice helical computed
tomography. Clin Oral Implants Res 2009; 20: 503-506.
Peck JN, Conte GJ. Radiologic
techniques using CBCT and 3-D treatment planning for implant placement. J Calif
Dent Assoc 2006; 36: 287-290.
Periago DR, Scarfe WC, Moshiri M,
Scheetz JP, Silveira AM, Farman AG. Kinear accuracy and reliability of cone
beam CT derived 3-dimensional images constructed using an orthodontic
volumetric rendering program. Angle Orthod 2008; 78: 387-395.
Pinsky HM, Dyda S, Pinsky RW, Misch KA,
Sarment DP. Accuracy of three-dimensional measurements using cone-beam CT.
Dentomaxillofac Radiol 2006; 35: 410-416.
Razavi T, Palmer RM, Davies J, Wilson
R, Palmer PJ. Accuracy of measuring the cortical bone thickness adjacent to
dental implants using cone beam computed tomography. Clin Oral Implants Res.
2010; 21: 718-725.
Sakabe J, Kuroki Y, Fujimaki S,
Nakajima I, Honda K. Reproducibility and accuracy of measuring unerupted teeth
using limited cone beam X-ray CT. Dentomaxillofac Radiol 2007; 36: 2-6.
SEDENTEXCT Guideline Development Panel.
Radiation Protection: Cone Beam CT for Dental and Maxillofacial Radiology
Provisional Guidelines 2009 (v 1.1 May 2009). www.sedentexct.eu
Sherrard JF, Rossouw PE, Benson BW,
Carrillo R, Buschang PH. Accuracy and reliability of tooth and root lengths
measured on cone-beam computed tomographs. Am J Orthod Dentofacial Orthop 2010;
137(4 Suppl): S100-8.
Stratemann SA, Huang JC, Maki K, Miller
AJ, Hatcher DC. Comparison of cone beam computed tomography imaging with
physical measures. Dentomaxillofac Radiol 2008; 37: 80-93.
Suomalainen A, Vehmas T, Kortesniemi M,
Robinson S, Peltola J. Accuracy of linear measurements using dental cone beam
and conventional multislice computed tomography. Dentomaxillofac Radiol 2008;
37: 10-17.
Tsutsumi K, Chikui T, Okamura K,
Yoshiura K. Accuracy of linear measurement and the measurement limits of thin
objects with cone beam computed tomography: effects of measurement directions
and of phantom locations in the fields of view. Int J Oral Maxillofac Implants.
2011; 26: 91-100.
Van Assche N, van Steenberghe D,
Guerrero ME, Hirsch E, Schutyser F, Quirynen M, Jacobs R. Accuracy of implant
placement based on pre-surgical planning of three-dimensional cone-beam images:
a pilot study. J Clin Periodontol 2007; 34: 816-821.
Van Elslande D, Heo G, Flores-Mir C,
Carey J, Major PW. Accuracy of mesiodistal root angulation projected by
cone-beam computed tomographic panoramic-like images. Am J Orthod Dentofacial
Orthop. 2010; 137 (4 Suppl):S94-9.
van Vlijmen OJC, Berge SJ, Swennen GRJ,
Bronkhorst EM, Katsaros C, Kuijpers-Jagtman AM (2009). Comparison of
cephalometric radiographs obtained from cone-beam computed tomography scans and
conventional radiographs. J Oral Maxillofac Surg 2009; 67: 92-97.
Veyre-Goulet S, Fortin T, Thierry A.
Accuracy of linear measurement provided by cone beam computed tomography to
assess bone quantity in the posterior maxilla: a human cadaver study. Clin
Implant Dent Relat Res 2008; 10: 226-230.
4.2: The developing dentition
Many children seek orthodontic treatment.
For children in the mixed dentition stage, where there are abnormalities in
eruption pattern, tooth position or signs of crowding, radiographs may be
required to determine the presence, absence, position and condition of teeth.
Most orthodontic appliance treatment takes place at around 12-13 years of age,
at which stage radiographs may be necessary to confirm the presence, absence,
position and condition of teeth as an aid to treatment planning.
Justification of X-ray examinations in
children is especially important because of the higher risks associated with
exposure in children (see section 2.4). Traditional radiological examination of
children undergoing orthodontic assessment relies on a panoramic radiograph,
supplemented by a lateral cephalometric radiograph in specific circumstances.
Intraoral radiographs are also used according to patient-specific needs. In
recent years, however, the availability of CBCT has led to this technique being
used by some clinicians as a means of radiological examination. The recent
review of Kapila et al (2011) provides a useful summary of the current status
of CBCT in orthodontics.
For assessment of facial bone shape,
position and inter-relationships, there must be a high accuracy of measurements
made with CBCT. Since the previous review, a large number of studies have been
published on dimensional accuracy (see Section 4.1.1), many using direct
measurement of skeletal material as a reference standard. Broadly speaking,
these can be summarised as demonstrating that dental CBCT has a high accuracy
for measurements, with any differences between image-derived measurements and
the reference standard being so small as to be clinically irrelevant.
The applications of dental CBCT in
assessment of the developing dentition for orthodontics will be considered
under two broad headings: localised applications to answer a specific question
and generalised application for examination of the entire dento-facial region.
4.2.1 Localised applications of CBCT
for the developing dentition
Unerupted
tooth localisation
A
frequent application of CBCT is for assessment of the position of an unerupted
tooth, particularly where the tooth is impacted. In these cases, an integral aspect
of the assessment is often the accurate identification of any resorption of
adjacent teeth. Such a situation is most often seen where maxillary canines are
ectopic and incisor roots are suspected of having undergone resorption (Walker
et al 2005). Traditional radiological assessment relies upon the use of
parallax movement between images taken with different perspectives. In some
specialised centres, MSCT has been used for this purpose, so some studies have
concentrated on this comparison of performance.
Teeth
are relatively large objects, having good contrast with the surrounding bone.
It is obvious that a three-dimensional imaging technique with acceptable
measurement accuracy and little distortion will identify position of teeth with
high diagnostic accuracy. A recent systematic review (Guerrero et al, 2011)
identified only four studies in which diagnostic accuracy had been determined
for CBCT in relation to impacted teeth against a reference standard, all of
which related to mandibular third molars (reviewed in Section 4.1.1). Our
systematic review also did not identify any diagnostic accuracy studies for
inclusion relevant to orthodontics.
In
the previous SEDENTEXCT review in 2009, the literature on this use of CBCT was
dominated by case reports and series (see Table 4.1) and those of Liu et al
(2007, 2008) were highlighted in view of their scale. On this occasion,
however, three studies (Haney et al 2010; Botticelli et al 2010; Katheria et al
2010) were identified by the Panel which measured aspects of “Diagnostic
Thinking Efficacy” and “Therapeutic Efficacy” (Fryback & Thornbury 1991).
Haney et al (2010) in a clinical study of impacted maxillary canine teeth,
showed that there were differences in diagnosis of tooth position between those
made using conventional radiography and those made using CBCT, although this
was only in a minority of observations. There were larger differences in
treatment plans when the two imaging methods were compared, while confidence in
diagnosis and treatment plans was greater when CBCT was used. Botticelli et al
(2010) showed that the understanding of canine position was different when CBCT
was used compared with conventional imaging and that, in a minority of cases,
treatment decisions were different. Similar findings for defining canine and
supernumerary tooth position were reported by Katheria et al (2010), while
observers in their study scored a significantly higher proportion of CBCT
examinations as “very useful” in treatment planning than for conventional radiographic
examinations. While there is a message here that the availability of CBCT
changes diagnosis and treatment plans for a proportion of cases, it must be
remembered that this may not be translated into better outcomes for patients.
Despite the expected
advantage of CBCT in tooth localisation, it is important to consider the impact
upon management of patients, the increased radiation dose and the likely higher
cost of CBCT examinations. Conventional radiography has served dentists and
specialist orthodontists well over many years, and the Panel concluded that
there is a need for research demonstrating changed (and improved) outcomes for
patients before widespread use of CBCT for this purpose could be considered. An
exception to this would be where current practice is to use MSCT for
localisation of unerupted teeth (Alqerban et al, 2009a). In such cases, CBCT is
likely to be preferred over MSCT if dose is lower. In any case, radiological
examination of maxillary canines is not usually necessary before 10 years of
age.
For the localised
assessment of an impacted tooth (including consideration of resorption of an
adjacent tooth) where the current imaging method of choice is MSCT, CBCT may
be preferred because of reduced
radiation dose
GP
|
External
resorption in relation to unerupted teeth
Assessment
of impacted tooth position also involves assessment of the presence or absence
of resorption in adjacent teeth. This application of CBCT has been considered
in several case series and non-systematic reviews (Table 4.1). The review of
Alqerban et al (2009a) considered this aspect in detail for the maxillary
canine.
The
Panel identified one relevant study for formal appraisal in the systematic
review of diagnostic accuracy (Alqerban et al 2009b) in which accuracy of
diagnosis of simulated resorption cavities in a skull was measured for
panoramic radiography and two CBCT systems. Their results showed that, overall,
sensitivity and specificity of CBCT were higher. Unfortunately their study did
not include intraoral radiography, which would normally be used in assessment
of impacted canines in this situation. Nonetheless, the studies on detection of
root resorption in an endodontic context, in which intraoral radiography was
the comparator imaging method (see Section 4.3.4), probably have relevance
here.
