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CBCT Imaging- The Dentists Third Eye: A Literatu re Based Review
Article · August 2014
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Abstract

Keywords: Radiation dose; radiation protection; dental radiography; cone-beam computed tomography .The emer gence of cone-beam computed tomography (CBCT) has expanded the field of oral and maxillofacial radiology . CBCT
imaging provides 3-dimensional volumetric data construction of dental and associated maxillofacial structures with isotropic
resolution and high dimensional accuracy . The 3-dimensional information appears to offer a potential for improved diagnosis
for a wide range of clinical applications and usually at lower doses than with “medical” multi slice CT . This article makes an
effort to provide an insight into the basics of CBCT technology , its advantages, limitations and its applications in various spec-
ialities of dentistry . Clinical implications along with the basic principles and guidelines for the use of CBCT in dental applica-
tions, devised by the European Academy of Dental and Maxillofacial Radiology (EADMFR) have also been discussed.
An electronic search was undertaken based on keywords using Medline/PubMed, Embase, Web of Science and Ovid database
resources up to December 2013 to identify appropriate articles, supplemented by a manual search using reference lists from rele-
vant articles. Inclusion criteria were mainly based on different combinations of keywords and restricted to articles published in
English language only.CBCT Imaging- The Dentists Third Eye: A Literature Based Review
1 2 2 2
Heeresh Shetty, Priyadarshini Hegde, Aditya Shetty, Mitra N Hegde
Introduction in a single arm rotation.2,3
Imaging is an important diagnostic adjunct in dentistry . 2- Principle on which CBCT works
dimensional (2D) imaging modalities have been used in The principle of CBCT is mainly based on 2 components:
dentistry since the first intraoral radiograph was obtained a) fixed x-ray source and b) detector with a rotating gantry . 1
in 1896. Panoramic radiography has been extensively us- Cone-shaped beam of ionizing radiation emitted from the
ed by dentists since its first introduction in the 1960's and X-ray source passes through the region of interest (ROI) to
was considered as a major breakthrough in the field of de- the x-ray detector on the other side. The gantry containing
ntal radiology providing dentists with a comprehensive im- the x ray source and the detector rotates around the patient's 0 0 0
age of the maxilla and mandible along with their associated head in either full 360, or partial 180-270 arcs. During ro-
structures. Magnification, distortion, superimposition and tation, the x-ray source emits radiation in a continuous or
misrepresentation of structures were some of the limitatio- pulsed mode allowing the detector to acquire multiple 'bas-
ns of these 2-dimensional radiographic modalities. is' projection radiographs. 2D projection images are obtai-
Though 3-dimensional (3D) radiographic imaging in the ned for a field of view (FOV) selected according to the reg-
form of computed tomography has been extensively used ion of interest. This working principle differs from a medi-
in medicine, its application in dentistry has be en curtailed cal CT, which creates a 3D image by stacking the individ-
largely due to its high radiation dose along with other fact- ual image slices which have been acquired by a fan shaped
ors such as accessibility and cost. The introduction of cone X-ray beam in a helical progression. Here each slice needs
beam computed tomography (CBCT) dedicated specifica- a separate scan and separate 2D reconstruction (Figure 1).
lly for the imaging of the maxillofacial region has revolut- Since CBCT exposure incorporates the entire FOV, only a
ionized the field of imaging in dentistry , facilitating the tra- single rotational sequence of the gantry is required to obta-
nsition of dental imaging from 2D to 3D images and expa- in enough data for image reconstruction. Hence, cone-
nding the role of imaging from diagnosis to image guidan- beam geometry has inherent quickness in volumetric data 2
ce of operative and surgical procedures. Dentistry is migr- acquisition and uses a less expensive radiation detector
ating from “radiographic interpretation” into “disease vis- when compared to that of a medical CT. During CBCT rot-
ualization” ation, single exposures are made at certain degree interv-
als, generating projection images, known as basis or proje-
What is CBCT ? ction images. These are just like lateral, oblique, A-P and P-
CBCT is a modified version of the regular CT, in which by A “cephalometric” radiographic images, each slightly offs-
using a cone shaped X-Ray beam, the scanner size, radia- et from one another . This complete set of images are called
tion dose and scanning time are all reduced. CBCT scan- as projection data. The number of images that comprise the
ning technology has its roots in medicine in angiography , projection data, called the frame rate varies, depending on 3
the system and settings applied. Higher the frame rate for a radiation therapy and intra-operative imaging procedures.
