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Applications of CBCT in dental practice:
A review of the literature
Hadi Mohammed Alamri, BDS Mitra Sadrameli, DMD Mazen Abdullah Alshalhoob, BDS
Mahtab Sadrameli, DMD, MAGD Mohammed Abdullah Alshehri, BDS, AEGD
n n n This article reviews the various clinical applications of cone beam
computed tomography (CBCT). A literature search was conducted
via PubMed for publications related to dental applications of
CBCT published between January 1998 and June 15, 2010. The
search revealed a total of 540 articles, 129 of which were clinically
relevant and analyzed in detail. A literature review demonstrated
that CBCT has been utilized for oral and maxillofacial surgery,
endodontics, implantology, orthodontics, temporomandibular joint
T
wo-dimensional (2D) imaging
modalities have been used in
dentistry since the first intraoral radiograph was obtained in
1896. Since then, dental imaging
techniques have advanced with the
introduction of tomography and
panoramic imaging. Tomography
made it possible to isolate areas
of interest within the scope of a
radiographic examination, while
panoramic imaging utilizes principles of tomography, making it possible to visualize the maxillofacial
structures in a single comprehensive image.1 More recent advances
in digital diagnostic imaging have
meant lower radiation doses and
faster processing times without
affecting the diagnostic quality
of the intraoral or panoramic
images. However, 2D images possess unique inherent limitations
(including magnification, distortion, and superimposition) that can
make it possible to misrepresent
structures.1 Cone beam computed
tomography (CBCT) is capable of
producing three-dimensional (3D)
images that can guide diagnosis,
treatment, and follow-up.
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dysfunction, periodontics, and restorative and forensic dentistry.
This literature review showed that the different indications for
CBCT are governed by the needs of the specific dental discipline
and the type of procedure performed.
Received: September 25, 2011
Final revisions: February 6, 2012
Accepted: March 13, 2012
Introduced in 1998 for dentoalveolar imaging, CBCT generates 3D
data at a lower cost and with lower
absorbed doses of radiation than
conventional CT.2 CBCT’s imaging
technique is based on a cone-shaped
X-ray beam that is centered on a 2D
detector, which offers the advantages
of a higher rate of acquisition; unlike
conventional CT, a parallel shift of
the detector system during rotation
is not required, which results in a
more efficient use of tube power.3
The cone-shaped beam rotates once
around the object (in this case, the
patient’s head and neck), capable of
producing hundreds of 2D images
of a defined anatomical volume
rather than the slice-by-slice imaging
found in conventional CT.3,4 The
images are then reconstructed in
a visualizable 3D data set using a
variation of the algorithm developed
by Feldkamp et al in 1994.5
CBCT offers numerous advantages compared to traditional 2D
radiography, including a lack of
superimposition, 1:1 measurements,
the absence of geometric distortions,
and 3D display. It is important to
note that by utilizing a relatively low
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ionizing radiation, CBCT offers 3D
representation of hard tissues with
minimal soft tissue information.6
Conventional CT systems offer
similar advantages (in addition to
providing information about soft
tissue); however, image acquisition
requires much higher levels of ionizing radiation and a longer scanning
time. In addition, the larger size of
conventional CT units makes them
poor alternatives for dental offices.7
This article presents a literature
review related to clinical applications of CBCT in dental practice.
Materials and methods
Using the phrase “cone beam computerized tomography in dentistry,”
a literature search was conducted
via PubMed for articles published
between January 1, 1998 and June
15, 2010. The search revealed a
total of 540 articles. A detailed
screening revealed 411 articles
focused on physical properties and
manufacturing specifications. These
articles were excluded, leaving 129
articles to be categorized according
to discipline and application. A
category was chosen arbitrarily for
Chart 1. Summary of CBCT application-related
articles according to dental specialty.
Periodontics
4.6%
Forensic dentistry
0.8%
Oral maxillofacial surgery
26.3%
TMJ disorders
5.4%
General dentistry
9.3%
Fig. 1. Radiograph showing impacted teeth
with close proximity to vital structures.
Orthodontics
11.6%
Implant dentistry
16.3%
articles that could have been classified in more than one discipline;
however, care was exerted to ensure
consistency in categorization of
duplicate applications.
Results
Of the 129 CBCT-related articles,
34 (26.3%) related to oral and
maxillofacial surgery, 33 (25.6%) to
endodontics, 21 (16.3%) to implant
dentistry, 15 (11.6%) to orthodontics, 12 (9.3%) to general dentistry,
7 (5.4%) to temporomandibular
joints (TMJs), 6 (4.65%) to periodontics, and 1 (0.8%) to forensic
dentistry (Chart 1).