Three
clinical studies have considered resorption in relation to impacted teeth from
a “Diagnostic Thinking Efficacy” and “Therapeutic Efficacy” perspective. The study
of Haney et al (2010) on impacted maxillary canines reported that there was
agreement between conventional and CBCT imaging on diagnosis of root resorption
in the majority of assessments, while intra-rater reliability was lower for
CBCT based assessments. Katheria et al (2010) found a significantly greater
proportion of cases were scored by observers as showing resorption, although
there was no consideration of the possibility of false positive scores.
Alqerban et al (2011) compared observers‟ detection of root resorption in
relation to impacted canine teeth in a clinical study with no reference
standard. They reported a higher detection rate of “slight” resorption and a
lower detection rate of “no resorption” using CBCT than when using panoramic
radiographs, although they did not use intraoral radiographs for comparison.
The results of these
studies should stimulate a note of caution. While it seems likely that the
three-dimensional information of CBCT will identify resorption of roots more
effectively than conventional intraoral radiographs, particularly on the facial
and palatal surfaces, there is no research evidence to suggest that this
information, or any
Table 4.1: Orthodontic
applications of CBCT identified and reviewed
Application
of CBCT for orthodontics
|
Reference
|
Cleft
palate assessment
|
Hamada
et al 2005
Mussig
et al 2005
Oberoi
et al 2009
Oka
et al 2006
Schneiderman
et al 2009
Wortche
et al 2006
|
Tooth
position and localisation
|
Bedoya
and Park 2009
Chaushu
et al 2004
Gracco
et al 2009
Kau
et al 2005
Kau
et al 2009
Nakajima
et al 2005
Walker
et al 2005
Liu
et al 2007
Liu
et al 2008
Mussig
et al 2005
Swart
et al 2008
|
Resorption
related to impacted teeth
|
Kau
et al 2005
Liu
et al 2008
|
Measuring
bone dimensions for mini-implant placement
|
Baumgaertel,
2009
Baumgaertel
& Hans 2009a
Baumgaertel
et al 2009b
Gracco
et al 2006
Gracco
et al 2007
Gracco
et al 2008
Kim
et al 2007
Park
& Cho, 2009
|
For
rapid maxillary expansion
|
Christie
et al 2010
Garrett
et al 2008
King
et al 2007
|
3-dimensional
cephalometry
|
Baumrind
et al 2003
|
Surface
imaging integration
|
Swennen
& Scutyser 2006
|
Airway
assessment
|
Maal
et al 2008
Aboudara
et al 2003
Kau
et al 2005
|
Age
assessment
|
Shi
et al 2007
Yang
et al 2006
|
Investigation
of orthodontic-associated paraesthesia
|
Erickson
et al 2003
|
changes in treatment, would alter the
eventual outcomes. The Panel concluded that there was no strong evidence to
support using CBCT as a “first line” imaging method for assessment of impacted
maxillary canine or supernumerary teeth in the context of root resorption
diagnosis, but that it may be indicated when conventional intraoral radiography
did not supply adequate information.
CBCT may be indicated for
the localised assessment of an impacted tooth (including consideration of
resorption of an adjacent tooth) where the current imaging method of choice
is conventional dental radiography and when the information cannot be
obtained adequately by lower dose conventional (traditional) radiography
C
|
For the localised
assessment of an impacted tooth (including consideration of resorption of an
adjacent tooth), the smallest volume size compatible with the situation
should be selected because of reduced radiation dose. The use of CBCT units
offering only large volumes (craniofacial CBCT) requires very careful
justification and is generally discouraged
GP BP
|
Cleft
palate
MSCT
is a widely accepted method of assessing clefts, despite the significant
radiation dose. The use of CBCT in this application has been the subject of
several non-systematic reviews and descriptive studies (Müssig et al 2005;
Hamada et al 2005; Wörtche et al 2006; Korbmacher et al 2007).
Three-dimensional information can be used to determine the volume of bone
needed for grafting and the adequacy of bone fill after surgery (Oberoi et al
2009; Shirota et al 2010). The Panel found this application of CBCT to be the
simplest to support, in view of the established use of three-dimensional images
and the potentially lower dose of CBCT.
Where the current imaging
method of choice for the assessment of cleft palate is MSCT, CBCT may be
preferred if radiation dose is lower. The smallest volume size compatible
with the situation should be selected because of reduced radiation dose
GP
|
Temporary
orthodontic anchorage using “mini-implants”
Several studies have
used CBCT to measure the available bone thickness for placing temporary
anchorage devices (TADs), also known as mini-implants (Gracco et al 2006; King
et al 2006; Gracco et al 2007; Gracco et al 2008; Kim et al 2007; King et al
2007; Baumgaertel 2009; Fayed et al 2010). In our previous review it was noted
that at the time “it was not clear when reviewing these studies whether the
aim was to measure bone thickness (using CBCT as a convenient method of
assessment) or whether CBCT was being proposed as a routine diagnostic tool”. Subsequently,
it now appears that CBCT is being used by some as a clinical tool prior to
placing TADs to identify optimal position and to avoid damage to roots (Lai et
al 2010; Kapila et al 2011). The use of surgical guides based on CBCT data has
also been suggested (Miyazawa et al 2010). Jung et al (2010) evaluated whether
CT or CBCT was needed preoperatively for placement of TADs; they found that
three dimensional imaging was only needed in rare cases of borderline
dimensions.
CBCT is not normally
indicated for planning the placement of temporary anchorage devices in
orthodontics
GP
|
4.2.2 Generalized application of CBCT
for the developing dentition
Large
volume (craniofacial) CBCT, imaging at least the entire facial skeleton, is currently
being used as a routine tool for orthodontic-related radiological assessment by
some clinicians (Kapila et al 2011; Smith et al 2011), particularly outside
Europe. In view of the radiation doses involved and the (largely) paediatric
age group of patients, this practice has become controversial and requires very
critical consideration.
The
European Guidelines on Radiation Protection in Dental Radiology (European
Commission, 2004) highlighted the research performed, prior to the introduction
of CBCT, which shows that clinical indicators and algorithms can reduce the
numbers of radiographs without compromising patient treatment. Various studies
have shown that radiographic information changes diagnosis and treatment plans
in a minority of patients and there is specific evidence that cephalometric
radiography is not always contributory to treatment planning (Han et al 1991;
Bruks et al 1999; Nijkamp et al 2008; Devereux et al 2011). A flow-chart to
support clinical decision making on the need for lateral cephalograms was
included in the British Orthodontic Society Guidelines of 2002 and in a recent
new edition (Isaacson et al 2008). Similar algorithms for selecting radiographs
for orthodontic patients have been presented in European Guidelines (European
Commission, 2004).
In
our current review, no studies were identified relevant to “Diagnostic
Accuracy”. This was not surprising, bearing in mind that orthodontic diagnosis
does not normally involve detection of pathosis in the usual sense. Studies of
measurement accuracy (see Section 4.1.1) are highly relevant to the tasks
involved in orthodontic diagnosis and treatment planning and suggest that CBCT
can produce accurate depictions of tooth size, tooth inter-relationships and
related bony anatomy. There is evidence that cephalograms synthesised from CBCT
volume datasets are accurate (Cattaneo et al 2008; Kumar et al 2007; Kumar et
al 2008), although existing guidelines state that it is inappropriate to
perform CBCT solely for the purposes of reconstructing two-dimensional
panoramic and cephalometric images (Health Protection Agency, 2009), a view
fully supported by the SEDENTEXCT Panel.
As
in our previous review, the Panel felt that much of the literature on using
large volume CBCT for routine orthodontic diagnosis and treatment was
anecdotal, case report- and opinion-based, with a lack of evidence of
significant clinical impact. While localised uses of CBCT (Section 4.2.1) have
supporting research evidence, no scientifically valid evidence was identified
to support the use of large volume CBCT at any stage of orthodontic treatment.
Amongst the justifications of using CBCT instead of conventional radiography
are that it allows accurate establishment of “boundary conditions” (Kapila et
al 2011) in patients with bucco-lingually narrow alveolar bone, compromised
periodontal or gingival anatomy and where movement of a tooth may involve
translocation past another tooth or obstruction. The Panel recognised that
there may be instances where three-dimensional information could assist in
patient management, but could not find evidence to define these situations. The
use of three-dimensional cephalometry has been presented by some authors as a
means of improved diagnosis and management, but the evidence for this opinion
is absent and there is no universally accepted method of three-dimensional
cephalometric landmark analysis.
As
such, the Panel could not recommend CBCT as a standard method of diagnosis and treatment
planning in orthodontic practice. This is in accord with national guidelines
within Europe (Isaacson et al, 2008; Haute Autorité de Santé 2009; Leitlinie
der DGZMK, 2009) and the recommendation of the American Association of
Orthodontists (American Association of Orthodontists, 2010). The Panel could,
however, see the potential value of large volume CBCT for assessment of
patients with complex craniofacial deformity requiring surgical or combined
surgical/orthodontic intervention at 16 years or over as part of planning for
the definitive procedure. Serial “monitoring” of skeletal growth should be
discouraged.
