Tuesday, 24 February 2015

#Tubuleslive Event: CBCT - Current Concepts in Dental 3D Imaging



This week's #Tubuleslive was with Andrew Legg about the use of Cone Beam Computerised Tomography (CBCT) in practice.

Despite a few technical glitches, Andrew delivered a highly topical and interesting talk and here I shall summarise the main points of his talk:
  • CBCT can be used in both implant dentistry and oral surgery to help both with diagnosis and treatment planning
  • 2D images such as DPTs can be misleading sometimes as it only gives a flattened view of a 3D object
  • You can use CBCT to scan patients as well as prostheses to treatment plan cases - placing gutta percha in points in the denture can help locate the prosthesis. 
  • Ideally you need around 4-5mm of sound bone to place an implant - CBCT can help you determine the amount and quality of the bone present
  • If you don't have enough bone to place an implant, you can consider angled implants, zygomatic implants or extensive bone grafts or sinus lifts
  • The UK guidelines of CBCT are containing in the HA-CREC-010 document
  • When considering performing or referring for these images, you need to adhere to the IRR (99) and the IRMER (2000) guidelines 
  • Usually in order to be a CBCT practitioner, you will need at least 11 hours of training 
  • When taking a CBCT you must justify the reason why you need to take one and specify which area you need to see
  • Record the justification and the report on the image fully in your notes. Dictated notes have been deemed contemporaneous
  • You must also perform a quality assessment if you take CBCT. At least 95% need to be of an acceptable standard. 
  • Unlike conventional dental radiographs, the quality assessment is only broken down into acceptable and unacceptable (< 5%), due to the scattering effect of metallic restorations
  • A small Field of Vision (FOV) CBCT usually amounts to around 2-4 times a DPT, whereas a large FOV amounts to 6-7 times. 
  • Doses keep decreasing with the newer machines 
  • Typical background radiations is 7-8 mSv a day, so a CBCT usually amounts to a couple of days worth of background radiation, although not all machines are the same
  • Uses of CBCT in oral surgery include: assessment of ID nerve position in impacted wisdom tooth extractions, position of impacted teeth in relation to adjacent teeth to assess potential to damage, assessment of periapical pathology prior to surgical endodontics
  • Uses of CBCT in implant dentistry include: assessment of bone volume and quality, proximity to vital structures e.g. ID nerve, mental foramen, sinuses, sinus assessment e.g. spicules, membrane thickness
  • The software you can use with your CBCT scan can be integrated e.g. Galaxis, Carestream, Icat Vision, or a third party software e.g. Nobel Clinician, Simplant, Osirix
  • You can use CBCT with digitial scanning system e.g. CEREC (please see the previous #Tubuleslive post to read about this) in order to plan the ideal position of the implants and create a drilling guide
  • With proper planning you can avoid complications such as a sublingual artery bleed as a result of lingual wall perforation
Together with the previous talk from Colin Campbell, these talks have given me a better understanding of the use of 3D imaging and scanning to plan and treat patients who require implants.


The next #Tubuleslive event will be next week the 26th of March: Principles of bone augmentation for implant dentistry with Dr Koray Feran.

Why not attend the live audience where you can get FREE CPD! 

To see my other posts about previous #TubulesLive events see here

Do you use CBCT in practice? Please share your experiences in the comments section below!



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