CBCT

Pour être légitime, le CBCT doit justifier d’apporter une information supplémentaire pour la pose d’un diagnostic, la prise de décision thérapeutique et la bonne prise en charge.

Endodontics:

⦁ Evaluating canal morphology

⦁ Identifying missed canals

⦁ Evaluating for resorption and the extent

⦁ Evaluate for fracture (might not see exact fracture line depending on its size, may just see

corresponding bone loss)

⦁ Evaluating predictability and success of a potential retreatment

⦁ When to refer

Suggestions:

● Small field of view which helps prevent scatter and noise

● Smallest voxel size / highest resolution possible

● Can consider applying metal artifact reduction if there are existing gutta percha or posts

Third molars:

⦁ Surgical planning (how many roots are present, any dilaceration, etc)

⦁ Proximity to IAN or floor of the maxillary sinus

⦁ Any potential resorption to adjacent second molars

⦁ Associated pathology (ie: Dentigerous cyst)

⦁ Post-op needs (evaluate healing, rule out osteomyelitis or osteonecrosis)

Suggestions:

● Large field of view

Orthodontics:

⦁ Impactions (orientation of impacted teeth, resorption of adjacent teeth)

⦁ Check root positioning

⦁ Generating a pano/ceph

Suggestions:

● Large field of view to capture all structures

● High resolution is not crucial

● Lead aprons with thyroid collars are not recommended if a lateral cephalometric is to be reconstructed. There may be severe artifacts

Implants:

⦁ Evaluating available bone height/width

⦁ Evaluating proximity to vital structures (IAN/mental foramen/incisive canal)

⦁ Virtual implant planning and guide fabrication

Suggestions:

● Depending on the number of implants, either a medium or large field of view to capture dental arches

● May help to have a restorative plan prior to CBCT

● High resolution is not crucial

Sinuses and nasal cavity:

⦁ Planning for sinus lifts

⦁ Evaluating any oro-antral communications and effects on the sinuses

Suggestions:

● Large field of view to capture entire structures (depends on your machine's FOV)

● High resolution is not crucial

TMJs:

⦁ Evaluate bony changes (ie: flattening, sclerosis, degenerative changes)

Suggestions:

● Large field of view or TMJ module if your machine has this option

● Can consider taking two scans, one with the patient closed and another with the patient

at the maximum opening

Airway:

⦁ Evaluate size of palatine, lingual, and nasopharyngeal tonsils

⦁ Your software may be able to quantify the volume of the airway and a minimum cross-sectional area

Suggestions:

● Large field of view

● High resolution is not crucial

● Patient should have their tongue touching the roof of the mouth with no swallowing motions

Pathology/other:

⦁ Evaluate any pathology and lesion extension an effect on surrounding structures

⦁ Get more diagnostic information beyond 2D radiographs

⦁ CBCT NOT USEFUL FOR SOFT TISSUE EVALUATION

Suggestions:

● Try to capture the borders of the entire lesion