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CAD/CAM international magazine of digital dentistry

Once again through software ma- nipulation, 3-D images can be viewed as conventional radiographs, maxi- mumintensityprojections(MIP),soft- tissue projections and a variety other views. Thisnearlyendlessabilitytomanip- ulatethedataaidsinthediagnosisand identification of disease, nerve canals, sinus morphology, dental caries, bone density, fractures, endodontic pa- thology, implant placement criteria, periodontal defects, bone pathology, fracturedteeth,iatrogenictrauma,TMJ morphology and disease, third-molar position and many more healthy or diseased conditions. _Early CBCT adoption with implants The first and primary use of CBCT for early adopters was implant placement. As the scope and the value of the information became better known, dentists of all branches began to see the value of MPRs and 3-D renderings including periodontics, endodontics, oral surgery, treatment of TMJ, ortho- dontics, implantology and general dentistry.1,7,8 Clinical periapical and panoramic radiographs for the placement of implants can be misleading with elongation, foreshortening, superimposition and geometrically incorrect data.7,8 A look at the implant in the periapical shows no obvious disease toanexistingintegratedimplant.Clinically,abuccal fistula was present with exudate and slight pain. The CBCT scan (Fig. 1) reveals a more accurate view showingabuccaldefectonasaggitalMPR.Asurgi- cal flap revealed a dehiscence of the coating of the implant. Removal of the foreign body resulted in an asymptomatic and healthy patient. The evaluation of the available bone for the ini- tial implant placement can be crucial for the long- termsuccessofthecase.Ifthereisinadequatebone available, grafting may be a necessity. CBCT studies render the most accurate information available at a lowradiationdose.Theperiapicalshowsanobvious lack of bone height, but does not show the buccal- lingual dimensions or an accurate view of the sinus morphology (Fig. 2). The MPR view of the CBCT shows all necessary measurementstoperformthesinusliftandgrafting with the immediate placement of the implant fix- ture(Fig.3).Three-dimensionalviewsshowthefloor of the sinus and any soft-tissue pathology (Fig. 4). Having accurate measurements in all dimensions is an advantage of CBCT scanning. _CBCT and endodontics Endodontics is a field that is rapidly adopting the use of CBCT and for good reason. The inherent geometric deficiencies of 2-D radiographs make the CBCT scan a valuable adjunct to investigate the root morphology in both 3-D and MPR. The typical periapical will show superimposed canals in the anteriors, bicuspids and molars as well as unwanted bone densities both buccal and lingual to the affected tooth making the image quality poor. Fig. 4_The 3-D CBCT showing anatomy of the maxillary sinuses. Fig. 5_Axial MPR showing mesial buccal roots in first, second and third molars. Fig. 6_Periapical showing minimal pathology with no radiolucency. Fig. 7_Coronal MPR showing a short fill on the mesial lingual and radiolucency. Fig. 8_Saggital MPR showing unfilled canal and radiolucency. I 07 CE article _ application of 3-D imaging I CAD/CAM 4_2012 Fig. 6 Fig. 7 Fig. 8 Fig. 5Fig. 4