Large volume CBCT should
not be used routinely for orthodontic diagnosis
D
|
For complex cases of
skeletal abnormality, particularly those requiring combined
orthodontic/surgical management, large volume CBCT may be justified in
planning the definitive procedure, particularly where MSCT is the current
imaging method of choice
GP
|
When health professionals change their
practice to adopt a more expensive diagnostic technique, particularly where
there are radiation-related risks in a predominantly young patient age group,
the onus is upon them to demonstrate significant improvement in patient
outcomes.
Research is needed to
define robust guidance on clinical selection for large volume CBCT in
orthodontics, based upon quantification of benefit to patient outcome
GP
|
4.2.3
References
Aboudara CA, Hatcher D, Nielsen IL,
Miller A. A three-dimensional evaluation of the upper airway in adolescents.
Orthodontics & Craniofacial Research 2003; 6 Suppl 1: 173-175.
Alqerban A, Jacobs R, Lambrechts P,
Loozen G. Root resorption of the maxillary lateral incisor caused by impacted
canine: a literature review. Clin Oral Investigation 2009a; 13: 247-255.
Alqerban A, Jacobs R, Souza PC, Willems
G. In-vitro comparison of 2 cone-beam computed tomography systems and panoramic
imaging for detecting simulated canine impaction-induced external root
resorption in maxillary lateral incisors. Am J Orthod Dentofacial Orthop.
2009b; 136: 764.e1-11; discussion 764-5.
Alqerban
A, Jacobs R, Fieuws S, Willems G. Comparison of two cone beam computed
tomographic systems versus panoramic imaging for localization of impacted
maxillary canines and detection of root resorption. Eur J Orthod. 2011; 33:
93-102.
American Association of Orthodontists.
Statement on the role of CBCT in orthodontics (26-10 H). eBulletin May 7
2010. www.aaomembers.org/Resources/Publications/ebulletin-05-06-10.cfm.
[Accessed 18 March 2011].
Ballrick JW, Palomo JM, Ruch E, Amberman
BD, Hans MG. Image distortion and spatial resolution of a commercially
available cone-beam computed tomography machine. Am J Orthod Dentofacial Orthop
2008; 134: 573-582.
Baumgaertel
S. Quantitative investigation of palatal bone depth and cortical bone thickness
for mini-implant placement in adults. Am J Orthod Dentofacial Orthop. 2009
Jul;136(1):104-8.
Baumrind S, Carlson S, Beers A, Curry S,
Norris K, Boyd Rl. Using three-dimensional imaging to assess treatment outcomes
in orthodontics: a progress report from the University of the Pacific. Orthod
Craniofac Res 2003; 6 Suppl 1: 132-142.
Bedoya MM, Park JH. A review of the
diagnosis and management of impacted maxillary canines. J Am Dent Assoc 2009;
140(12): 1485-93
Botticelli S, Verna C, Cattaneo PM,
Heidmann J, Melsen B. Two- versus three-dimensional imaging in subjects with
unerupted maxillary canines. Eur J Orthod. 2010 Dec 3. [Epub ahead of print]
Bruks A, Enberg K, Nordqvist I, Hansson
A, Jannson L, Svenson B. Radiographic examinations as an aid to orthodontic diagnosis
and treatment planning, Swed Dent J 1999; 23: 77–85.
Baumgaertel, S. Quantitative
investigation of palatal bone depth and cortical bone thickness for
mini-implant placement in adults. Am J Orthod Dentofacial Orthop 2009; 136(1):
104-8 .
Baumgaertel, S,Hans, MG. Assessment of
infrazygomatic bone depth for mini-screw insertion. Clin Oral Implants Res
2009; 20(6): 638-42.
Baumgaertel,
S,Hans, MG. Buccal cortical bone thickness for mini-implant placement. Am J
Orthod Dentofacial Orthop 2009; 136(2): 230-5.
Cattaneo PM, Bloch CB, Calmar D,
Hjortshøj M, Melsen B. Comparison between conventional and cone-beam computed
tomography-generated cephalograms. Am J Orthod Dentofacial Orthop 2008; 134:
798-802.
Chaushu S, Chaushu G, Becker A. The role
of digital volume tomography in the imaging of impacted teeth. World J Orthod
2004; 5: 120-132.
Christie KF, Boucher N,Chung C-H.
Effects of bonded rapid palatal expansion on the transverse dimensions of the
maxilla: a cone-beam computed tomography study. Am J Orthod Dentofacial Orthop
2010; 137(4 Suppl): S79-85
Devereux L, Moles D, Cunningham SJ,
McKnight M. How important are lateral cephalometric radiographs in orthodontic
treatment planning? Am J Orthod Dentofacial Orthop. 2011;139: e175-81.
Erickson M, Caruso JM, Leggit L. Newtom
QR-DVT 9000 imaging used to confirm a clinical diagnosis of iatrogenic
mandibular nerve paresthesia. J Calif Dent Assoc 2003; 31: 843-845.
Fayed MM, Pazera P, Katsaros C. Optimal
sites for orthodontic mini-implant placement assessed by cone beam computed
tomography. Angle Orthod 2010; 80: 939-951.
Garrett BJ, Caruso JM, Rungcharassaeng
K, Farrage JR, Kim JS, Taylor GD. Skeletal effects to the maxilla after rapid
maxillary expansion assessed with cone-beam computed tomography. Am J Orthod
Dentofacial Orthop 2008; 134: 8-9.
Gracco
A, Lombardo L, Cozzani M, Siciliani G. Quantitative evaluation with CBCT of
palatal bone thickness in growing patients. Prog Orthod 2006; 7: 164-174.
Gracco A, Luca L, Cozzani M, Siciliani G.
Assessment of palatal bone thickness in adults with cone beam computerised
tomography. Aust Orthod J 2007; 23: 109-113.
Gracco A, Lombardo L, Cozzani M,
Siciliani G. Quantitative cone-beam computed tomography evaluation of palatal
bone thickness for orthodontic miniscrew placement (2008) Am J Orthod
Dentofacial Orthop 2008; 134: 361-369.
Gracco
A, Lombardo L, Mancuso G, Gravina V, Siciliani, G. Upper incisor position and
bony support in untreated patients as seen on CBCT. Angle Orthodontist 2009;
79(4): 692-702
Guerrero ME, Shahbazian M, Elsiena
Bekkering G, Nackaerts O, Jacobs R, Horner K. The diagnostic efficacy of cone
beam CT for impacted teeth and associated features: a systematic review. J Oral
Rehabil 2011; 38: 208-216.
Hahn W, Fricke-Zech S, Fricke J, Gruber
RM, Dullin C, Zapf A, Hannig C, Kubein-Meesenburg D, Sadat-Khonsari R.
Detection and size differentiation of simulated tooth root defects using
flat-panel volume computerized tomography (fpVCT). Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 2009; 107:272-278.
Han UK, Vig. KW, Weintraub JA, Vig PS,
Kowalski CJ. Consistency of orthodontic treatment decisions relative to
diagnostic records, Am J Orthod Dentofacial Orthop 1991; 100: 212–219.
Haney E, Gansky SA, Lee JS, Johnson E,
Maki K, Miller AJ. Comparative analysis of traditional radiographs and
cone-beam computed tomography volumetric images in the diagnosis and treatment
planning of maxillary impacted canines. Am J Orthod Dentofacial Orthop 2010;
137: 590-597.
Hamada Y, Kondoh T, Noguchi K, Iino M,
Ishii H, Mishima A, Kobayashi K, Seto K. Application of limited cone beam
computed tomography to clinical assessment of alveolar bone grafting: a
preliminary report. Cleft palate Craniofac J 2005; 42: 128-137.
Haute Autorité de Santé. Tomographie
Volumique a Faisceau Conique de la Face (Cone Beam Computerized Tomography).
Rapport d‟évaluation Technologique. Service évaluation des actes
professionnels. Saint-Denis La Plaine: Haute Autorité de Santé, 2009. http://www.has-sante.fr
Health Protection Agency. The Radiation
Protection Implications of the Use of Cone Beam Computed Tomography (CBCT) in
dentistry – What You Need To Know. Chilton: Health Protection Agency, 2009.
Isaacson
KG, Thom AR, Horner K, Whaites E. Orthodontic Radiographs. Guidelines for the
use of radiographs in orthodontics. British Orthodontic Society: London, 2008.
Jung BA, Wehrbein H, Wagner W, Kunkel M.
Preoperative Diagnostic for Palatal Implants: Is CT or CBCT Necessary? Clin
Implant Dent Relat Res. 2010; Feb 3. [Epub ahead of print]
Kapila S, Conley RS, Harrell Jr WE. The
current status of cone beam computed tomography imaging in orthodontics.
Dentomaxillofac Radiol 2011; 40: 24-34.
Katheria BC, Kau CH, Tate R, Chen JW,
English J, Bouquot J. Effectiveness of impacted and supernumerary tooth
diagnosis from traditional radiography versus cone beam computed tomography.
