Role Of CBCT In Implant Dentistry



Cone Beam Computed Tomography (CBCT) is of great importance in Implant Dentistry. It is a diagnostic imaging modality that helps to deliver high-quality, accurate three-dimensional (3D) representations of the osseous elements of the maxillofacial skeleton. These latest and effective systems help to deliver a small field of view images at a low dose to the dentist with a sufficient spatial resolution for the perfect procedure in implant surgery. In this blog, we will understand the detailed reasoning about Dental CBCT systems and the role of Dental CBCT as an imaging adjunct for implant surgery and other procedures such as in endodontics.

What is Dental CBCT?

According to FDA (https://www.fda.gov/radiation-emitting-products/medical-x-ray-imaging/dental-cone-beam-computed-tomography#:~:text=computed%20tomography%20devices.-,Description,%2Dshaped%20X%2Dray%20beam. ), “Cone-beam computed tomography systems (CBCT) are a variation of computed tomography systems. The CBCT systems used by dental professionals rotate around the patient, capturing data using a cone-shaped X-ray beam. These data are used to reconstruct a three-dimensional (3D) image of the following regions of the patient’s anatomy: dental (teeth); oral and maxillofacial region (mouth, jaw, and neck); and ears, nose, and throat (“ENT”).”
The importance of cone beam computed tomography (CBCT) in the diagnosis and/or planning of endodontic problems is reflected in the exponential rise in publications in the last two decades. The traditional CT is a unique type of x-ray machine used in cases where regular dental analysis or facial x-rays are not sufficient. It is not regularly used because the radiation exposure from this scanner is relatively more than regular dental x-rays. However, this type of CT scanner helps to generate three-dimensional (3-D) images of dental structures, soft tissues, nerve paths and bone in the craniofacial region in a single scan. Images obtained with cone beam CT are more helpful for precise treatment planning in implant dentistry.

Cone beam CT is not the same as traditional CT. With cone beam CT, an x-ray beam in the shape of a cone surrounds the target area of the patient’s mouth and generates a large number of images, also called views. The need to develop the technology of dental cone beam CT is to produce similar types of images but with a much smaller and less expensive technique that could be placed in an outpatient office. Cone beam CT provides an in-depth image of the bone and is performed to understand the issues of the jaw, dentition, bony structures of the face, nasal cavity and sinuses. One of the best advantages of cone beam CT is low radiation exposure compared to conventional CT.

Role of Dental CBCT in Dental Implantology

Dental radiology plays a crucial role in clinical dentistry and CBCT (cone beam computed tomography), an ever-evolving diagnostic tool. It is one of the fundamental parts throughout the patient care pathway that helps in more accurate and informed diagnosis and treatment planning. Imaging helps the dentist to select the clinically justified part, based on the individual patient, following referral parameters for the optimum treatment plan. Fortunately, conventional dental x-rays have diagnostic value; however, they are ultimately limited as 2D depictions of 3D structures. CBCT scanners may differ in terms of its capabilities; but it is crucial to know that getting the best results at the end and getting the best diagnostic information in the initial stage is dependent on both the patient and the operator. As radiographers, we can properly scan the field of view and voxel parameters based on the clinical indications and individual patients. It helps to manage the exposure and gain the best level of diagnostic information. Following are some of the crucial stages that take place while performing the procedure:

  1. Imaging:
    Preliminary CT examination of the mandible or maxilla for implantation uses a bone algorithm to obtain contiguous 1 mm thick axial images of the mandible (excluding the condyles) or the maxilla parallel to the alveolar ridge. The patient can wear a custom-designed stent during CT examination for more accuracy. A volume of data is acquired by CBCT, which is then reformatted and three different types of two-dimensional (2D) images are synthesized.
  2. Image Interpretation:
    The most important information to analyse is the location of the indicated site, bony height and width(with the cortex included) and inclination from the vertical are noted. Bone atrophy and remodeling of the alveolar ridge are common after tooth removal or loss; important landmarks should be noted, such as the bony depth to the mandibular canal and the distance to the inferior recess of the maxillary sinus or to the floor of the nasal cavity. If a stent is not used, similar data should be recorded from edentulous areas or at selective sites such as parasymphyseal and premolar locations. The quality of bone directly affects the success of osseointegrated implants.
  3. Interactive Implant Treatment Planning:
    An interactive computer program can be used for examination before dental implantation. With the aid of interactive software, another approach for the transfer of implant planning to the surgical site is to use computer-aided design/computer-aided manufacturing technique.. These programs enable the clinician to transfer CT/CBCT findings into the surgical area. Using one of these software programs, clinician uses CT data obtained with the same displays of axial, cross-sectional and panoramic images allowing them for pre-operative simulation of implant placement, prosthetic simulation and bone augmentation simulation that makes the software the state-of-the-art imaging tool for implants. Bony width and height and regional abnormalities are determined and measurements of bony attenuation are performed. In addition, an implantology team can manipulate graphically displayed implants to allow a more accurate selection of implant size and orientation and a better appreciation and estimation of reconstructive needs like bone-graft augmentation.

Benefits of Dental CBCT

  • This process helps to get a three-dimensional image and helps the dentist to view the exact location and extent of lesions or a region.
  • It also helps to view exact bone width and height
  • Shows bone density and quality
  • Enables dentists to visualize the complete anatomy of the tooth and its surrounding areas from all angles, including the nerves and bones.
  • Allows cross-sectional and translational views of the intraoral structures Helps to evaluate the periapical regions that helps dentists to get an in-depth
  • knowledge of the long-term prognosis before or after endodontic treatment.
  • It helps accurately fabricate dental prostheses and reduces the dental clinic visits for trials.

Conclusion

To know more about the role of CBCT in Dental Implantology, you can enroll in our explicit series of Online Lectures “Basics of Dental Implantology '' with our Founder and Program Instructor: Dr. Avi Ramavat (BDS, MDS Oral & Maxillofacial Surgery). He is the Founder and Director of Ideal Dental Care, Indore, India & Founder of docMEP, Indore, India. In this blog, you will be able to Diagnose and Plan routinely done basic Dental Implantology cases. You will also learn about all the basic Dental Implantology cases clinically and radiographically so that you can give the right advice to your patients. Before you operate on your own patient, it is advisable to place 10 to 15 implants in a patient under the supervision of an expert. This series of lectures will make sure that you can associate with good Dental Implantology Clinics and your journey of restoring the patient with Dental Implant begins. If you are already placing implants, this series of online lectures will take you to the next level by boosting your confidence to extend your services into extended edentulous spaces. Call us now to know more.

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