Interpretation Basics of Cone Beam Computed Tomography

The American Academy of Periodontology (AAP) created a set of questions regarding CBCT use based on published research in 2017. They asked three main questions when reviewing CBCT research, covering goals, benefits, potential risks, and the bottom line.

“Should CBCT imaging replace two‐dimensional (2D) radiographic analysis of regional anatomy in the surgical management of patients requiring dental implants?”

Diagnosis and treatment outcome assessment.

Implant treatment planning.

Anatomic characterization.

CBCT helped to identify incidental findings that may influence treatment including but not limited to anatomic variants, pathologies and fractures. CBCT supports minimally invasive therapy for dental implants and provides a method to educate patients.

Quantity of bone, alveolar ridge morphology, maxillary sinus location, and mandibular canal location are important information prior to placing an implant. Standard intraoral radiographs provide the height of bone available but do not show whether there are ridge defects or concavities ( Figures 2.17and 2.18). CBCT imaging provides information on these things to ensure implant placement within the bone and not surrounding soft tissues. Cross‐sectional views are recommended to view the facial‐lingual width and morphology of the alveolar ridge. The recommended voxel size is 0.3 mm to reduce the overall radiation exposure.

Figure 2.17. Reconstructed pantomograph and cross‐sectional slices showing lingual concavity in posterior mandible (white arrow) and mandibular canal noted in red.

Figure 2.18. Reconstructed pantomograph and cross‐sectional slices showing facial concavity in anterior maxilla (white arrow).

Long‐term radiation hazards of effective dose accumulation are still unknown, so the practitioner should minimize exposure when possible.

CBCT should be used as an adjunct to 2D imaging when the benefits outweigh the risks.

“Is CBCT imaging useful in determining risk to periodontal structures in patients requiring tooth movement?”

Evaluate changes in alveolar bone thickness and height around natural teeth.

CBCT aids in identifying patients undergoing orthodontic treatment who are at risk for alveolar bone/soft‐tissue deficiencies.

Long‐term radiation hazards of effective dose accumulation are still unknown, so the practitioner should minimize exposure when possible.

CBCT can assist in planning orthodontic therapy and aid in identifying those with thin bone.

“Does CBCT imaging add clinical value in diagnostic assessment and treatment planning for the management of periodontitis?”

Current evidence does not support routine use of CBCT in managing periodontitis.

Long‐term radiation hazards of effective dose accumulation are still unknown, so the practitioner should minimize exposure when possible.

CBCT provides little benefit managing periodontal disease.

1 AAE and AAOMR Joint Position Statement; use of cone beam computed tomography in endodontics—2015/2016 update. ( https://www.aae.org/specialty/clinical‐resources/guidelines‐position‐statements/).

2 Chakravarthy, P. V. K., Telang, L. A., Nerali, J., et al. (2012). Cracked tooth: A report of two cases and role of cone beam computed tomography in diagnosis. Case Reports in Dentistry, 2012, 525364.

3 Durack, C., and Patel, S. (2012). Cone beam computed tomography in endodontics. Braz Dent J, 23 (3), 179–91.

4 Joint Position Paper AAE and AAOMR; use of cone‐beam computed tomography in endodontics ( http://c.ymcdn.com/sites/www.aaomr.org/resource/resmgr/Docs/AAOMR‐AAE_postition_paper_CB.pdf).

1 Clinical recommendations regarding use of cone beam computed tomography in orthodontics. Position statement by the American Academy of Oral and Maxillofacial Radiology. ( https://www.aaomr.org/assets/Journal_Publications/Position_Papers/1.%20clinical%20recommendations%20%20regarding%20use%20of%20cbct%20in%20orthodontics.%20position%20statement%20by%20the%20american%20%20academy%20of%20oral%20and%20maxillofaci.pdf).

2 Fisher, J. (2015). Take only CBCTs on these types of orthodontic cases. New Advances in Digital Dentistry, 1, 1.

3 Kapila, S., Conley, R. S., Harrell Jr, W. E. (2011). The current status of cone beam computed tomography imaging in orthodontics. Dentomaxillofac Radiol, 40 (1), 24–34.

4 Rossini, G., Cavallini, C., Cassetta, M., et al. (2012). Localization of impacted maxillary canines using cone beam computed tomography. Review of the literature. Ann Stomatol (Roma), 3 (1), 14–8.

1 Mandelaris, G. A., Scheyer, E. T., Evans, M., et. al. (2017). American Academy of Periodontology best evidence consensus statement on selected oral applications for cone‐beam computed tomography. J Periodontol, 88, 939–45.

2 Quereshy, F. A., Barnum, G., Demko, C., et al. (2012). Use of cone beam computed tomography to volumetrically assess alveolar cleft defects—preliminary results. J Oral Maxillofac Surg, 70 (1), 188–91.

3 Tsai, P., Torabinejad, M., Rice, D., et al. (2012). Accuracy of cone‐beam computed tomography and periapical radiography in detecting small periapical lesions. J Endod, 38, 965–70.

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