Pediatr Dent. 2010; 32: 304-309.
Kau CH, Richmond S, Palomo JM, Hans MG.
Three-dimensional cone beam computerized tomography in orthodontics. J Orthod
2005; 32: 282-293.
Kau CH, Pan P, Gallerano RL, English JD.
A novel 3D classification system for canine impactions--the KPG index. The
International Journal of Medical Robotics and Computer Assisted Surgery: MRCAS
2009; 5(3): 291-6
Kim S, Choi Y, Hwang E, Chung K, Kook Y,
Nelson G. Surgical positioning of orthodontic mini-implants with guides
fabricated on models replicated with cone-beam computed tomography. Am J Orthod
Dentofacial Orthop 2007; 131: S82-S89.
King KS, Lam EW, Faulkner MG, Heo G,
Major PW. Predictive factors of vertical bone depth in the paramedian palate of
adolescents." Angle Orthod 2006; 76: 745-751.
King KS, Lam EW, Faulkner MG, Heo G,
Major PW. Vertical bone volume in the paramedian palate of adolescents: a
computed tomography study. Am J Orthod Dentofacial Orthop 2007; 132: 783-788.
Korbmacher
H, Kahl-Nieke B, Schollchen M, Heiland M. Value of two cone-beam computed
tomography systems from an orthodontic point of view. J Orofac Orthop 2007; 68:
278-289.
Kumar V. In Vivo Comparison of
Conventional and Cone Beam CT Synthesized Cephalograms. Angle Orthodont 2008;
78: 873-879.
Kumar V, Ludlow JB, Mol A, Cevidanes L.
Comparison of conventional and cone beam CT synthesized cephalograms. Dentomaxillofac
Radiol 2007; 36: 263-269.
Lai RF, Zou H, Kong WD, Lin W. Applied
anatomic site study of palatal anchorage implants using cone beam computed
tomography. Int J Oral Sci 2010; 2: 98-104.
Lane C, Harrell W. Completing the
3-dimensional picture. Am J Orthod Dentofacial Orthop 2008; 133: 612-620.
Lascala CA, Panella J, Marques MM.
Analysis of the accuracy of linear measurements obtained by cone beam computed
tomography (CBCT-NewTom). Dentomaxillofac Radiol 2004; 33: 291-294.
Leitlinie der DGZMK. Dentale
Volumentomographie (DVT) - S1 Empfehlung. Deutsche Zahnärztliche Zeitschrift
64, 2009: 490 - 496.
Liedke GS, Dias de Silveira HE, Dias de
Silveira HL, Dutra V, Poli de Figueiredo JA. Influence of Voxel Size in the
Diagnostic Ability of Cone Beam Tomography to Evaluate Simulated External Root
Resorption. J Endod 2009; 35: 233-235.
Liu
D, Zhang W, Zhang z, Wu Y, Ma X. Three-dimensional evaluations of supernumerary
teeth using cone-beam computed tomography for 487 cases. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 2007; 103: 403-411.
Liu D, Zhang W, Zhang z, Wu Y, Ma X.
Localization of impacted maxillary canines and observation of adjacent incisor
resorption with cone-beam computed tomography. Oral Surg Oral Med Oral Pathol
Oral Radiol Endod 2008; 105: 91-98.
Loubele M, Van Assche N, Carpentier K,
Maes F, Jacobs R, Van Steenberghe D, Suetens P. Comparative localized linear
accuracy of small-field cone-beam CT and multislice CT for alveolar bone
measurements. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 105:
512-518.
Ludlow JB, Laster WS, See M, Bailey LTJ,
Hershey HG. Accuracy of measurements of mandibular anatomy in cone beam
computed tomography images. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2007; 103: 534-542.
Maal TJJ, Plooij JM, Rangel FA,
Mollemans W, Schutyser AC, Bergé SJ. The accuracy of matching three-dimensional
photographs with skin surfaces derived from cone-beam computed tomography. Int
J Oral Maxillofac Surg 2008; 37: 641-646.
Marmulla R, Wörtche R, Muhling J,
Hassfeld S. Geometric accuracy of the NewTom 9000 Cone Beam CT. Dentomaxillofac
Radiol 2005; 34: 28-31.
Mischkowski RA, Pulsfort R, Ritter L,
Neugebauer J, Brochhagen HG, Keeve E, Zoller J E. Geometric accuracy of a newly
developed cone-beam device for maxillofacial imaging. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 2007; 104: 551-559.
Miyazawa K, Kawaguchi M, Tabuchi M, Goto
S. Accurate pre-surgical determination for self-drilling miniscrew implant
placement using surgical guides and cone-beam computed tomography. Eur J Orthod
2010; 32: 735-740.
Moshiri M, Scarfe WC, Hilgers ML,
Scheetz JP, Silveira AM, Farman AG. Accuracy of linear measurements from
imaging plate and lateral cephalometric images derived from cone-beam computed
tomography. Am J Orthod Dentofacial Orthop 2007; 132: 550-560.
Müssig
E, Wörtche R, Lux CJ. Indications for digital volume tomography in
orthodontics. J Orofac Orthop 2005; 66: 241-249.
Nakajima A, Sameshima GT, Arai Y, Homme
Y, Shimizu N, Dougherty H. Two- and three-dimensional orthodontic imaging using
limited cone beam-computed tomography. Angle Orthod 2005; 75: 895-903.
Nijkamp P, Habets L, Aartman I, Zentner
A, The influence of cephalometrics on orthodontic treatment planning, Eur J
Orthod 2008; 30: 630–635.
Oberoi S, Chigurupati R, Gill P, Hoffman
WY, Vargervik K. Volumetric assessment of secondary alveolar bone grafting
using cone beam computed tomography. Cleft Palate Craniofac J. 2009
Sep;46(5):503-11.
Ogawa T, Enciso R, Shintaku WH, Clark
GT. Evaluation of cross-section airway configuration of obstructive sleep
apnea. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103: 102-108.
Oka, H, Moriguchi, T,Sato, Y.
Postoperative assessment of secondary bone grafting to the alveolar cleft using
three-dimensional cone beam computed tomography. Japanese Journal of Plastic
and Reconstuctive Surgery 2006; 49(1): 49-57.
Park J, Cho HJ. Three-dimensional
evaluation of interradicular spaces and cortical bone thickness for the
placement and initial stability of microimplants in adults. Am J Orthod
Dentofacial Orthop 2009; 136(3): 314.e1-12; discussion 314-5
Peck JN, Conte GJ. Radiologic techniques
using CBCT and 3-D treatment planning for implant placement. J Calif Dent Assoc
2006; 36: 287-290.
Periago DR, Scarfe WC, Moshiri M,
Scheetz JP, Silveira AM, Farman AG. Kinear accuracy and reliability of cone
beam CT derived 3-dimensional images constructed using an orthodontic
volumetric rendering program. Angle Orthod 2008; 78: 387-395.
Rungcharassaeng K, Caruso JM, Kan JY,
Kim J, Taylor G. Factors affecting buccal bone changes of maxillary posterior
teeth after rapid maxillary expansion. Am J Orthod Dentofacial Orthop 2007;
132: 428.e1-8.
Schneiderman
ED, Xu H, Salyer, KE. Characterization of the maxillary complex in unilateral
cleft lip and palate using cone-beam computed tomography: a preliminary study.
J Craniofac Surg 2009; 20 Suppl 2: 1699-710
Shi H, Scarfe WC, Farman AG. (2007).
Three-dimensional reconstruction of individual cervical vertebrae from cone-beam
computed-tomography images. Am J Orthod Dentofacial Orthop 2007; 131: 426-432.
Shirota T, Kurabayashi H, Ogura H, Seki
K, Maki K, Shintani S. Analysis of bone volume using computer simulation system
for secondary bone graft in alveolar cleft. Int J Oral Maxillofac Surg 2010;
39: 904-908.
Smith BR, Park JH, Cederberg RA. An
evaluation of cone-beam computed tomography use in postgraduate orthodontic
programs in the United States and Canada. J Dent Educ. 2011; 75: 98-106.
Stratemann SA, Hunag JC, Maki K, Miller
AJ, Hatcher DC. Comparison of cone beam computed tomography imaging with
physical measures. Dentomaxillofac Radiol 2008; 37: 80-93.
Suomalainen A, Vehmas T, Kortesniemi M,
Robinson S, Peltola J. Accuracy of linear measurements using dental cone beam
and conventional multislice computed tomography. Dentomaxillofac Radiol 2008;
37: 10-17.
Swart RJ, Kiekens RMA, Borstlap WA,
Kuijpers-Jagtman AM. Orthodontics in general practice 4. Impaction of maxillary
front teeth. Nederlands Tijdschrift voor Tandheelkunde 2008; 115(5): 252-8
Swennen
GRJ, Schutyser F. Three-dimensional cephalometry: spiral multi-slice vs
cone-beam computed tomography." Am J Orthod Dentofacial Orthop 2006; 130:
410-416.
