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ePaper created 2015-09-29, 13:02:58 | version 1.38.0
I case report _ CBCT in diagnostic and treatment planning _Introduction Endodonticsisafieldofdentistrythatrequirespre- cision and accuracy at their highest levels. The same preconditions apply to the image quality needed for endodonticdiagnosis.ConeBeamComputedTomog- raphy (CBCT) has turned out to be an excellent point- of-careimagingsolutionforanendodonticpracticeas the quality and quantity of diagnostic information is far superior to any other imaging modality. EventhoughtheradiationdoseofCBCTimagingis naturally higher in comparison to 2-D imaging, the doselevelisstillveryreasonableandquicklyoffsetby the yielded diagnostic data. Radiation hygiene is, nevertheless, constantly a hot topic both at academic and practical discussions within dentistry. The rapid technological progress of CBCT technology has discovered new means of de- creasing the patient dose while improving, or at least maintaining, the diagnostic information intact. Low- dose programmes might not instantly appear to be compatiblewiththeresolutionrequirementsofen- dodontic images, but new innovations open up the avenue for decreased dose also for endodontic pa- tients. ThiscasestudydescribeshowCBCTprovideskeyin- formation of relevance in endodontic diagnoses and treatmentplanning,andhowlowerresolutionandthus lower radiation dose may be totally applicable also for follow-upimagingofcertaintypeofendodonticcases. Itisjustaquestionofjustificationandoptimisationof the patient dose versus needed image quality—about choosingtherightresolutionforthejob. _Case report A46-year-oldmalepatientcametotheclinicfora check-up.Anativepanoramicimage(CRANEXD,dose area product DAP 70mGy/cm2) revealed a symptom- less apical periodontitis in a root canal treated d17. Root canal treatment had been performed 4 years earlier (Fig. 1). Astherewasnohealingtobedetected,itwasnec- essary to make a further treatment plan. The patient hadbeenpreviouslysurgicallyoperatedonforcancer, and at the time of the diagnosis there was no infor- mation of follow-up care for the disease. In order to acquire more information, to confirm the diagnosis and to find out the root morphology of thed17,aCBCTscan(CRANEX3D,FOV6x4withhigh resolution, exposure values 90kV, 8,0mA, 6,10s, DAP 380,7mGy/cm2) was taken as a further radiological examination (Fig. 2). Retreatment would have been one option of treatment, but because of the cyst-like finding in the apical area pushing the maxillary sinus bottom up, root resection was chosen. CBCT images proved the rootmorphologytobefavorableforit,andasaresult, anapicoectomywasperformedonemonthlater.Both thebuccalandpalatalrootswerefilledwithBiodentin retrograde fillings. Fig. 1_Panoramic radiograph examination. CBCTas a diagnostic and treatment planning tool and assessment of low dose programs for endodontic follow-up cases Author_ Dr Sirpa Pöyry, Finland 26 I cone beam3_2015 Fig. 1 This article is related to free online CE course available on DT Study Club website.Please visit www.dtstudyclub.com or just follow the QR code above. _ce credit cone beam