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Liabilities and Risks of Using Cone beam Computed Tomography

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Presentation on theme: "Liabilities and Risks of Using Cone beam Computed Tomography"— Presentation transcript:

1 Liabilities and Risks of Using Cone beam Computed Tomography
Bernard Friedland, BChD, MSc, JD, Dale A. Miles, BA, DDS, MS, FRCD(C)  Dental Clinics  Volume 58, Issue 3, Pages (July 2014) DOI: /j.cden Copyright © 2014 Elsevier Inc. Terms and Conditions

2 Fig. 1 (A) Two-dimensional (2D) grayscale axial view showing an implant near the mental foramen (blue arrow). (B) Three-dimensional (3D) color reconstructed view showing a hint of implant immediately adjacent to the inferior alveolar canal before it exits the mental foramen (white arrow). (C) Three-dimensional color reconstructed image using a virtual endoscopic tool (OnDemand3D, CyberMed, Irvine, CA) showing a high-resolution image of the implant apparently in the foramen or canal. (D) Using the same virtual endoscopic tool, we discovered the implant in actual contact with the inferior alveolar nerve canal (white arrow). In this case, the patient had some parasthesia and the recommendation to the referring clinician was to immediately remove the implant. Dental Clinics  , DOI: ( /j.cden ) Copyright © 2014 Elsevier Inc. Terms and Conditions

3 Fig. 2 (A) Apical lesion discovered on tooth #31 on acquiring volume for examining impacted tooth #32. This apical lesion was not appreciated on the 2D grayscale periapical radiograph. (B) Small furcation defect or possible lesion of endodontic origin from lateral canal of this tooth. (C) Inferior alveolar nerve (IAN) “painted” in software to reveal that apical lesion on tooth #31 may be irritating the nerve. Tooth #32 is also in contact with the IAN, which is important for presurgical planning information. Dental Clinics  , DOI: ( /j.cden ) Copyright © 2014 Elsevier Inc. Terms and Conditions

4 Fig. 3 (A) At first glance, tooth #16 appears to have fused roots in the 2D reconstructed image. (B) Three-dimensional reconstruction and rotation of the image reveals multiple, divergent, and fine roots, any one of which might be fractured during the surgical removal of the tooth. (C, D) Painting the inferior alveolar nerves shows that it intimately contacts the apices of teeth #17 and #32. As an aid to presurgical planning, possible surgical misadventure, and postoperative sequelae, CBCT is invaluable to help depict for the patient the potential problems with the removal of these impacted teeth. Dental Clinics  , DOI: ( /j.cden ) Copyright © 2014 Elsevier Inc. Terms and Conditions

5 Fig. 4 This scan was done for the purpose of planning mandibular implants. It is an example of an FOV that is much larger than is required. The dentist is responsible for reading the entire scan and not just the region (mandible) related to the reason for taking the scan. Dental Clinics  , DOI: ( /j.cden ) Copyright © 2014 Elsevier Inc. Terms and Conditions

6 Fig. 5 (A) This reconstructed panoramic image shows a large FOV depicting a mucous retention cyst. The superior dome-shaped border (white arrows) allows one to make the diagnosis. (B) From this view of a different patient’s scan, it is clear that the superior border of a mucous retention cyst that fills or largely fills the maxillary sinus, as it does in (A), would not be visible, making a diagnosis impossible. This shows the importance of doing a large FOV scan in the posterior maxilla. Dental Clinics  , DOI: ( /j.cden ) Copyright © 2014 Elsevier Inc. Terms and Conditions

7 Fig. 6 This cropped axial image is of a small FOV scan undertaken for endodontic purposes. The large arrow points to the palatal cortex. There is destruction of the palatal cortex (small arrows). Together with other views (not shown) from this scan, the lesion was identified as being malignant. Biopsy showed it to be an osteogenic sarcoma. Dental Clinics  , DOI: ( /j.cden ) Copyright © 2014 Elsevier Inc. Terms and Conditions


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