given scan time, more is the data that is collected to con- This technology was developed as an alternative to the fan-
struct the image. Though high frame rates improve image based conventional CT scanners due to the high demand –
for an imaging technique that would cover a large scan area quality they also increase radiation dose to the patient prop
1 2
Department of Conservative Dent istry and Endodontics, Nair Hospital Dental College, Mumba i, A B Shetty Memorial Institute of Dental
Sciences, Derlakatte, Mangalore, Karnataka , India. Dr. Heeresh Shetty , Correspondence: email: heereshshetty@yahoo.com
95 Indi an J Stomatol 2014;5(3):95-1 01

ortionately .Finally reconstruction software programs inc- and conventional spiral CT with respect to data acquisition
orporating sophisticated algorithms including backfiltered and reconstruction method, image spatial resolution, cont-5
projection are applied to these projection data to generate a rast, artefacts and patient radiation dose. CBCT is advant-
3-dimensional (3D) volumetric data set, that can be used to ageous over conventional CT in terms of radiation dose
provide secondary reconstruction images in 3 orthogonal reduction, lesser cost and increased availability . However ,
planes (axial, sagittal and coronal). The resolution and CBCT images suffer from several artefacts due to inferior 6therefore detail of CBCT imaging is decided by the indiv- detector efficiency and beam homogeneity . The influence
idual volume elements or voxels produced from the volu- these artifacts have on image quality and diagnostic accur –
metric dataset. In CBCT imaging, voxel dimensions are acy may vary depending on the scanning and reconstructi-
primarily dependent on the pixel size on the area detector on setting of the individual machine.
and not on slice thickness as with that of conventional CT.
Since, the resolution of the area detector is sub-millimeter CBCT v/s Dental X-Ray
(range: 0.09-0.4mm), this principally determines the size Cone beam images are undistorted or accurate dimensio-
of the voxels. Hence, CBCT units in general provide voxel nally , when compared to panoramic images which are both
resolutions that are isotropic i.e., equal in all 3 dimensions. magnified and distorted. The problem of magnification by
itself can be addressed, as long as the magnification factor 4
Terminologies is calculat ed. However distortion, on the other hand is the
Collimation: The adjusting of the beam at the radiation so- unequal magnification of different sections of the same
urce that creates varying sizes of images; smaller the scan image, because of which panoramic images cannot be reli-
size lesser is the radiation for any given voxel size. ed on for making measurements.
Voxel: The 3-D equivalent of a pixel; the smallest sub-unit In addition, while CBCT images are able to provide cross-
of a CBCT volume. This is associated with resolution and sectional , axial, coronal, sagittal, and pa noramic views, a
exposure. panoramic image is unidimensional, either a mesio-distal
Hounsfield units (HU): A quantitative measure of the rad- or antero-posterior view . Further , in a panoramic image all
iolucency of different materials in a CAT scan. These units the structures between the x-ray tube and the image detec-
allow for differentiation of the relative densities of various tor are superimposed on one another . With CT it is possible
biological structures. For example, HUs are involved when to separate out the various structures, for example, the left 7assessing the bone density of the potential implant site. condyle from the right one.
Micr osievert (Sv): An international unit used to measure 2effective dosages of radiation. Advantages
Rapid scan time
Conventional Computed Tomography (CT) v/s Cone In CBCT , projection images are acquired in a single rotat-
Beam Computed Tomography (CBCT) ion and therefore scan time is comparable to that of pano-
There are several characteristic differences between CBCT ramic radiography .
96
Figure 1: Cone beam CT (top) compared to
‘fan-beam' CT (below)Figure 2: Rapid prototyping technique for the fabrica tion
of physical replicas of 3D computer generated models Indi an J Stomatol 2014;5(3):95-1 01

Indian J Stomatol 2013;4(1):36-39
Beam limitation Applications in dentistry
Collimation of the CBCT primary x-ray beam enables li- Oral and Maxillofacial Surgery
mitation of the radiation to the area of interest. Hence an 1)Investigate the exact location of jaw pathology in 3D 10
optimum FOV can be selected for each patient based on images.
suspected disease presentation and region of interest. 2)To assess impacted teeth, to assess supernumerary teeth 11,12Image accuracy and their relation to vital structures.
