31
Volume1 Issue6
|
S
upporting
Y
our
P
ractice
Cone BeamComputedTomography
HOWCANCBCT ENHANCE
PATIENTCARE?
How isCBCTused indental offices?
If youare involved in implants, then
CBCT is very relevant toyour practice.
CBCT’s superior spatial resolution in three
dimensions alsomakes it useful indiagnosis
and treatment planning for endodontics,
complexunerupted teeth, andexamination
of potentially serious lesions, suchasbenign
neoplasms affecting theanatomically
complexmaxilla. TounderstandhowCBCT
canenhanceyour patient care, youneed to
know its clinical indications toensureyou
avoidunnecessaryexposure.
Whatare thebenefitsofusingCBCT
for implants?
Thereare skilled surgeonsand implantologists
with tremendous experiencewhocan safely
place implantswithoutCBCT, at least for
someof their patients. But if you lack that skill
or experience, the safest option for youand
your patient is touseCBCTaspart of your
pre-implant planning.
WithoutCBCT, there is an increased riskof
inadvertentlyplacing the implant into the
mandibular canal, submandibular fossaor
maxillary sinus, andalso thecanals running
to the lingual foramenat themidline,
where thebranches from the lingual artery
are found. A sublingual hemmorhage is
potentially life-threatening, asdocumented
in2dozen reports so far.
Howdoes the radiation risk
associatedwithCBCTcompare to
other typesofdental imaging?
It goeswithout saying that every radio-
graphicexposure shouldhaveat last one
clear clinical indication. CBCT imparts a signif-
icantlygreater radiationdose to thepatient’s
Since its initial applicationas a convenient and less expensivealternative tomedical computed tomography (CT) for
osseointegrated implants, theuses for conebeam computed tomography (CBCT) technology indentistryhave grown.CDA
spokewithDr.DavidMacDonald, fellowof theRoyalCollege ofDentists ofCanadaand chair inoral andmaxillofacial
radiologyat theUniversityofBritishColumbia, togethis perspectives on thebenefits and risks associatedwithCBCT.
head thanconventional radiography—and
more than just 1or 2panoramic radiographs,
more likeat least 10. Because there isno safe
radiationdoseand theeffectsof radiation
arecumulative, dentistsneed tocontinue
toobserveALARA (As LowasReasonably
Achievable)—particularly for children, our
most vulnerablepatients. AtUBCDentistry,
we infrequentlyuseCBCTonchildren.
Also, CBCThas an initial steep learning
curve—andwith this, an increased likelihood
of retakes. Therefore, thedental teammust
ensure its technical competencebyprior
practicewithappropriatephantomsbefore
exposing thepatient. Given thepotential
risks associatedwith repeated scans, prac-
titionerswill need toweigh thebenefits to
justifyeachdecision to scan.
What impactwill regulatoryand
otherdentalprofessionalbodieshave
onCBCTuse?
The reduction in riskof radiation-induced
harm is amajor interest of our regulatory
bodies. In2011, theRoyal CollegeofDental
SurgeonsofOntarioproduced regulationson
CBCT. The regulations stipulate that dentists
whoarenot credentialedoral andmaxillo-
facial specialistsmust takeacourseonCBCT
beforeoperatingaCBCTunit, andcanusea
fieldof viewof 8cmor less, confined to the
jaws. This excludes the temporomandibular
joints.
TheEuropeanguidelines, originallynamed
SEDENTEXCT,werepublished inMay2012.
Theseguidelineshavebeenadoptedby
theBritishColumbiaDental Association
as thebasisof itsCBCTcourses for its
members.
a
DavidMacDonald
BDS,BSc(Hon),
LLB(Hon),MSc,
DDS(Edin),DDRRCR,
FDSRCPS,FRCD(C)
Dr.MacDonald is chair,
divisionof oral&
maxillofacial radiology,
facultyofdentistry,
UniversityofBritish
Columbia,Vancouver,BC.
VisitOasisDiscussions to
hear a seriesof
5audio interviews
withDr.MacDonald
onCBCT, startingwith:
