Prof. Mohamed Ekram Basic Applications of CBCT

1. Prof. Mohamed Ekram
Cone Beam Computed Tomography (CBCT)
How to improve your practice outcome
and increase your income by using CBCT

2. M.Ekram
Cone Beam Computed Tomography
(CBCT) is the new frontier in dental
radiology.
It is probably the fastest growing area
in our discipline.
The advanced technology in computer
science made it necessary to make use
of it in dental radiography.

3. Objectives of this presentationObjectives of this presentation
Introduce Cone Beam principles
Discuss applications of CBCT
Demonstrate some interesting & unexpected
lesions.
Answer your questions
M.Ekram

4. Why take a 3D image?
2D 3D
When viewingWhen viewing two - dimensionaltwo - dimensional images , theimages , the
three - dimensionalthree - dimensional anatomy responsible foranatomy responsible for
the image must be considered.the image must be considered.

5. Reported
Case 1

6. 2 D representation of the implant area3D reconstruction of the implant area

7. Reported
Case 2

10. M.Ekram
Principles of Computed
Tomography in General
SCANORA 3D

11. A
Axial
3D 3DimentionalSagittal
C
Coronal
Sagittal Coronal
Axial
Planes of the head (cuts)

12. Production of a single axial cut.
Each rotation produces another slice
roduction of Conventional CT Image
The default is a slice
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Fan shaped Beam

13. Axial
Saggital
SaggitalCoronal

14. Generation of views in
Conventional Medical
CT
3 - D
Coronal
Saggittal
3. Reconstruction
1. Slice is the
Default
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15. How the CBCT Images (CBCT)
are Generated ?
detector
Cone-shaped x-ray
beam
X-ray source
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16. 1. 3 – D
Default
3. Reconsruction
Axial
Coronal
Sagittal
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Generation of views in
CBCT
SCANORA 3D

17. Complete data can be reformatted to produce
images in other planes
Generation of CBCT Images
Axial
Sagittal
Coronal
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18. 2-D images can, then, be obtained in any plane, including the
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Reformatted panoramic
cross-sectional
cuts of the jaws.

19. X-ray source
object
Line detector
Movement of translation
and axis of rotation
From Multislice CT...
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Fan shape beam
X-ray source
object
axis of rotation
Flat panel
detector
...to real 3D CBCT
Cone
or Rectangle
What is the difference between
conventional CT and CBCT ?

20. M.Ekram
Advantages of CBCT over
Conventional CT
What is the difference between conventional CT and CBVT ?

21. Smaller in size & less space ccupyingSmaller in size & less space ccupying
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22. Time saving.Time saving.
The decrease scanning time 20 – 40 seconds
minimizes the risk of motion artifacts.

23. Safer withSafer with
SignificantSignificant
exposure doseexposure dose
reductionreduction
Exposure dose is 78 % to 96 % less than
conventional CT
A s
L ow
A s
R easonably
A chievable
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24. Conventional medical CT
Cone Beam CT

25. This is not exactly applicable to the first
generations of CBCT units.

26. The CBCT machine should possess
different Fields of View (FOV).

27. When the large FOV is the only
available FOV the following
results:
Less safety and more radiation
exposure for the patient.
false bone density results due to
huge amount of scattered
radiation.
When the Small FOV is the only available
FOV the following results:
Limited coverage of the
cranio-facial region with few
amount of information.

28. Dentally more specific than Conventional CTDentally more specific than Conventional CT
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Advantages of CBCT over
Conventional (medical) CT

29. Supplied with more specific softwareSupplied with more specific software
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30. Easier orientation of theEasier orientation of the
occlusal planeocclusal plane
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This is essential for correct slice direction
Face bow + Chair movement

31. Bone window
Soft tissue modes
Soft tissue and hard tissue filters.
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32. Color coding of structures of different CT numbers.
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33. Applications of CBCT
Implant site evaluation.
Assessment of impacted teeth.
3D & 2D Orthodontic/ orthognathic evaluation.
Maxillofacial trauma & fractures.
Maxillofacial lesions.
TMJ assessment.
Maxillofacial deformities & alveolar Clefts.
Examination of the Paranasal sinuses
Air way examination.
Other dental applications as endodontics &
Peridontal assessment.
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34. Implant site evaluation.
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35. Bone quantity With 1 :1 Correspondence
(in all 3 dimensions, vertical, B-L & M-D)
Bone quality (only gives an idea)
Bone anatomy
Location of the vital structures
Presence of any minute bone pathology or small
remaining root fragments which cannot be always
detected by 2D plain radiographs
Useful information obtained from the
CBCT for the dental implantologist:
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36. Mesio-distal dimension: to determine the number
& diameter of the implants to be placed
1.5- 2mm between an implant & a natural tooth &
3mm between 2 implants
Bone Quantity
Vertical dimension: to determine the implant length
taking into consideration 2mm safety margin from
the IAC & 1 mm from the maxillary sinus & nasal
floor.ucco-lingual dimension: to determine the implant diameter
mm of bone should be present all around the implant
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37. Only gives an idea about estimated bone t
Bone quality is determined by obtaining the
CT. number (Bone density) in HU from the
CBCT software.
Mainly
Cortical
Symphysis
Mainly
Spongy
Post Mandible
Thick
Cortical &
Dense Spongy
Post Mandible
Thin
Cortical & Less
Dense Spongy
Ant Maxilla
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D5

38. D1 1250 or more
D2 850 -1250
D3 350 - 850
D4 150 - 350
D5 < 150
Quality in Hounsfield Units (in CT)
D5

39. Location of the Inferior alveolar canal from the
crest of the alveolus leaving a 2mm safety margin
Mental foramen.
Inferior border of the mandible.
Maxillary sinus.
Nasal floor.
Location of the vital structures
Nasal floor
Cross section
In the IAC
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40. Radiographic tracing is achieved by delineating the inferior alveolar canal on
he radiograph for easier measurement recording.
Radiographic Tracing :
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41. Radiographic Tracing
( Cross sections )
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42. Bone measurements
(Height & B-L width)
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43. Bone
Undercuts
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 Lingual perforation & injury to the adjacent
 vessels due to improper drilling direction.