CBCT imaging produces images with sub-millimeter isot- 3)To evaluate changes in the cortical and trabecular bone
ropic voxel resolution ranging from 1.4mm to as low as related to bisphosphonate-associated osteonecrosis of 130.09mm. Because of this characteristic, subsequent seco- the jaws.14ndary (axial, coronal and sagittal) and multi-planar recons- 4)It is also used in the assessment of bone grafts.
tructed (MPR) images achieve a level of spatial resolution 5)Investigate paranasal sinuses and to assess obstructive 15,16that is ideal for maxillofacial applications. sleep apnoea.
Reduced patient radiation dose compar ed to convent- 6)To investigate mid facial fractures, orbital fracture asse-
ional CT ssment and management, and interoperative visualizati-17-19Published literature indicate that the effective dose (E) var-on of the facial bone fractures.ies for various full field of view in CBCT devices from 29-7)Treatment planning of orthognathic and facial orthomo-477μSv depending on the type and model of CBCT equip -rphic surgeries.ment and FOV selected. CBCT provides an equivalent pat-
ient radiation dose of 5-80 times that of a single film-based Endodontics20,21 panoramic radiograph, 1.3-22.7% of a comparable conve -1)In diagnosing apical lesions. 8,9
ntion al CT exposure.2)Superior to 2D radiographs in detecting vertical root fra-20,22 Interactive maxillofacial imagingctures.CBCT unit reconstruct the projection data to provide inter-3)Superior to periapical radiographs in the detection of fr-23,24 relational images in axial, sagittal and coronal planes. In actures in buccolingual or mesiodistal directions.addition, data can be reoriented such that the patient's ana- 20,25,26
4)In the detection of horizontal root fractures.tomic features are realigned.5)To detect and measure the extent of internal and external 20,26
root resorptions. 2
Limitations 20,26
6)To determine the variation in root canal morphology .The present CBCT technology has limitations related to 7)Pre-sur gical assessment of the proximity of the tooth to the “cone beam” projection geometry , detector sensitivity adjacent vital structures, the size and extent of a lesion, and contra st resolution. These param eters crea te an inher – 20
and the anatomy and morphology of roots.ent image “noise” that reduces image clarity such that they are unable to record soft tissue contrast due to the relatively Implant Dentistrylow dosages applied for maxillofacial imaging.1)To measure bone quality and quantity which has led to a Image artefacts such as streaking, shading, rings and dist- 27,28
reduction in implant failure.ortion are other factors which impair CBCT image quality . 2)Presence of special softwares to construct surgical guid-Streaking and shading due to high areas of attenuation (me- 29,30
es has reduced the possibility of structural damage.tallic restorations) and inherent spatial resolution may hin-3)To assess the success of bone grafts and post-treatment der in the visualization of structures in the dento-alveolar 31
evaluations.region.
97Type of examination
Digital/F Speed, with rectangular collimation FMX
Digital/F speed, with round collimation FMX
Conventional single IOP A
Panoramic
Lateral cephalometric
CT Maxillo-mandibular
CT Maxilla
Intra oral radiographs(FMX),Panoramic and lateral
cephalometric radiographs
CBCT Large FOV
CBCT Medium FOV
CBCT small FOV34.9
170.7
<8.3
2.7-24.3
2.3-5.6
180-2100
1400
43.2-200.6
260-136
166-84
122-92Appr oximate effective dose in μSv
46,47
Table 1: Radiation dose of various imaging procedures i n dentistry Indi an J Stomatol 2014;5(3):95-1 01

Indian J Stomatol 2013;4(1):36-39 Orthodontics and functional testing before full scale fabrication. This
1)Special softwares in orthodontic assessment has enabled slice by slice fabrication technique has developed a strong
the use of CBCT images in cephalometric analysis and bond with the computed tomography data for fabrication of
has led to CBCT becoming the tool of choice for asses- anatomic structures.