Applications in oral and
maxillofacial surgery
3D images acquired with CBCT
have been used to investigate the
exact location and extent of jaw
pathologies and assess impacted
(Fig. 1) or supernumerary teeth and
the relationship of these teeth to
vital structures.6,8-23 CBCT images
are used for pre- and postsurgical
assessment of bone graft recipient
sites and to evaluate osteonecrosis
Endodontics
25.6%
changes of the jaws (such as those
associated with bisphosphonates)
and paranasal sinus pathology and/
or defect.10,11,24-28 CBCT technology
has also been used for thorough
pretreatment evaluations of patients
with obstructive sleep apnea, to
determine an appropriate surgical
approach (when necessary).28,29
As CBCT units become more
widely available, dentists have
increasingly utilized this technology to evaluate maxillofacial
trauma. In addition to overcoming
the structural superimpositions that
can be seen in panoramic images,
CBCT allows accurate measurement of surface distances.30,31 This
particular advantage has made
CBCT the technique of choice for
investigating and managing midfacial and orbital fractures, postfracture assessment, interoperative
visualization of the maxillofacial
bones, and intraoperative navigation during procedures involving
gunshot wounds.32-37
CBCT is used widely for planning
orthognathic and facial orthomorphic surgeries, where detailed
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Fig. 2. Periapical radiograph showing a periapical lesion (courtesy of Dr. Frederic Barnett).
visualization of the interocclusal
relationship and representation of the
dental surfaces to augment the 3D
virtual skull model is vital. Utilizing
advanced software, CBCT allows for
minimum visualization of soft tissue,
allowing dentists to control posttreatment esthetics and evaluate the
outline of the lip and bony regions of
the palate in cases of cleft palate.38-43
Applications in endodontics
CBCT imaging is a useful tool
for diagnosing periapical lesions
(Fig. 2).2,6,44-54 While controversial,
several studies have suggested that
contrast-enhanced CBCT images
can be used to differentiate between
apical granulomas and apical cysts
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Information Technology/Computers Applications of CBCT in dental practice
Fig. 3. An orthopantogram
showing an apical cyst.
Fig. 4. A CBCT image of the
apical cyst in Figure 3.
Fig. 5. An orthopantogram for a full-mouth rehabilitation case. Only limited data
can be obtained from this image.
Fig. 6. CBCT images for the patient in Figure 5. Data obtained from these images in regard to bone
quality, implant length and diameter, and implant location and proximity to vital structures were
superior to that available from Figure 5.
by measuring the lesion’s density
(Fig. 3 and 4).2,48,54,55 Others have
described the use of CBCT as a tool
to categorize the origin of the lesion
as endodontic or non-endodontic,
which might suggest an alternate
course of treatment.45 The validity
of these topics is currently under
debate; however, they do underline
the need for (as well as the popularity of) non-invasive techniques to
diagnose lesions that traditionally
had been diagnosed through invasive procedures.
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Several clinical case reports have
focused on using high-resolution
CBCT images to detect vertical
root fractures.2,6,45,54-57 CBCT is
considered to be superior to periapical radiographs for detecting vertical
root fractures, measuring the depth
of dentin fracture, and detecting
horizontal root fractures.6,45,54,58,59
CBCT imaging also allows for
early detection of inflammatory
root resorption, a diagnosis that
is rarely possible when using
conventional 2D radiographs.6,60,61
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Not only can CBCT detect root
resorption (external or internal)
and cervical resorption, it can
also identify the extent of a
lesion.2,6,45,53,54,56,62-66
CBCT can be used to determine
the number and morphology of
roots and associated canals (both
main and accessory), establish
working lengths, and determine
the type and degree of root angulation.2,6,27,45,54,56,62-64 CBCT offers
a far more accurate evaluation of
existing root canal obturations
than 2D imaging.2,46,50,56 CBCT
is also used to detect pulpal
extensions in talon cusps and the
position and location of fractured
instruments.67,68 Because of its
reliability and accuracy, CBCT has
also been used to evaluate canal
preparation with different instrumentation techniques.69,70
CBCT is a reliable presurgical
tool for assessing a tooth’s proximity to adjacent vital structures,
allowing for accurate measurement of the size and extent of a
lesion and the anatomy of the
area.2,6,45,47,49,53-56,68,71-73 In posttrauma emergency cases where
tooth assessment is required, CBCT
imaging can help dentists to determine the most suitable treatment
approach.45,54,74,75
Fig. 7. Clinical photograph of multiple implants placed five
years earlier.
Fig. 8. Periapical radiograph of
implants that replaced teeth No.
8 and 9. Only limited data can be
obtained from this image.
Fig. 9. CBCT image clearly showing the amount
of bone loss.