44. Implant
Simulation
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45. Compuer guided implant surgery
and Surgical Guides
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Precise preoperative planning software can be used
to accurately plan the placement of dental implants
using integrated data from a CBCT scan.

46. Disadvantages of Implant site
analysis
Programs based on medical CT
Systems.
Very high patient radiation dose.
No notable updating (e.g.DentaScan 2+).
More expensive than CBCT.
Time consuming.
No limited area examination is always possible.
Most of the cross sectional cuts in a single
examination are non-corrected (cannot be
customized).

47. Bone graft simulation

49. 3D printing derived from CBCT Data

51. Impacted Teeth.
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Visualization of the impacted teeth in the 3 dimensions.
The relation of the impacted tooth to the vital structures
The effect of the impacted tooth on adjacent teeth.

52. Interpretation of 3D images
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Surface mode &
transparent modes
3D Endoscopy

53. Reported
Case

55. CBCT In Periodontal evaluation

56. M.Ekram
Facial and lingual aspects

57. 3D Lingual panoramic view
3D facial panoramic view

59. Orthodontics
&
Orthognathic surgery
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60. Multiple 2D images can be reformatted
3 D image (surface mode)Multiple 2D images can be reformatted
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Orthodontics & Orthognathic surgery

62. 3D Cephalometric Anlysis

63. Photo
wrapping to
CBCT

64. Photo wrapping
to CBCT

65. M.Ekram
Maxillofacial
lesions

66. Exact extent of the lesion in 3
dimensional prospective
Relation of the lesion to vital
structures.
invasion to adjacent
structures or not.
CBCT In Maxillofacial lesions

67. Reported case

68. Visualization in 3D

69. Reformatted panoramic views

70. Axial views
Coronalviews

71. M.Ekram
Examination of Sailvary Glands

72. Reported case

73. Salivary Stone In The Duct

74. Segmentation
Submandibular S.G duct Stone

75. M.Ekram
3D reconstructed imageSagittal View
Duct Stone
Examination of Sailvary Glands

76. M.Ekram
Sagittal View
Axial view
Cross section view
Sailvary Glands Duct Stone

78. M.Ekram
3D reconstructed imageSagittal View
Duct Stone
Examination of Sailvary Glands

79. Reported
Case

80. Deep lobeSuperficial
lobe
Coronal section of the skull
Showing pooling of the contrast material in the
superficial and deep lobes of the parotid gland.
RT

81. 3-D view of skull
Showing pooling of the contrast solution in the
superficial lobe of the parotid gland.
Pooling of
contrast material
RT
Sialographic appearance compatible
with
Sjogren’s Syndrome.

82. Maxillofacial deformities
&
Alveolar Clefts
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83. It assess the 3D extension and dimension
of the defects to evaluate the amount &
Orientation of the graft material
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84. M.Ekram
Extent of the defect in
The sagittal plane

85. Paranasal sinuses
Mucous
Retention
cyst
Mucous
Retention
cyst
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86. Inferior & medial displacement of the fractured segment
Maxillofacial Trauma.
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Mandibular body fracture

87. Gun shot
injury

88. Reported case

89. A 14 years old boy with
history of a gunshot.
Clinically presented with an
anterior open bite with facial
lacerations.
CBCT examination revealed
bilateral comminuted
complex fracture.

90. 3D visualization

91. Treatment was performed by simple MMF

92. TMJ assessment
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93. CBCT of the TMJ
CoronalSagittal
Axial 3D 3Dimentional

94. M.Ekram

95. Endodontics
Atypical anatomy Internal resorption

96. Airway
endoscopy
Air way examination.
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97. Airway measurements
& color coding
Measurements color
coding
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98. CBCT Reporting
Impactions

99. The Dicom Environment

100. Server and PACS survices
 Radiology Center Access with all images loaded.
 Referring doctor Access to the server site (Address).
 Referring doctor Access to his own sector
 ImageTransfer.

101. Serial
Unexpected
finding No of Cases
1 Caries
2 Periodontal disease
3 Dental anomalies
4 iInfections
5
Odontogenic & allied
lesions
6 Forein bodies
7 Total No of cases
The Unexpected Findings

102. Reported
Case

103. Aim of examination: Implant planning upper R #4 & #5

104. Unexpected finding: Periapical radiolucency related to Upper left #7
The roots are in very close proximity to the maxillary sinus

105. Reported
Case

106. Aim of examination: Implant planning upper
anterior region (missing teeth and others
indicated for extraction).

108. Unexpected finding: Carious lesion in the lower right t# 4 & Lower left # 3

109. The Non-sense
imaging !!!

110. ?
? ?
?

112. Now you can restart your practice on
these new basis safely, quickly, and with
greater diagnostic information and
knowing all the details about your
patient.

113. Thank You
for Your attention