sing facial growth, age, airway function, and disturban- Stereolithography in particular fabricates parts from a vat 32-34
of photo-curing polymer using a computer guided UV las- ces in tooth eruption.
er. The UV laser moves, scans the curing polymer fusing 2)Reliable tool in assessing the proximity of the tooth to
the selected layer onto a platform. The platform then shifts vital structures that may interfere with orthodontic treat-35down the thickness of one slice and the laser sweeps the ment.
second layer . This process is repeated many times till the 3)Cases that require the placement of tiny screw implants
part is built from bottom to top. Slice thickness may vary as temporary anchors, CBCT acts as a useful visual gui-
from 0.05-0.15mm. Commonly used resin in medical appl- ding technique for safe insertion of these anchors as well
ications is the stereocol resin, which is medical grade resin as to assess the bone density before, during and after tre-36-38that is FDA class VI approved. atment.
Clinical Considerations TMJ Imaging
The impact of CBCT technology on maxillofacial imaging 1)Imaging device of choice in cases of trauma, pain and
since its introduction cannot be underestimated. This does dysfunction, and fibro-osseous ankylosis, as well as in 33,39not imply that CBCT should be considered as an imaging the detection of condylar cortical erosion and cysts.
modality of first choice in dental practice. As cone beam 2)The use of 3D features facilitates the safe application of
exposure provides a radiation dose to the patient higher the image-guided puncture technique, which is a treatm-1,9,46,4740than any other imaging procedure in dentistry . It is ent modality for TMJ disk adhesion.
very important that the clinician abide by the code of pr- 3)Able to determine the true position of the condyle in the
actice. There should be justification of the exposure to the fossa, which may reveal the possibility of dislocation of
patient such that the total potential diagnostic outcomes the disk in the joint and the extent of translation of the
over-weigh the risks involved. CBCT should not be consid- condyle in the fossa, thereby facilitating easy measure-
ered a alternative for standard digital radiographic proce- ment of the roof of the glenoid fossa and provides the
dures. ability to visualize soft tissue around the TMJ, which
may reduce the requirement for the use of MRI in these 4841,42Radiation Measur ement cases.
The basic concepts associated with the radiation dose are
a) absorbed dose b) equivalent dose and c) ef fective dose. Periodontics
The absorbed dose is the amount of X-ray energy absorbed 1)Facilitates in obtaining a detailed morphological descri-
by a unit mass (total weight) of tissue. The SI unit is Gray ption of the bone with measurement accuracy equal to 43(Gy). The equivalent dose is used for comparing the biolo- that of direct measurement with a periodontal probe.26,43gic effect of different types of radiation on a tissue or an or-2)Helps in assessing furcation involvement.gan. The SI unit is Sievert (Sv). For the estimation of radia-3)Facilitates accurate measurement of intrabony defects tion risk, which is the possibility of biological outcome aft-as well the ability to assess dehiscence, fenestration def-26,43 er radiation exposure, the concept of effective dose is used. ects and periodontal cysts.The effective dose is a measurement of the degree of harm-
ful effects on the human body of one kind of radiation. The Operative DentistrySI unit for the effective dose is the Sievert, but in practice, The use of CBCT in detecting caries cannot be justified be-milli- or micro-Sievert is often used. Radiation dose of var-cause CBCT delivers a higher radiation dose to the patient ious imaging procedures in dentistry has been enumerated compared to conventional 2D radiographs with no additio-in Table 1.nal benefit.
