Cone Beam Computed Tomography

(CBCT)

Basic Concept

การสง่ภาพถ่ายรงัสีเอกสารท่ีใชส้ง่ CBCT

AAE and AAOMRListed indication for potential use in selected case

1. Differential Diagnosis2. Evaluation of anatomy and complex morphology3. Intraoperative and postoperative assessmnt of endodotic treatment complications4. Dentoalveolar trauma5. Internal and external root resorption6. Presurgical case planing7. Dental implant case planing8. Assessment of endodontic treatment outcomes

Differential Diagnosis

Lesions of non-endodontic origin

Differential Diagnosis

Diagnosis of treatment failure

Differential Diagnosis

Vertical root fractures- VRF run along the long axis of a tooth are often difficult to diagnose clinically.- Sensitivity : 18.8 - 100% (115)- The presence of root canal filling in the teeth lowers the specificity of CBCT in detecting VRF, this has been attributed to the radiopaque material causing streak artifacts that mimic fracture lines.

Evaluation of anatomy and complex morphology

Anomalies- E.g. Dens invaginatus - Root morphology, canal anatomy, root curvatures, additional roots, anomalies within canal (obstruction, narrowing, bifurcation).

Evaluation of anatomy and complex morphology

Root canal system morphology

Intraoperative or postoperative assessment of endodontic treatment

complicationsOverextended root canal obturation material- Accidental introduction of root canal instruments, irrigting solutions, obturationa material and root tip into the vital structure. - Use of CBCT as an aid in localization and management.

Intraoperative or postoperative assessment of endodontic treatment

complicationsSeperated endodontic instrument

Intraoperative or postoperative assessment of endodontic treatment

complicationsCalcified canal identificationCBCT can suggest the best tactile for locating calcified canals in the chamber floor and rootsInsertion of radiopaque markers can facilitate reliable canal localization using available mutiplanar reformations..CBCT can be important adjunct to magnification and illumination.

Intraoperative or postoperative assessment of endodontic treatment

complicationsLocalization of perforation- There was no significant difference in the detection of root perforations between PA and CBCT radiography.- CBCT images suffer from beam hardening artifact resulting from root canal obturation and restorative materials which creates challenges to the interpretation of root integrity.

Dentoalveolar trauma

CBCT imaging offered improved visualization of the location and angulation of root fractures compared to periapi cal and occlusal intraoral radiographs.

The decision to use CBCT imaging for assessment of trau- matic injuries should be based on the diagnostic yield expected and in accordance with the “as low as reasonably achievable” (ALARA) principle.

Internal and External root resorption

CBCT imaging of these resorptive lesions provides the clinician with enhanced information so that more appropriate treatment planning options are available. CBCT assessments can provide the true size and position of all resorptive defects in the region of interest

Presurgical case planing

Assessment of endodontic outcomes