Wörtche R, Hassfeld S, Lux CJ, Müssig E,
Hensley FW, Krempien R, Hofele C. Clinical application of cone beam digital
volume tomography in children with cleft lip and palate. Dentomaxillofac Radiol
2006; 35: 88-94.
Walker L, Enciso R, Mah J.
Three-dimensional localization of maxillary canines with cone-beam computed
tomography. Am J Orthod Dentofacial Orthop 2005; 128: 418-423.
4.3: Restoring the dentition
4.3.1:
Dental caries diagnosis
The
use of CBCT as part of caries detection and diagnosis has been the subject of
several laboratory research studies on extracted teeth. The relative ease of
obtaining a valid reference standard means that the studies provide useful
evidence of diagnostic value. In the previous review, we noted that much of the
research had been performed using “limited” CBCT (small volumes with specific
equipment) and that results are not transferable to all CBCT machines, as pointed
out by Haiter-Neto et al (2008). Since then, several studies have been
performed with alternative CBCT systems. Also since our previous review, a few
studies have been performed which study occlusal caries.
Seven
studies of proximal caries detection were included in the systematic review
(Tsuchida et al 2007; Haiter-Neto et al 2008; Young et al 2009; Qu et al 2010;
Kayipmaz et al 2010; Senel et al 2010; Zhang et al 2011). In five of these, in
which Receiver-Operating Characteristic Curve (ROC) analysis was used, there
was no significant difference in diagnostic performance between the CBCT
systems and intraoral radiography. The other two studies (Haiter-Neto et al
2008; Young et al 2009), in which sensitivity and specificity were presented rather
than ROC values, found higher sensitivity for detection of proximal dentine
caries with a small volume, high resolution CBCT system, although Haiter-Neto
et al (2008) reported no difference in overall true scores between CBCT and
conventional radiographic imaging.
Three
studies of occlusal caries detection were included in the systematic review
(Haiter-Neto et al 2008; Young et al 2009; Kayipmaz et al 2010). All of these
present data indicating increased sensitivity for occlusal caries diagnosis
compared with conventional radiography. Young et al (2009) found that this was
accompanied by a loss of specificity, while Haiter-Neto et al (2008) found (as
with proximal caries detection) no differences in overall true scores. Any
deterioration in specificity observed with CBCT imaging may reflect artefactual
radiolucencies beneath the cusp enamel, reported by Young et al (2009). The
studies of Kamboroglu et al (2010a and 2010b) could not be included in the
systematic review, as they did not present recognised data on diagnostic
accuracy; their work, however, suggests that occlusal caries depth measurements
from CBCT correlate with histopathology better than intraoral radiographic
images.
The
current evidence suggests that limited CBCT has a similar diagnostic accuracy
to conventional radiography for the detection of proximal caries in posterior
teeth in vitro. For occlusal caries detection, the reports of higher
sensitivity with CBCT suggest that further research would be of value. The
representation of caries depth may be superior (Akdeniz et al 2006; Haiter-Neto
et al 2008; Tsuchida et al 2007; Kamboroglu et al 2010a). One practical
challenge to using CBCT for caries detection in the clinical situation, not
addressed in the laboratory studies, is that metallic restorations will produce
artefacts that would reduce diagnostic accuracy.
The
Panel concluded that the evidence did not support the clinical use of CBCT for
caries detection and diagnosis. Nonetheless, CBCT examinations performed for
other purposes should be carefully examined for caries lesions shown
fortuitously when performing a clinical evaluation (report).
CBCT is not indicated as a method of caries
detection and diagnosis
B
|
4.3.2: Periodontal assessment
The
diagnosis of periodontal diseases depends on a clinical examination. This may
be supplemented by radiological examination if this is likely to provide
additional information that could potentially change patient management or
prognosis. Radiographs do not have a role in diagnosis of periodontal disease,
but are used as a means of demonstrating the hard tissue effects of periodontal
disease, particularly the bony attachment loss. As pointed out in previous
guidelines (European Commission, 2004), there is no clear evidence to support
any robust recommendations on selection of radiological examinations. Those
guidelines recommended that “existing radiographs, e.g. bitewing radiographs
taken for caries diagnosis, should be used in the first instance”.
Conventional
two-dimensional radiographs have significant limitations in demonstrating the
periodontal attachment of teeth. Two-dimensional images do not show irregular
bone defects or buccal/lingual attachments clearly. The attraction of a
three-dimensional image is, therefore, considerable. The scientific literature
on periodontal uses of CBCT is small and the Panel identified only two in
vitro studies suitable for systematic review of diagnostic accuracy (Mol
& Balasundaram 2008; Noujeim et al 2009). Using ROC analysis, Mol &
Balasundaram (2008) demonstrated that one CBCT system was superior to
conventional intraoral radiographs for diagnosis of the presence of periodontal
bone loss in dried skeletal material. Noujeim et al (2009) created
interradicular bone cavities in mandibles and found that a CBCT system was more
accurate in detection of these than conventional radiography.
Several
other studies were informally reviewed. Limited volume CBCT can provide
accurate depiction of periodontal bone defects with good dimensional accuracy
in laboratory studies (Mengel et al, 2005; Pinsky et al 2005; Mol &
Balasundaram 2008), but with the latter study showing a less impressive
performance for CBCT in the anterior regions. Interestingly, however, one study
reported no significant differences in linear measurements between bone
sounding, conventional radiography and CBCT (Misch et 2006), although
buccal/lingual measurements could not be made by radiography. This lack of
statistically significant difference between conventional and CBCT images was
also reported in another laboratory study (Vandenberghe et al 2007). In a large
ex vivo study, however, CBCT measurement accuracy was significantly
better than intraoral radiography when cross-sectional images were used, but
not when a panoramic reconstruction was employed (Vandenberghe et al 2008). The
same study showed that CBCT was superior to intraoral radiography for crater
and furcation defect imaging, reflecting case reports and non-systematic review
opinion (Ito et al 2001; Kasaj & Willershausen 2007; Naitoh, 2006).
In
a small clinical study of patients selected for periodontal surgery for
maxillary molar furcation lesions, Walter et al (2010) found that pre-surgical
CBCT estimates of furcation involvement of these teeth had a high level of
agreement with intra-surgical findings. Takane et al (2010) used CBCT to
facilitate guided tissue regeneration by allowing the prefabrication of the
regeneration membrane material, while Bhatavadekar & Paquette (2008)
reported the potential role of CBCT in evaluating the response to surgery and
regenerative treatment of intrabony defects.
CBCT is not indicated as a routine method of
imaging periodontal bone support
C
|
Limited volume, high resolution CBCT may be
indicated in selected cases of infra-bony defects and furcation lesions,
where clinical and conventional radiographic examinations do not provide the
information needed for management
C
|
Where CBCT images include the teeth, care should
be taken to check for periodontal bone levels when performing a clinical
evaluation (report)
GP
|
4.3.3:
Assessment of periapical disease
Diagnosis
of periapical inflammatory pathosis is a common and important task for
dentists. A number of case reports and non-systematic reviews have highlighted
the value of CBCT for identification of periapical lesions in selected cases
(Nakata et al 2006; Cotton et al, 2007; Patel et al, 2007). The research
studies addressing this aspect of use of CBCT are limited by the extreme,
probably insurmountable, difficulty of obtaining a true reference standard in
human clinical studies. Our previous SEDENTEXCT review concluded that there was
some evidence that CBCT identifies more periapical lesions on posterior teeth
than traditional radiography, but further research studies assessing diagnostic
accuracy were required. A subsequent study showed that CBCT identified more,
and larger, periapical bone defects following apicectomy than did conventional
radiography (Christiansen et al 2009). Őzen et al (2009) found improved
observer agreement values when artificial periapical lesions were assessed with
CBCT compared with conventional imaging. In the current review, four studies
were identified that were eligible for systematic review (Stavropoulos &
Wenzel, 2007; de Paula-Silva et al 2009; Patel et al 2009a; Soğur et al 2009),
all of which were laboratory studies. Research designs were varied, using human
and animal teeth and artificially created periapical lesions, but included one
study performed in dogs in vivo with histopathologically validated
periapical inflammatory lesions (de Paula-Silva et al 2009).
The
current evidence suggests that high resolution CBCT may have higher sensitivity
for detection of periapical lesions than conventional radiography in laboratory
studies and that this is achieved without loss of specificity. However, the
results should be interpreted with caution when based on the available studies.
In practice, clinical signs and symptoms add significantly to the diagnostic
process and radiological evidence is not always of critical importance.
Furthermore, the relatively high economic cost of CBCT compared with intraoral
radiography should not be ignored. Consequently, the Panel concluded that it
was not appropriate to recommend CBCT as a standard method for diagnosis of
periapical inflammatory disease.
