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ePaper created 2014-12-05, 15:38:45 | version 1.33.01
08 I I opinion _ CBCT in dental office Expert testimony is by definition the opinion of one practitioner. It is an opinion based on fact, evidence, experience, and knowledge which the expert believes to be relevant, valid, and upheld in the scientific community. When reviewing a case for suspected malprac- ticetheexpertexaminesmanythings,including,but not limited to: chart notes, radiographic studies, depositions, and professional correspondences. In the last five years, the author has noticed a re- markable increase in the number of cases in which plaintiffs and defence attorneys, as well as experts, rely on pre and/or post-procedure CBCT imaging studies to assist in proving malpractice or defend- inggoodpractice. Post-treatmentradiographicim- agingtoprovemalpracticeorsupportgoodpractice is not new to medicine. In fact in the years preced- ing WWI, some of the highest malpractice claims were awarded in cases where post-treatment radi- ographs played a pivotal role. Logicwoulddictatethatifplaintiffsanddefence counsels and experts are making CBCT part of their strategy, then CBCT must be not only prevalent and pertinent but of significant value in the formation of an opinion by an expert (and the jury) when re- viewing a case. CBCT can be seen as an additional and important piece of information to help explain why the doctor did what he did or why an unfortu- nateoutcomeoccurred.Additionally,CBCTprovides powerful and easily understandable images for layperson jury. Recognising the value that CBCT adds to a case does not necessarily indicate that CBCT is the standardofcareineachandeverycase.Thedecision to obtain a CBCT study before the procedure is determined by the dentist based on his experience and knowledge of the case. _Literature Support For any technology to be considered as a stan- dard of care, a plethora of literature in support for the technology should exist. The literature must discuss the risk and benefits of the technology, its application to patient care, and guidelines and protocols for acceptable use. To assess the influence of CBCT in the dental lit- erature, the author performed a PubMed literature search in October for the words cone beam CT, cone beam CT + dental, cone beam CT + dental implants, cone beam CT + orthodontics, cone beam CT+ oral surgery, cone beam CT + endodontics in the search line. The results are in Table 1. EvaluationofTable1dataclearlyshowsasignif- icantpresenceintheliteratureofarticlespertaining to the use of CBCT in the various disciplines in dentistry. The vast majority of literature discovered pertains to addressing the use of CBCT in treatment planninganddiagnosisofpatientsindentalimplant therapy, oral and maxillofacial surgery, orthodon- tics, and endodontics. Articles on new applications ofCBCTtechnologytopatientcarewerealsopreva- lent in the sample. Some articles addressed the risk and benefits of CBCT but none denounced CBCT as harmful to the patient or insignificant in treatment planning and diagnosis. Two similar PubMed re- views of the literature on CBCT were performed by authors Alamri et al (Applications of CBCT in dental practice: A review of the literature. Gen Dent 2012: 60(5):390–400) and De Vos et al (Cone-beam computerized tomography (CBCT) imaging of the oral and maxillofacial region: A systematic review of the literature. Int J Oral Maxillofax Surg 2009; 38: 609–625). Both of these exhaustive articles demonstrate the plethora of literature addressing CBCT and its application in the many disciplines in dentistry. _Professional Guidelines For a technology such as CBCT to become a standard of care in dentistry, guidelines for its use and application in patient care must be established by the organisational bodies of those disciplines in dentistry who employ the technology to treat patients. In dentistry, the dental practitioners most involved in the use and application of CBCT in pa- tientcareincludegeneraldentists,oralandmaxillo- facialsurgeons,endodontists,oralandmaxillofacial radiologists, orthodontists, and periodontists. The American Dental Association has over 180,000 licensed dentists representing approxi- mately 75 % of dentists in the USA. The American DentalAssociationpublishedanadvisorystatement article in its principal journal, The Journal of the American Dental Association, in August 2012. The article discusses the many positive aspects of CBCT, but stops short of calling CBCT a new standard of care. Rather, the ADA encourages the dentist to use cone beam4_2014 Key words in search Number of articles Year article first appeared CBCT 5,537 1988 CBCT + dental 1,951 1998 CBCT + dental implant 617 2002 CBCT + orthodontics 725 2003 CBCT + oral surgery 1,041 1998 CBCT + endodontics 313 2007 Table I CBE0414_06-11_Whitesides 28.11.14 11:55 Seite 3 CBCT 5,5371988 CBCT + dental 1,9511998 CBCT + dental implant 6172002 CBCT + orthodontics 7252003 CBCT + oral surgery 1,0411998 CBCT + endodontics 3132007 CBE0414_06-11_Whitesides 28.11.1411:55 Seite 3