Applications in implant
dentistry
The increasing need for dental
implants to replace missing teeth
requires a technique capable of
obtaining highly accurate alveolar
and implant site measurements
to assist with treatment planning
and avoid damage to adjacent vital
structures during surgery. In the
past, such measurements generally
were obtained by utilizing 2D
radiographs and (in specific cases)
with the aid of conventional CT.
However, CBCT is the preferred
option for implant dentistry, providing greater accuracy in measuring
compared to 2D imaging, while
utilizing lower doses of radiation
(Fig. 5 and 6).11,15,71,76-88 New software has reduced the possibility of
malpositioned fixtures and damaged
anatomical structures.76,83,89-92
CBCT has reduced implant
failures by providing information
about bone density, the shape of
the alveolus, and the height and
width of the proposed implant
site for each patient.28,71,79,80,93,94
CBCT does not provide accurate
Hounsfield unit (HU) numbers;
as a result, bone density numbers
measured with this technique
cannot be generalized over a
Fig. 10. CBCT image showing
total buccal plate destruction.
Fig. 11. CBCT image taken to assess bone density during
treatment.
group of CBCT units or patients.
However, CBCT’s effectiveness in
quantifying and assessing the shape
of the alveolus has led to improved
case selection.79,84,87 By knowing in
advance the complications that can
occur during a specific proposed
treatment, the treatment plan can
be designed to address the complications or to plan an alternate treatment. CBCT is commonly utilized
in postsurgical evaluations to assess
bone grafts and the implant’s position in the alveolus (Fig. 7–10).87
Applications in orthodontics
The introduction of new software
in orthodontic assessment, such
as Dolphin (Dolphin Imaging
& Management Solutions) and
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InVivo Dental (Anatomage), has
allowed dentists to use CBCT
images for cephalometric analysis,
making it the tool of choice for
assessing facial growth, age, airway
function, and disturbances in tooth
eruption.11,71,83,86-100
CBCT is a reliable tool for assessing the proximity of impacted teeth
to vital structures that could interfere
with its orthodontic movement.101,102
When mini-implants are required
as temporary anchors, CBCT offers
visual guides for safe insertion, thus
avoiding accidental and irreparable
damage to the existing roots.103-105
Assessing bone density before,
during, and after treatment can show
whether it is decreasing or remaining
the same (Fig. 11).106,107
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Information Technology/Computers Applications of CBCT in dental practice
Table 1. Typical doses (in MsV)
produced by dental radiological
procedures.11
Procedure
Dosage
Intraoral (F speed,
rectangular collimator)
0.001
Intraoral (E speed,
round collimator)
0.004
Full-mouth set (E speed,
round collimator)
0.080
Lateral ceph (F speed,
rare-earth screen)
0.002
Dental panoramic technique
(F speed, rare-earth screen)
0.015
Cone beam CT, both jaws
0.068
Hospital CT, both jaws
0.600
Fig. 12. Multiple endodontically treated teeth with a history of periapical surgery.
(Reprinted from Dental Update, by permission
of George Warman Productions [UK] Ltd.)
CBCT displays multiple views
of the maxillofacial complex with a
single scan, giving dentists access to
anterior, coronal, and axial images,
in addition to a 3D reconstruction
of the bony skeleton. These images
can be rotated, allowing dentists to
visualize multiple planes and angles,
including some that are not available
with 2D radiography.108,109 CBCT
images are self-corrected for magnification, producing orthogonal images
with a practical 1:1 measuring ratio;
as a result, CBCT is considered a
more accurate option than panoramic and traditional 2D images.110
Applications in TMJ disorders
Diagnostic imaging of the TMJ
is crucial for proper diagnosis of
diseases and dysfunctions associated
with joint conditions. According to
Tsiklakis et al, although CT is readily available, it is not very popular
in dentistry, due in large part to
its high cost and the high dose of
radiation involved.111 CBCT makes
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it possible to examine the joint
space and the true position of the
condyle within the fossa, which is
instrumental in revealing possible
dislocation of the joint disk.2,111
CBCT’s accuracy and lack of
superimposition makes it possible
to measure the roof of the glenoid
fossa and visualize the location
of the soft tissue around the
TMJ, which can offer a workable
diagnosis and reduce the need for
MRI.112-114 According to Tsiklakis
et al, MRI “is considered one of the
most useful investigations since it
provides images of both soft tissue
and bony components.”111 While
MRI is recommended for TMJ
soft tissue evaluation, CBCT offers
lower doses of radiation. However,
it should be emphasized that unlike
CT and MRI, CBCT does not
provide soft tissue detail.