CBCT is not indicated as a standard method for
identification of periapical pathosis
GP
|
Limited volume, high resolution CBCT may be
indicated for periapical assessment, in selected cases, when conventional
radiographs give a negative finding when there are contradictory positive
clinical signs and symptoms
GP
|
Where CBCT images include the teeth, care should
be taken to check for periapical disease when performing a clinical
evaluation (report)
GP
|
4.3.4:
Endodontics
Conventional
endodontic imaging relies on intraoral radiography. In multi-rooted teeth and
more complex cases (e.g. suspected root perforations; resorptions and atypical
canal systems) intraoral radiographs at different beam angulations are used to
achieve a range of perspectives and allow parallax localisation. MSCT is impracticable
for dentists and hard to justify on the basis of radiation dose. Endodontic
treatment requires images in three phases of management: diagnosis, during
treatment (working length estimation, master cone check image) and in
post-treatment review. Endodontic treatment itself includes orthograde
treatment and surgical endodontic procedures.
The
three-dimensional images from CBCT appear to offer a valuable new method of
imaging root canal systems, and there are several non-systematic reviews in the
literature that give a favourable perspective (Cotton et al 2007; Nair et al
2007; Patel et al 2007). Endodontics requires, however, a high level of image
detail, and it is important to remember that available dental CBCT systems
offer resolutions far lower (by approximately one order of magnitude) than
those of modern intraoral radiography. Furthermore, because endodontic
treatment is a single tooth procedure, CBCT systems incapable of reducing the
field of view to suitable dimensions will expose areas to radiation without
patient benefit.
In
our previous review, we highlighted a few studies in which a superior
performance of CBCT in identifying root canals was reported but in which there
was no independent reference standard (Loftag-Hansen et al 2007; Low et al
2008; Matherne et al 2008). We also found that the impact of CBCT on management
decisions had not been addressed in any detail, although one study on posterior
teeth (Loftag-Hansen et al 2007) reported that CBCT added additional clinically
relevant information in 70% of cases. We concluded that research was needed to
establish objectively the diagnostic accuracy of CBCT in identifying root canal
anatomy and to quantify its impact on management decisions.
Since
then, several descriptive clinical studies (Neelakantan et al 2010a; Wang et al
2010; Zheng et al 2010; Zhang et al 2011) and two laboratory studies (Baratto
Filho et al 2009; Neelakantan et al 2010b) have used CBCT for imaging root
canal anatomy in substantial patient populations or samples. All concluded that
CBCT has a role to play in identification of root canal systems, notably for
the identification of presence/ absence of a second mesio-buccal canal (MB2) in
maxillary first molars.
In
our current review, no study entirely satisfied our inclusion criteria for
systematic review regarding the task of identifying root canals. One in
vitro study (Blattner et al 2010), however, which investigated the
identification of MB2 canals in maxillary first molars, provided the raw data
to permit calculation of sensitivity and specificity and a decision was taken
to include it in the formal review. In their small sample of teeth (n=20),
sensitivity of observations using CBCT for identification of MB2 canals was 77%
and specificity 83%. In a review paper, Scarfe et al (2009) reported
unpublished data on the importance of the resolution of the CBCT system,
suggesting that resolutions in the order of 0.12mm or less are optimal.
|
CBCT is not indicated as a standard method for
demonstration of root canal anatomy
GP
|
|
Limited volume, high resolution CBCT may be
indicated, for selected cases where conventional intraoral radiographs
provide information on root canal anatomy which is equivocal or inadequate
for planning treatment, most probably in multi-rooted teeth
GP
|
There
was no literature regarding the use of CBCT during endodontic treatment or as
part of post-treatment review eligible for systematic review. One laboratory
study (Soğur et al, 2007) has shown that CBCT gave inferior images of the
homogeneity and length of root canal fillings compared with intraoral
radiographs.
Limited volume, high resolution CBCT may be
indicated for selected cases when planning surgical endodontic procedures.
The decision should be based upon potential complicating factors, such as the
proximity of important anatomical structures
GP
|
Our
previous review highlighted several case reports and case series demonstrating
a value of CBCT for imaging cases of inflammatory external root resorption
(Maini et al, 2008 ; Cohenca et al, 2007; Walter et al, 2008; Patel et al,
2007; Patel & Dawood, 2007) and internal resorption (Cotton et al, 2007).
Our recommendation at that time gave cautious approval of a potential
diagnostic role for CBCT.
Subsequently,
there have been several research studies of resorptions, including four which
were suitable for inclusion in the systematic review (Liedke et al 2009; Patel
et al 2009b; Kamboroğlu & Kursun 2010; Durack et al 2011). Three of these
were laboratory studies using drilled holes in extracted teeth, while one was a
clinical study (Patel et al 2009b). Three addressed external resorption (Liedke
et al 2009; Patel et al 2009b; Durack et al 2011) and two considered internal
resorption (Patel et al 2009b; Kamboroğlu & Kursun 2010). The clinical
study was a useful attempt to obtain in vivo data, but suffers from a
small sample size and, most importantly, a reference standard that is based
upon the index tests (consensus based on CBCT and conventional radiographic images).
The laboratory external resorption models suffer from a lack of comparability
with the clinical situation, where adjacent bony changes will influence
detection and where resorption cavities may be different to the drilled defects
prepared for the research studies.
For
external resorption, the two laboratory studies (Liedke et al 2009; Durack et
al 2011) suggest that CBCT provides high sensitivity and specificity for
detection of artificial lesions on mandibular incisors. For artificial internal
resorption lesions, Kamboroğlu & Kursun (2010) found some limitations in
sensitivity and specificity for the CBCT system tested but, unfortunately, they
did not involve a comparator conventional imaging method. For both types of
resorption, there is some evidence that resolution of the CBCT system
influences diagnostic accuracy (Liedke et al 2009; Kamboroğlu & Kursun
(2010).
External
resorption is sometimes idiopathic and unexpected, but there are sub-groups of
patients and teeth in which there is increased risk, notably after severe
dental luxation and avulsion injuries. As pointed out by Durack et al (2011)
resorption may progress rapidly and early treatment is advantageous. In such
cases, the use of CBCT may be justified, but the timing of the imaging is
unclear. The unpredictability of the condition means that a negative finding on
one occasion would not exclude resorption at a later date. Repeated CBCT
examinations would be hard to justify without research evidence of its value,
particularly in children. On the basis of largely laboratory evidence on
limited samples, the Panel found it difficult to arrive at a recommendation
with a strong evidence grade.
Internal
resorption is usually identified by chance on radiographs, so it seems likely
that the role of CBCT would be reserved for cases where the resorption was
extensive, where perforation of the root surface was in question and where
three-dimensional information could help in decision-making on extraction or
retention.
|
Limited volume, high resolution CBCT may be
indicated in selected cases of suspected, or established, inflammatory root
resorption or internal resorption, where three-dimensional information is
likely to alter the management or prognosis of the tooth
D
|
As described in our previous review, there are
several other potential applications of CBCT in endodontic practice (Table
4.2).
Table
4.2: Endodontic uses of CBCT
Endodontic
applications of CBCT
|
Reference
|
Differentiation
of pathosis from normal anatomy
Relationships
with important anatomical structures
Aiding
management of dens invaginatus and aberrant pulpal anatomy
External
resorption
Internal
resorption
Lateral
root perforation by a post
Accessory
canal identification
Surgical
management of fractured instrument
Aiding
surgical endodontic planning
|
Cotton
et al 2007
Cotton
et al 2007
John
2008
Siraci
et al 2006
Maini
et al 2008
Cohenca
et al 2007
Walter
et al 2008
Patel
et al 2007
Patel
& Dawood 2007
Cotton
et al 2007
Young
2007
Cotton
et al 2007
Nair
et al 2007
Patel
& Dawood 2007
Tsurumachi
et al 2007
Patel
et al 2007
Patel
& Dawood 2007
|
It
seems likely from these case reports and non-systematic reviews that CBCT will
have several valuable applications in selected cases. The absence of
high quality studies available for this systematic review underlines the need
for further research in this important area of dental practice.
4.3.5:
Dental trauma
Trauma
to teeth is a fairly common event faced by dentists in clinical practice. As
described in our previous review, case reports and non-systematic reviews have
included comments about the potential role of CBCT in assessment of dental
injuries, as shown below:
Table
4.3: CBCT in dental trauma
Application
of CBCT for dento-alveolar trauma
|
Reference
|
Root
fractures
Luxation
injuries
Avulsion
Root
resorption as a post-trauma complication
|
Terakado
et al 2000
Cohenca
et al 2007a
Cotton
et al 2007
Nair
et al 2007
Patel
& Dawood 2007
Cohenca
et al 2007a
Patel
et al 2007
Walter
& Krastl 2008
Cohenca
et al 2007b
Walter
et al 2008
|
Unlike
our previous review, on this occasion we were able to identify eight
publications for the systematic review on the detection of root fractures using
CBCT (Hassan et al 2009; Iikubo et al 2009; Wenzel et al 2009; Hassan et al
2010; Kamboroglu et al 2010; Melo et al 2010; Ozer 2010; Varshozaz et al 2010),
seven of which were laboratory studies using extracted teeth and the other an in
vivo animal study (Iikubo et al 2009). Some studies included root-filled
teeth, while others did not. The study of Mora et al (2007) was not included in
the review because it did not use a commercially available CBCT system, while
that of Bernardes et al (2009) was excluded because it did not report
diagnostic accuracy. All studies in which a comparison was made report significantly
higher diagnostic accuracy for CBCT compared with conventional radiography,
although “low” resolution scans (possibly around 0.3mm or larger voxel
dimensions) may not offer this diagnostic advantage (Wenzel et al 2009; Hassan
et al 2010; Kamboroglu et al 2010). The presence of root fillings in teeth may
reduce specificity (increased false positive diagnoses) by artefact (Hassan et
al 2010). Melo et al (2010) assessed diagnostic accuracy in the presence of
root fillings without a comparison with conventional radiography and also
reported problems with specificity. These workers also examined teeth
containing metal posts; they found a lower sensitivity and specificity than for
teeth with fractures but without posts. They also reported significantly inferior
diagnostic performance when 0.3mm voxels were used, compared with 0.2mm voxels.