Patient radiation protection from CBCT Forensic DentistryIt is important that appropriate safety measures are taken CBCT is a non-invasive method to estimate the age of a pe-44 for the protection of the patient against radiation hazards rson based on the pulp tooth ratio.during CBCT imaging. Some of the radiation protection
devices include, leaded thyroid collar for the protection of 3D and Stereolithographythe thyroid gland, leaded glasses for the protection of the Stereolithography belongs to a set of engineering technolo-eyes, leaded hat for the protection of the brain, and leaded gies called Rapid Prototyping (Figure 2). Rapid prototyp- 48
apron for the protection of the body trunk. Various studies ing permits the fabrication of physical replicas of 3D com-
have supported the useof thyroid collars and have conclu-puter generated models in a layered approach. After 3D re-
ded that, 2 tightly fitted collars in the front and back of the construction, the software slices the file from top to bottom neck resulted in 61% thyroid dose reduction for a large and then the slice data is transferred to a machine which FOV, 72% thyroid dose reduction for a medium FOV, and fabricates the part slice by slice. This technology has been 49,50
70% thyroid dose reduction for a small FOV). The use of extensively used in the field of engineering for the quick
leaded glasses during a CBCT examination was also inves- fabrication of design parts for physical analyses, form, fit
98 Indi an J Stomatol 2014;5(3):95-1 01

51
18. Dentists responsible for CBCT facilities who have not tigated. Prins et al, in their study showed that the radiation
previously received 'adequate theoretical and practical dose to the eye lens could be reduced by over 60% without
training' should under go a period of additional theo- having a deleterious effect on the image quality in the area
retical and practical training that has been validated by of clinical significance.
an academic institution (University or equivalent). Wh- A set of 20 basic guidlines have been formulated for the 52ere national specialist qualifications in DMFR exist, the use of CBCT in clinical practice:
design and delivery of CBCT training programmes sho- 1. CBCT examinations must not be carried out unless a
uld involve a DMF Radiologist. history and clinical examination have been performed.
19. For dento-alveolar CBCT images of the teeth, their su- 2. CBCT examinations must be justified for each patient to
pporting structures, the mandible and the maxilla up to demonstrate that the benefits outweigh the risks.
the floor of the nose (e.g., 8x8cm or smaller fields of vi- 3. CBCT examinations should potentially add new inform-
ew), clinical evaluation ('radiological report') should be ation to aid the patient's management.
made by a specially trained DMF Radiologist or, where 4. CBCT should not be repeated 'routinely' on a patient wit-
this is impracticable, an adequately trained general den- hout a new risk/benefit assessment having been perfo-
tal practitioner . rmed.
20. For non-dento-alveolar small fields of view (e.g., tem- 5. When accepting referrals from other dentists for CBCT
poral bone) and all craniofacial CBCT images (fields of examinations, the referring dentist must supply suffici-
view extending beyond the teeth, their supporting stru- ent clinical information (results of a history and exami-
ctures, the mandible, including the TMJ, and the maxilla nation) to allow the CBCT practitioner to perform the
up to the floor of the nose), clinical evaluation (radiol- justification process.
ogical report) should be made by a specially trained 6. CBCT should only be used when the question for which
DMF Radiologist or by a Clinical Radiologist (Medical imaging is required cannot be answered adequately by
Radiologist). lower dose conventional (traditional) radiography .
7. CBCT images must under go a thorough clinical evalu-
Conclusion ation (radiological report) of the entire image dataset.
The CBCT is a valuable adjunct to the dentists armamenta- 8. Where it is likely that evaluation of soft tissues will be
rium. It is a sophisticated tool, requiring special skills for required as part of the patient's radiological assessment,
operation and image manipulation. Like any device in the the appropriate imaging should be conventional medi-
digital age, continuous evolution and refinement is expe- cal CT or MRI, rather than CBCT .
cted. Future advancements will most likely be directed to- 9. CBCT equipment should offer a choice of volume sizes,
ward reducing scan time; providing multinodal imaging, and examinations must use the smallest volume that is
improving image fidelity , including soft tissue contrast; compatible with the clinical situation if this provides
and inc orporating function-specific protocols t o minim ize less radiation dose to the patient.
patient dose (e.g., small FOV for dentoalveolar imaging 10. Where CBCT equipment offers a choice of resolution,
and medium or large FOV for dentofacial orthopedic ima- the resolution compatible with adequate diagnosis and
ging). However , it is important to have an indication for its the lowest achievable radiation dose should be used.
use, taking into consideration not to over-expose patients to 11. A quality assurance programme must be established
non indicated procedures. CBCT examinations must not be and implemented for each CBCT facility , including eq-
performed unless the benefits clearly outweigh the risks. uipment, techniques and quality control procedures.
12. Aids to accurate positioning (light beam markers) must
always be used.
