Dentaltown March 2015 - (Page 44)

case presentation (CBCT) feature by Dale A. Miles, DDS, MS, FRCD (C) Cone Beam 3D- Is It Really for Me? Introduction Making clinical decisions with 2D grayscale images is hard. Humans and human structures are not ﬂat; patients are three dimensional. How do we expect to know the truth about the extent of a disease process, or a tooth position and its relation to important anatomic structures, when we're actually guessing at the extent of disease from ﬂat, grayscale images? Unfortunately, many dentists did not master the intricacies of interpreting X-ray ﬁlms, phosphor plates, digital images- intraoral or panoramic-even before the advent of cone beam 3D imaging and visualization in 3D color. Do you remember struggling with Clark's rule, tube shift principles, the buccal object rule or the SLOB rule, just to ﬁgure out if a mesiodens was on the palatal or the facial? By the way, the SLOB rule stands for "same on lingual opposite on buccal" and is the simplest way to localize objects on X-rays. It took us 25 years of teaching to ﬁgure that one out! So along comes CBCT (cone beam computed tomography) which, although simple to perform, is quite complex to understand and master1. And it isn't even computed tomography. The acquisition of the image occurs with one pass around the patient, unlike conventional medical CT which moves the patient lying on a gantry into a scanner at 1mm up to 1cm increments with very high X-ray dose to the patient. Conventional CT detects every "point" in the scan. CBCT detects (captures) only very small cubes, called voxels. This is a partial explanation for why we do not get true Hounsﬁeld units in CB 3D/CBCT imaging. The dose from a conventional medical CT head scan has been calculated at 2,100 microsieverts (µSv). The dose from a typical 8cm x 8cm FOV (ﬁeld of view) Cone Beam 3D scan subjects the patient to only about 17 to 360 microsieverts.2 44 MARCH 2015 // dentaltown.com And unlike conventional medical CT, cone beam 3D imaging is dentally speciﬁc. It was made for us! And by the way, we receive 3,600 microsieverts annually just walking around the planet exposed to things like radon, cosmic rays and consumer products. Cone beam 3D imaging, used prudently, is the least of our worries-from the radiation exposure point of view. So you have to ask yourself the very question posed in the headline of this article: "Is cone beam 3D imaging really for me?" I assure you the answer is a rhetorical and resounding yes! How do you decide? If you answer yes to any or all following questions, cone beam 3D imaging will be invaluable to you. 1. Do you do root canals? 2. Do you perform extractions? 3. Have you struggled with locating the position of the tooth that is impacted? 4. Have you ever had to rule out sinus problems mimicking a toothache? 5. Have you ever had questions about the appearance of a condyle on a panoramic image? 6. Are you planning to place implants surgically? 7. Are you planning to learn about obstructive sleep apnea and how dentists can play an important role and possibly save lives? 8. Have you ever had to take a panoramic to try to determine if a fracture was present in either the maxilla or the mandible? 9. Have you ever struggled to determine whether there was any residual periapical disease present following root-canal therapy by looking at your 2D grayscale images? 10. Do you have to spend $75,000-$200,000 to own a machine just to ﬁnd out if there's a residual periapical lesion on a toothache treated endodontically? http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown March 2015

On Dentaltown.com
Howard Speaks: 20 Feet from Stardom: Delegate like Jagger
Professional Courtesy: Married to My Profession
Continuing Education Update
Help Me Treatment Plan This Case
CBCT Technology: What Will the Future Bring?
New Luting Composite: Variolink Esthetic
Cone Beam 3D—Is It Really for Me?
Four Digital Marketing Mistakes that Impede Practice Growth
New Products
Poll
From Scaling to Therapy: A Day in the Life of a Dental Hygienist
The Value of a Dental Practice: Why Tracking “Attributable” Expenses Matters
I am Seeing a Lot of HPV Lesions in the Mouth Lately; What is the Protocol, Remove Them or What?
Dental Podcasts: What They Are and How They Work
Service Profi le: Garfi eld Refi ning
CE: Posterior Maxilla Implant Rehabilitation: A Challenging Task
Product Profile: Dentsply Caulking
Women in Dentistry: Intro
Women in Dentistry: Work/Life Balance: Flexibility and Creative Scheduling Go a Long Way
Women in Dentistry: The Lucy Hobbs Project
Women in Dentistry: Female Dentists in Conservative Muslim Nations Face Challenges and Threats
Women in Dentistry: The American Association of Women Dentists: Representing Women from Products to Leadership
Ad Index
Women in Dentistry: Q&A
Women in Dentistry: The Sky's the Limit: Hygienist Turned Entrepreneur Shows What's Possible
Product Profi le: SmartBox
Dentally Incorrect

Dentaltown March 2015