In
practice, patients with suspected root fracture fall into two broad categories.
First, there are those with acute trauma to anterior teeth, often children.
Secondly, there are patients whose teeth may have fractured due to chronic
trauma during normal function, usually in endodontically treated teeth. In the
first group, the acute injuries may mean CBCT is not feasible due to treatment
priorities and the problems associated with traumatised children of
immobilisation for the scan. In such cases, it would seem reasonable to limit
the radiological examination to simple radiographs and use CBCT at a later date
if the conventional radiographs provide inadequate information for managing the
patient. In the second group, the weight of evidence suggests that root
fillings and posts limit diagnostic accuracy. Of course, in some of these cases
diagnosis can be made, and prognosis assessed, on clinical examination evidence
alone, so imaging may not always be indicated. In other cases conventional
radiography may provide sufficient information for management.
The
role of CBCT in more significant trauma is considered under “Surgical
applications”, below.
4.3.6:
References
Akdeniz BG, Gröndahl HG, Magnusson B.
Accuracy of proximal caries depth measurements: comparison between limited cone
beam computed tomography, storage phosphor and film radiography. Caries Res
2006; 40: 202-207.
Baratto Filho F, Zaitter S, Haragushiku
GA, de Campos EA, Abuabara A, Correr GM. Analysis of the internal anatomy of
maxillary first molars by using different methods." J Endod 2009; 35:
337-342.
Bernardes RA, deMoraes IG, Húngaro
Duarte MA, Azevedo BC, de Azevedo JD, Bramante CM. Use of cone beam volumetric
tomography in the diagnosis of root fractures. Oral Surg Oral Med Oral Pathol
Oral Radiol Endod 2009; 108: 270-277.
Bhatavadekar NB, Paquette DW. Long-term
follow-up and tomographic assessment of an intrabony defect treated with enamel
matrix derivative. J Periodontol 2008; 79: 1802-1808.
Blattner TC, George N, Lee CC, Kumar V,
Yelton CDJ. Efficacy of cone-beam computed tomography as a modality to
accurately Identify the presence of second mesiobuccal canals in maxillary
first and second molars: a pilot study. J Endod 2010; 36: 867–870
Christiansen
R, Kirkevang LL, Gotfredsen E, Wenzel A. Periapical radiography and cone beam
computed tomography for assessment of the periapical bone defect 1 week and 12
months after root-end resection. Dentomaxillofac Radiol 2009; 38: 531-536.
Cohenca N, Simon JH, Mathur A, Malfaz
JM. Clinical indications for digital imaging in dento-alveolar trauma. Part 1:
traumatic injuries." Dental Traumatol 2007a; 23: 95-104.
Cohenca NJH, Simon JH, Mathur A, Malfaz
JM. Clinical indications for digital imaging in dento-alveolar trauma. Part 2:
root resorption. Dent Traumatol 2007b; 23: 105-113.
Cotton TP, Geisler TM, Holden DT,
Schwartz SA, Schindler WG. Endodontic applications of cone-beam volumetric
tomography. J Endod 2007; 33: 1121-1132.
De Paula-Silva FWG, Wu M-K, Leonardo MR,
da Silva SA, Wesselink PR. Accuracy of periapical radiography and cone-beam
computed tomography scans in diagnosing apical periodontitis using
histopathological findings as a gold standard. J Endod 2009; 35: 1009-1012.
Durack C, Patel S, Davies J, Wilson R,
Mannocci F. Diagnostic accuracy of small volume cone beam computed tomography
and intraoral periapical radiography for the detection of simulated external
inflammatory root resorption. Int Endod J 2011; 44: 136-147.
Estrela C, Reis Bueno M, Rodrigues Leles
C, Azavedo B, Ribamar Azevedo J. Accuracy of cone beam computed tomography and
panoramic and periapical radiography for detection of apical periodontitis. J
Endod 2008a; 34: 273-279.
Estrela C, Reis Bueno M, Azevedo BC,
Azevedo JR, Pecora JD. A new periapical index based on cone beam computed
tomography. J Endod 2008b; 34: 1325-1331.
European Commission. Radiation
Protection 136. European Guidelines on Radiation Protection in Dental
Radiology. Luxembourg: Office for Official Publications of the European
Communities, 2004. Available from: http://ec.europa.eu/energy/nuclear/radioprotection/publication/doc/136_en.pdf
Haiter-Neto
F, Wenzel A, Gotfredsen E. Diagnostic accuracy of cone beam computed tomography
scans compared with intraoral image modalities for detection of caries lesions.
Dentomaxillofac Radiol 2008; 37: 18-22.
Hannig C, Krieger E, Dullin C, Merten
H-A, Attin T, Grabbe E, Heidrich G. Volumetry of human molars with flat
panel-based volume CT in vitro. Clin Oral Invest 2006; 10: 253-257.
Hassan B, Metska ME, Ozok AR, van der
Stelt P, Wesselink PR. Detection of vertical root fractures in endodontically
treated teeth by a cone beam computed tomography scan. J Endod 2009; 35:
719-722.
Hassan B, Metska ME, Ozok AR, van der
Stelt P, Wesselink PR.. Comparison of five cone beam computed tomography
systems for the detection of vertical root fractures J Endod 2010; 36:126-129.
Iikubo M, Kobayashi K, Mishima A,
Shimoda S, Daimaruya T, Igarashi C, Imanaka M, Yuasa M, Sakamoto M, Sasano T.
Accuracy of intraoral radiography, multidetector helical CT, and limited
cone-beam CT for the detection of horizontal tooth root fracture. Oral Surg
Oral Med Oral Pathol Oral Radiol Endod. 2009; 108: e70-74.
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; 72: 696-702.
John V. Non-surgical management of
infected type III dens invaginatus with vital surrounding pulp using
contemporary endodontic techniques. Aust Endod J 2008; 34: 4-11.
Kamboroğlu K, Kurt H, Kolsuz E, Őztaş B,
Tatar ĺ, Çelik HH. Occlusal caries depth measurements obtained by five
different imaging modalities. J Digit Imaging 2010a; Nov 30 [Epub ahead of
print].
Kamboroğlu
K, Murat S, Yüksel SP, Cebeci ARĺ, Paksoy CS. Occlusal caries detection by
using a cone-beam CT with different voxel resolutions and a digital intraoral
sensor. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010b; 109: e63-e69.
Kamburoğlu K, Murat S, Yüksel SP, Cebeci
AR, Paksoy CS. Detection of vertical root fracture using cone-beam computerized
tomography: an in vitro assessment. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod. 2010c;109: e63-69.
Kamburoğlu K, Kursun S. A comparison of
the diagnostic accuracy of CBCT images of different voxel resolutions used to
detect simulated small internal resorption cavities. Int Endod J 2010; 43:
798-807.
Kasaj A, Willershausen B. (2007).
Digital volume tomography for diagnostics in periodontology. Int J Comput Dent
2007; 10: 155-168.
Kayipmaz S, Sezgin ŐS, Saricaoğlu ST,
Çan G. An in vitro comparison of diagnostic abilities of conventional
radiography, storage phosphor, and cone beam computed tomography to determine
occlusal and approximal caries. Eur J Radiol 2010; Oct 7 [Epub ahead of print].
Liedke GS, da Silveira HE, da Silveira
HL, Dutra V, de Figueiredo JA. Influence of voxel size in the diagnostic
ability of cone beam tomography to evaluate simulated external root resorption.
J Endod 2009; 35: 233-235.
Loftag-Hansen S, Huumonen S, Gröndahl K,
Gröndahl H-G. Limited cone-beam CT and intraoral radiography for the diagnosis
of periapical pathology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;
103:114-119.
Low KMT, Dula K, Bürgin W, von Arx, T.
Comparison of periapical radiography and limited cone-beam tomography in
posterior maxillary teeth referred for apical surgery. J Endod 2008; 34:
557-562.
Maini AP, Durning P, Drage N.
Resorption: within or without? The benefit of cone-beam computed tomography
when diagnosing a case of an internal/external resorption defect. Br Dent J
2008; 204: 135-137.
Matherne
RP, Angelopoulos C, Kulild JC. Use of cone-beam computed tomography to identify
root canal systems in vitro. J Endod 2008; 34: 87-89.
Melo SL, Bortoluzzi EA, Abreu M Jr,
Corrêa LR, Corrêa M. Diagnostic ability of a cone-beam computed tomography scan
to assess longitudinal root fractures in prosthetically treated teeth. J Endod.