1.Mohammed AA, Hadi MA, Mazen AA. CBCT applications 13. All new installations of CBCT equipment should unde-in dental practice: A literature review . Dental News 2011;18: rgo a critical examination and detailed acceptance tests 19-32.before use to ensure that radiation protection for staff, 2. Scarfe WC, Farman AG. What are Cone-Beam CT and How members of the public and patient are optimal.Does it Work? Dent Clin N Am 2008;52:707-30.14. CBCT equipment should under go regular routine tests 3. Bassam H. Applications of Cone Beam Computed Tom-
to ensure that radiation protection, for both practice/fac- ography in Orthodontics and Endodontics. Drukkers GVO
ility users and patients hasn’ t significantly deteriorated. vormgevers publications, 2010;10-13.
4. Schwartz Al. Improving Precision with CBCT Imaging. 15. For staff protection from CBCT equipment, the guide-
Dentistry Today , 6 January 2011. lines detailed in Section 6 of the European Commission
5. Loubele M, Guerrero ME, Jacobs R, Suetens P, van Steenb- document 'Radiation Protection 136. European Guideli-erghe D. A comparison of jaw dimensional and quality asse-nes on Radiation Protection in Dental Radiology' shou-ssments of bone characteristics with cone-beam CT, spiral ld be followed.tomography , and multi-slice spiral CT. Int J Oral Maxillofac 16. All those involved with CBCT must have received ade-Implants 2007;22:446-54.quate theoretical and practical training for the purpose 6. Loubele M, Jacobs R, Maes F, Denis K, White S, Coudyzer
of radiological practices and relevant competence in ra- W, Lambrichts I, van Steenber ghe D, Suetens P. Image qu-
diation protection. ality vs radiation dose of 4 cone beam computed tomography
scanners. Dentomaxillofac Radiol 2008;37:309-19. 17. Continuing education and training after qualification
7. Serman NJ. Pitfalls of panoramic radiology in implant surg- are required, particularly when new CBCT equipment
ery. Ann Dent 1989;48:13-16. or techniques are adopted.8. Schulze D, Heiland M, Thurmann H, Adam G. Radiation ex-Refer ences
99 Indi an J Stomatol 2014;5(3):95-1 01

posure during midfacial imaging using 4- and 16-slice com- Endod. 2009;35:719-22.
puted tomography , cone beam computed tomography syst- 25. Patel S. New dimensions in endodontic imaging: Part 2. Cone
ems and conventional radiography . Dentomaxillofac Radiol beam computed tomography . Int Endod J 2009;42:463-75.
2004;33:83-86. 26. Tetradis S, Anstey P, Graff-Radford S. Cone beam computed
9. Ludlow JB, Davies-Ludlow LE, Brooks SL, Howerton WB. tomography in the diagnosis of dental disease. J Calif Dent
Dosimetry of 3 CBCT devices for oral and maxillofacial ra- Assoc. 2010;38:27-32.
diology: CB Mercuray , New T om 3G and i-CA T. Dentom- 27. Hatcher DC, Dial C, Mayor ga C. Cone beam CT for pre-sur –
axillofac Radiol 2006;35:219-26. gical assessment of implant sites. J Calif Dent Assoc. 2003;
10. Closmann JJ, Schmidt BL. The use of cone beam computed 31:825-33.
tomography as an aid in evaluating and treatment planning 28. Ganz SD. CT Scan T echnology An Evolving T ool for Avo-
for mandibular cancer . J Oral Maxillofac Surg 2007;65:766- iding Complications and Achieving Predictable Implant Pla-
71. cement and Restoration. Int Mag Oral Implant 2001;1:6-13
11. Danforth RA, Peck J, Hall P. Cone beam volume tomogra- 29. Almog DM, Lamar J, Lamar FR, Lamar F. Cone beam com-
phy: An imaging option for diagnosis of complex mandib- puterized tomography based dental imaging for implant pla-
ular third molar anatomical relationships. J Calif Dent Assoc nning and surgical guidance, Part 1: Single implant in the
2003;31:847-52. mandibular molar region. J Oral Implantol 2006;32:77-81.
