cone beam international magazine of cone beam dentistry

I 09 CE article _ application of 3-D imaging I cone beam1_2014 pockets, point to X-rays and propose treatment only to have patients refuse treatment because they do not under- stand what we are clinically describ- ing. Using the 3-D portion of the CBCT scan can improve the understanding and acceptance of treatment plans. Theimagesareapictureoftheproblem thatisownedbythatpatientandmuch easier to understand by the layperson. Illustrating periodontal defects and pockets allows the patient to better participate in the process (Fig. 13). The MPRs and the 3-D projections aid in surgical planning for periodontists, allowing for accurate measurements and bone analysis prior to osseous surgery that doctors cannot get using the periapicals or panoramics. Studies have shown that CBCT images are more accurate than pan- oramic radiographs. For the periodontist placing implants, the ability to measure bone density and avoid important anatomy is important.4, 5 _Orthodontics Orthodontists are beginning to adopt large field-of-view CBCT. Recent studies show that linear measurements of bony structures are more ac- curate using CBCT and have less distortion than currently used methods of measurement: lateral cephalometric, posteroanterior (PA) and submen- tovertex (SMVT).5 Accurate measurements of tooth volume and tooth position can aid in accelerated treatment times and more precise treatment. Alongwithtoothposition,densityofboneandsize ofarches,theorthodontistalsohasanaccurateeval- uation of the temporomandibular joint and position of the condyles. Impacted teeth are easily identified andpositioneitherbuccalorlingualcanbeconfirmed prior to movement or removal. Both MPRs and 3-D projections give the clinician a complete picture of the problems and the treatment course. With a single CBCT scan, orthodontists can pro- duce all of the information they need: panoramic, cephalametric, PA, SMVT, tooth size and volume, crowding evaluation in any plane, TMJ evaluation and airway analysis, all with both soft-tissue and skeletal information.5,7 _Conclusion We treat our patients in 3-D, and now, with conebeamcomputedtomography,wearechanging the way we diagnose from 2-D to 3-D. The addition of this technology will increase your diagnostic skills with better and more complete information at your disposal. As with any type of invasive diag- nostic tool, clinicians should weigh the risk to ben- efit in using CBCT scans. Judicious use of CBCT and knowledge of patient’s lifetimedosesshouldalwaysbeaconsiderationaswell as the availability of other diagnostic tests appropri- ate for the problems of the patient. When adopting new technology, training is paramount. Along with trainingcomestheresponsibilityofthedoctortoread and diagnose information from CBCT scans. Do not avoid CBCT from lack of knowledge; in- stead,takethisopportunitytobecomeabetterdiag- nostician and radiologist. As you review radiology and pathology, your use of CBCT will aid in making themostaccuratediagnosisandthemostcomplete treatment plans._ Editorial Note: A complete list of references is available fromthepublisher. Fig. 12_The 3-D rendering showing supernumary teeth and positions. Fig. 13_The 3-D rendering with periodontal defects and calculus bridge. Dr Dan McEowen is a 1982 graduate of Loma Linda School of Dentistry and has been in private practice for 26 years.He is a founding member of theWorld Clinical Laser Institute,achieving a mastership level of proficiency. He has been active in FDA approval of oral surgery techniques using Erbium lasers.McEowen has lectured and trained internationally in techniques using lasers in general and specialty dental fields. HeisamemberoftheICOIandisactiveinimplantology. McEowen has been involved in cone beam technology for more than five years and owns 3-D Imaging Center in Maryland. cone beam_about the author Fig. 13Fig. 12 CBE0114_06-09_McEowen 31.01.14 15:49 Seite 4