2010; 36:1879-1882.
Mengel R, Candir M, Siratori, K,
Flores-de-Jacoby L. Digital volume tomography in the diagnosis of periodontal
defects: an in vitro study on native pig and human mandibles. J Periodontol
2005; 76: 665-673.
Misch KA, Yi ES, Sarment DP. Accuracy of
cone beam computed tomography for periodontal defect measurements. J
Periodontol 2006; 77: 1261-1266.
Mol A, Balasundaram A. In vitro cone
beam computed tomography imaging of periodontal bone. Dentomaxillofac Radiol
2008; 37: 319-324.
Mora MA, Mol A, Tyndall DA, Rivera EM.
In vitro assessment of local computed tomography for the detection of
longitudinal tooth fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2007;103: 825-829.
Nair MK, Nair UP. Digital and advanced
imaging in endodontics: a review. J Endod 2007; 33: 1-6.
Naitoh M, Yamada S, Noguchi T, Ariji E,
Nagao J, Mori K, Kitasaka T, Suenaga Y. Three-dimensional display with
quantitative analysis in alveolar bone resorption using cone-beam computerized
tomography for dental use: a preliminary study. Int J Periodontics Restorative
Dent 2006; 26: 607-612.
Nakata
K, Naiyoh M, Izumi M, Inamoto K, Ariji E, Nakamura, H. Effectiveness of dental
computed tomography in diagnostic imaging of periradicular lesion of each root
of a multirooted tooth: a case report. J Endod 2006; 32: 583-587.
Neelakantan P, Subbarao C, Ahuja R,
Subbarao CV, Gutmann JL. Cone-Beam Computed Tomography Study of Root and Canal
Morphology of Maxillary First and Second Molars in an Indian Population. J
Endod 2010a; 36: 1622-1627.
Neelakantan P, Subbarao C, Subbarao CV
Comparative Evaluation of Modified Canal Staining and Clearing Technique,
Cone-Beam Computed Tomography, Peripheral Quantitative Computed Tomography,
Spiral Computed Tomography, and Plain and Contrast Medium–enhanced Digital
Radiography in Studying Root Canal Morphology. J Endod 2010b; 36: 1547-1551.
Noujeim M, Prihoda TJ, Langlais R,
Nummikoski P. Evaluation of high-resolution cone beam computed tomography in
the detection of simulated inter-radicular bone lesions. Dentomaxillofac Radiol
2009; 38: 156-162.
Őzen T, Kamburoğlu K, Cebeci ARI, Yuskel
SP, Paksoy C. Interpretation of chemically created periapical lesions using 2
different dental cone-beam computerized tomography units, an intraoral digital
sensor, and conventional film. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2009; 107: 426-432.
Őzer SY. Detection of vertical root
fractures of different thicknesses in endodontically enlarged teeth by cone
beam computed tomography versus digital radiography. J Endod 2010; 36:
1245–1249.
Patel S, Dawood A. The use of cone beam
computed tomography in the management of external cervical resorption lesions.
Int Endod J 2007; 40: 730-737.
Patel S, Dawood A, Mannocci F, Wilson R,
Pitt Ford T. Detection of periapical bone defects in human jaws using cone beam
computed tomography and intraoral radiography. Int Endod J 2009a; 42: 507-515.
Patel
S, Dawood A, Pitt Ford T, Whaites E. The potential applications of cone beam
computed tomography in the management of endodontic problems. Int Endod J 2007;
40: 818-830.
Patel S, Dawood A, Wilson R, Horner K,
Mannocci F. The detection and management of root resorption lesions using
intraoral radiography and cone beam computed tomography - an in vivo
investigation. Int Endod J 2009b; 42: 831-838.
Pinsky HM, Dyda S, Pinsky RW, Misch KA,
Sarment DP. Accuracy of three-dimensional measurements using cone-beam CT.
Dentomaxillofac Radiol 2006; 35: 410-416.
Qu X, Li G, Zhang Z, Ma X. Detection
accuracy of in vitro approximal caries by cone beam computed tomography
images. Eur J Radiol 2010; Feb 23. [Epub ahead of print]
Rigolone M, Pasqualini D, Bianchi L,
Berutti E, Bianchi SD. Vestibular surgical access to the palatine root of the
superior first molar: “low dose cone-beam” CT analysis of the pathway and its
anatomic variations. J Endod 2003; 29: 773-775.
Scarfe WC, Levin MD, Gane D, Farman AG.
Use of cone beam computed tomography in endodontics. Int J Dent 2009;
2009:634567. Epub 2010 Mar 31.
Şenel B, Kamboroğlu K, Űçok Ő, Yüksel
SP, Őzen T, Avsever H. Diagnostic accuracy of different imaging modalities in
detection of proximal caries. Dentomaxillofac Radiol 2010; 39: 501-511.
Siraci E, Cem Gungor H, Taner B, Cehreli
ZC. Buccal and palatal talon cusps with pulp extensions on a supernumerary
primary tooth. Dentomaxillofac Radiol 2006; 35: 469-472.
Soğur
E, Baksi BG, Gröndahl H-G. Imaging of root canal fillings: a comparison of
subjective image quality between limited cone-beam CT, storage phosphor and
film radiography. Int Endod J 2007; 40: 179-185.
Soğur E, Baksi BG, Gröndahl H-G, Lomcali
G, Sen BH. Detectability of chemically indiced periapical lesions by limited
cone beam computed tomography, intra-oral digital and conventional film
radiography. Dentomaxillofac Radiol 2009; 38: 458-464.
Stavropoulos A, Wenzel A. Accuracy of
cone beam dental CT, intraoral digital and conventional film radiography for
the detection of periapical lesions. An ex vivo study in pig jaws. Clin Oral
Invest 2007; 11: 101-106.
Takane M, Sato S, Suzuki K, Fukuda T,
Asano Y, Honda K, Arai Y, Ito K. Clinical application of cone beam computed
tomography for ideal absorbable membrane placement in interproximal bone
defects. J Oral Sci. 2010; 52: 63-69.
Terakado M, Hashimoto K, Arai Y, Honda
M, Sekiwa T, Sato H. Diagnostic imaging with newly developed ortho cubic
super-high resolution computed tomography (Ortho-CT). Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 2000; 89: 509-518.
Tsuchida R, Araki K, Okano T. Evaluation
of a limited cone-beam volumetric imaging system: comparison with film
radiography in detecting incipient proximal caries. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 2007; 104: 412-416.
Tsurumachi T, Honda K. A new cone beam
computerized tomography system for use in endodontic surgery. Int Endod J 2007;
40: 224-232.
Vandenberghe B, Jacobs R, Yang J.
Diagnostic validity (or acuity) of 2D CCD versus 3D CBCT-images for assessing
periodontal breakdown. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;
104: 395-401.
Vandenberghe B, Jacobs R, Yang J. Detection
of periodontal bone loss using digital intraoral and cone beam computed
tomography images: an in vitro assessment of bony and/or infrabony defects.
Dentomaxillofac Radiol 2008; 37: 252-260.
Varshosaz M, Tavakoli MA, Mostafavi M,
Baghban AA. Comparison of conventional radiography with cone beam computed
tomography for detection of vertical root fractures: an in vitro study. J Oral
Sci 2010; 52: 593-597.
Walter,
C, Krastl G, Izquierdo A, Hecker H, Weiger R. Replantation of three avulsed
permanent incisors with complicated crown fractures. Int Endod J 2008; 41:
356-364.
Walter C, Weiger R, Zitzmann NU.
Accuracy of three-dimensional imaging in assessing maxillary molar furcation
involvement. J Clin Periodontol 2010; 37: 436–441.
Wang Y, Zheng QH, Zhou XD, Tang L, Wang
Q, Zheng GN, Huang DM. Evaluation of the root and canal morphology of
mandibular first permanent molars in a western Chinese population by cone-beam
computed tomography. J Endod 2010; 36: 1786-1789.
Wenzel A, Haiter-Neto F, Frydenberg M,
Kirkevang LL. Variable-resolution cone-beam computerized tomography with
enhancement filtration compared with intraoral photostimulable phosphor
radiography in detection of transverse root fractures in an in vitro model.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108: 939-945.
Young GR. Contemporary management of
lateral root perforation diagnosed with the aid of dental computed tomography.
Aust Endod J 2007; 33: 112-118.
Young SM, Lee JT, Hodges RJ, Chang T-L,
Elashoff DA,, White SC. A comparative study of high-resolution cone beam
computed tomography and charge-coupled device sensors for detecting caries.
Dentomaxillofac Radiol 2009; 38: 445-451.
Zhang
Z, Qu X, Li G, Zhang Z, Ma X. The detection accuracies for proximal caries by
cone-beam computerized tomography, film, and phosphor plates. Oral Surg Oral
Med Oral Pathol Oral Radiol Endod 2011; 111:103-108
Zhang
R, Yang H, Yu X, Wang H, Hu T, Dummer PM. Use of CBCT to identify the
morphology of maxillary permanent molar teeth in a Chinese subpopulation. Int
Endod J 2011; 44:162-169.
Niciun comentariu:
Trimiteți un comentariu