12. Liu DG, Zhang WL, Zhang ZY, Wu YT, Ma XC. Three-dim- 30. Dreiseidler T, Mischkowski RA, Neugebauer J, Ritter L, Zö-
ensional evaluations of supernumerary teeth using cone-be- ller JE. Comparisons of cone-beam imaging with orthopa-
am computed tomography for 487 cases. Oral Surg Oral ntomography and computerized tomography for assessment
Med Oral Pathol Oral Radiol Endod 2007;103 403-1 1. in pre-sur gical implant dentistry . Int J Oral Maxillofac Imp-
13. Chiandussi S, Biasotto M, Dore F, Cavalli F, Cova MA, Di lants 2009;24: 216-25.
Lenarda R. Clinical and diagnostic imaging of bisphospho- 31. Palomo JM, Kau CH, Palomo LB, Hans MG. Three-dimen-
nate-associated osteonecrosis of the jaws. Dentomaxillofac sional cone beam computerized tomography in dentistry .
Radiol 2006;35:236-43. Dent Today 2006;25:130,132-35.
14. Hamada Y, Kondoh T, Noguchi K, Iino M, Isono H, Ishii H, et 32. Farman AG, Scarfe WC. Development of imaging selection
al. Application of limited cone beam computed tomography criteria and procedures should precede cephalometric asses-
to clinical assessment of alveolar bone grafting: A prelimi- sment with cone-beam computed tomography . Am J Orthod
nary report. Cleft Palate Craniofac J 2005;42:128-37. Dentofac Orthop 2006;130: 257-65.
15. Bassam H. Reliability of Periapical Radiographs and Ortho- 33.Howerton WB Jr, Mora MA. Advancements in digital ima-
pantomograms in Detection of Tooth Root Protrusion in the ging: what is new and on the horizon? J Am Dent Assoc.
Maxillary Sinus: Correlation results with Cone Beam Com- 2008;139:20S-24S.
puted Tomography . J Oral Maxillofac Res 2010;1:e6. 34.Aboudara CA, Hatcher D, Nielsen IL, Miller A. A three-dim-
16. Naitoh M, Hirukawa A, Katsumata A, Ariji E. Evaluation of ensional evaluation of the upper airway in adolescents. Ort-
voxel values in mandibular cancellous bone: relationship hod Craniofac Res 2003;6:173-75.
between cone-beam computed tomography and multislice 35.Erickson M, Caruso JM, Leggitt L. Newtom QR-DVT 9000
helical computed tomography . Clin Oral Implants Res. imaging used to confirm a clinical diagnosis of iatrogenic
2009;20:503-6. mandibular nerve paresthesia. J Calif Dent Assoc 2003;31:
17. Blessmann M, Pohlenz P, Blake FA, Lenard M, Schmelzle R, 843-45.
Heiland M. Validation of a new training tool for ultrasound 36. SH, Choi YS, Hwang EH, Chung KR, Kook YA, Nelson G.
as a diagnostic modality in suspected mid facial fractures. Surgical positioning of orthodontic mini-implants with gui-
Int J Oral Maxillofac Surg 2007;36:501-6. des fabricated on models replicated with cone-beam comp-
18. Zizelmann C, Gellrich NC, Metzger MC, Schoen R, Schmel- uted tomography . Am J Orthod Dentofac Orthop 2007;131:
zeisen R, Schramm A. Computer -assisted reconstruction of S82-89.
orbital floor based on cone beam tomography . Br J Oral 37.Kim SH, Kang JM, Choi B, Nelson G. Clinical application of
Maxillofac Surg 2007;45:79-80. a stereolithographic surgical guide for simple positioning of
19. Heiland M, Schmelzle R, Hebecker A, Schulze D. Intraope- orthodontic mini-implants. World J Orthod 2008;9:371-82.
rative 3D imaging of the facial skeleton using the SIRE 38.Gracco A, Lombardo L, Cozzani M, Siciliani G. Quantitative
MOBIL Iso-C3D. Dentomaxillofac Radiol 2004;33:130-32. evaluation with CBCT of palatal bone thickness in growing
20. Cotton TP, Geisler TM, Holden DT, Schwartz SA, Schindler patients. Prog Orthod 2006;7:164-74.
WG. Endodontic applications of cone-beam volumetric to- 39.Honda K, Larheim TA, Johannessen S, Arai Y, Shinoda K,
mography . J Endod 2007;33:1 121- 32. Westesson PL. Ortho cubic super -high resolution computed
21. De Paula-Silva FW, Santamaria M Jr, Leonardo MR, Con- tomography: a new radiographic technique with application
solaro A, da Silva LA. Cone-beam computerized tomogra- to the temporomandibular joint. Oral Surg Oral Med Oral
phic, radiographic, and histologic evaluation of periapical Pathol Oral Radiol Endod 2001;91:239-43.
repair in dogs' post-endodontic treatment. Oral Surg Oral 40.Honda K, Bjornland T. Image-guided puncture technique for
Med Oral Pathol Oral Radiol Endod 2009;108:796-805. the superior temporomandibular joint space: value of cone
22. Ozer SY. Detection of vertical root fractures of different thi- beam computed tomography (CBCT). Oral Surg Oral Med
cknesses in endodontically enlar ged teeth by cone beam co- Oral Pathol Oral Radiol Endod 2006;102:281-86.
mputed tomography versus digital radiography . J Endod 41.Tsiklakis K, Syriopoulos K, Stamatakis HC. Radiographic
2010;36:1245-49. examination of the temporomandibular joint using cone be-
23. Hassan B, Metska ME, Ozok AR, van der Stelt P, Wesselink am computed tomography . Dentomaxillofac Radiol 2004;
PR. Comparison of five cone beam computed tomography 33:196-201.
systems for the detection of vertical root fractures. J Endod 42.Honda K, Matumoto K, Kashima M, Takano Y, Kawashima
2010;36:126-29. S, Arai Y . Single air contrast arthrography for temporoma-
24. Hassan B, Metska ME, Ozok AR, van der Stelt P, Wesselink ndibular joint disorder using limited cone beam computed
PR. Detection of vertical root fractures in endodontically tr- tomography for dental use. Dentomaxillofac Radiol 2004;
eated teeth by a cone beam computed tomography scan. J 33: 271-73.
100 Indi an J Stomatol 2014;5(3):95-1 01

Indi an J Stomatol 2014;5(3):95-1 01
10143.Tyndall DA, Rathore S. Cone-Beam CT Diagnostic Appli- Endod 2008;106:106-14.
cations: Caries, Periodontal Bone Assessment, and Endod- 48.Li G. Patient radiation dose and protection from cone-beam
ontic Applications. Dent Clin N Am 2008; 52: 825-41. computed tomography . Imaging Science in Dentistry 2013;
44.Yang F, Jacobs R, Willems G. Dental age estimation through 43:63-69.
volume matching of teeth imaged by cone-beam CT . Fore- 49.Qu XM, Li G, Sanderink GC, Zhang ZY, Ma XC. Dose red-
nsic Sci Int 2006;159:S78-83. uction of cone beam CT scanning for the entire oral and
45.Sarment DP , Sukovic P , Clinthorne N. Accuracy of Implant maxillofacial regions with thyroid collars. Dentomaxillofac
Placement with a Stereolithographic Surgical Guide. Int J Radiol 2012;41:373-78.
Oral Maxillofac Implants 2003;18:571-77. 50.Qu X, Li G, Zhang Z, Ma X. Thyroid shields for radiation
46.Ludlow JB, Davies-Ludlow LE, White SC. Patient risk relat- dose reduction during cone beam computed tomography sc-
ed to common dental radiographic examinations: the impact anning for different oral and maxillofacial regions. Eur J
of 2007 International Commission on Radiological Protect- Radiol 2012;81:e376-80.
ion recommendations regarding dose calculation. J Am Dent 51.Prins R, Dauer LT, Colosi DC, Quinn B, Kleiman NJ, Bohle
Assoc 2008;139:1237-43. GC, et al. Significant reduction in dental cone beam compu-
47.Ludlow JB, Ivanovic M. Comparative dosimetry of dental ted tomography (CBCT) eye dose through the use of leaded
CBCT devices and 64-slice CT for oral and maxillofacial glasses. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
radiology . Oral Surg Oral Med Oral Pathol Oral Radiol 2011;112:502-7.
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