These advantages outlined above
have made CBCT the best imaging
device for cases involving trauma,
fibro-osseous ankylosis, pain,
dysfunction, and condylar cortical
erosion and cysts.71,86,115-117
Applications in periodontics
According to Vandenberghe et al,
2D intraoral radiography is the
most common imaging modality
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used for diagnosing bone morphology, such as periodontal bone
defects. However, the limitations of
2D radiography could cause dentists to underestimate the amount
of bone loss or available bone due
to projection errors and has led to
errors in identifying reliable anatomical reference points.118 These
findings confirm the observation by
Misch et al that 2D radiographs are
inadequate for detecting changes in
bone level or determining the architecture of osseous defects.119 CBCT
provides accurate measurement
of intrabony defects and allows
clincians to assess dehiscence,
fenestration defects, and periodontal cysts.2,120-122 While CBCT and
2D radiographs are comparable in
terms of revealing interproximal
defects, only 3D imaging such as
CBCT can visualize buccal and
lingual defects.2,6,118,119,123
CBCT has been used to obtain
detailed morphologic descriptions
of bone as accurately as direct
measurement with a periodontal
probe.2,118,119 CBCT can also be
used to assess furcation involvement of periodontal defects
and allow clinicians to evaluate
postsurgical results of regenerative
periodontal therapy.2,6,123
Fig. 13. Periapical radiograph showing a
compromised crown-to-root ratio.
Applications in operative
dentistry
Based on the literature, CBCT
cannot be justified for detecting
occlusal caries. Not only does CBCT
deliver higher doses of radiation than
conventional 2D radiographs, it provides lower resolution than intraoral
radiographs.6 Table 1 summarizes
typical radiation doses from various
dental radiological procedures.6
Applications in forensic
dentistry
Age estimation is an important
aspect of forensic dentistry. It is
imperative that clinicians are able to
estimate the age of the individuals
placed in the legal system (and those
who are deceased) as accurately as
possible. This is particularly the
case in Europe, as Yang et al noted
in 2006: “Every year thousands of
unaccompanied minors with no official identification documents trespass
the borders of all European countries
hoping to find shelter and protection
in the country of destination. On
top of that, a lot of criminal acts are
committed by individuals pretending
to be beneath the age of majority.
In all these cases, verification of
chronological age is required in
Fig. 14. CBCT image showing the
absence of the buccal plate and
the compromised palatal plate,
indicating which teeth require
extraction and site grafting prior
to implant placement.
Fig. 15. Clinical photograph taken after extractions of teeth
No. 7–10 and bone grafting.
order to be entitled to a guardian
and social benefits, as is the case in
Belgium unaccompanied minors.”124
The literature is populated with
articles for estimating age based on
the correlation of changes of teeth
related to age. Enamel is largely
immune from such changes beyond
normal wear and tear; however, the
pulpodentinal complex (dentin,
cementum, and the dental pulp)
shows physiologic and pathological
changes with advancing age.124
Typically, extraction and sectioning are required to quantify these
morphological changes, which is
not always a viable option. CBCT,
however, provides a non-invasive
alternative.124
Discussion
CBCT scanners represent a significant advancement in dental and
maxillofacial imaging since their
introduction to dentistry in the
late 1990s.125 This literature review
revealed that of the 540 articles on
CBCT published in the last 12 years,
129 demonstrated clinical applications; most of these 129 articles
related to oral and maxillofacial
surgery, endodontics, implants, and
orthodontics. CBCT use in operative
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dentistry is limited because of its
higher radiation dose compared to
conventional 2D radiography and
its inability to provide new or additional diagnostic information. Also,
more research is required to explore
the various benefits of CBCT in the
field of forensic dentistry.
Although this review did not
discover any articles concerning
prosthodontic applications of the
3D scanner, the improved standard
of care seen in prosthodontic treatment can be attributed to CBCT use
related to other dental specialties.
For example, CBCT has been used
for prosthetic-driven implant placement, maxillofacial prosthodontics,
and TMD evaluations, which in
turn have increased the success of
prosthodontic treatment by incorporating additional patient data into
the treatment plan. CBCT images
are an important adjunct in complex
treatment cases, particularly in cases
where multiple teeth and bony areas
must be assessed (Fig. 12–15).
The newer CBCT systems can
be used for specific dental applications; in addition, they offer higher
resolution and lower exposure and
are less expensive than previously
available systems.
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Information Technology/Computers Applications of CBCT in dental practice
Table 2. Basic principles concerning the use of CBCT in dental applications.126
•CBCT examinations must not be carried out unless a history and
clinical examination have been performed.
•CBCT equipment should undergo regular routine tests to ensure
that radiation protection, for both practice/facility users and
patients, has not deteriorated significantly.
•CBCT examinations must be justified for each patient to demonstrate
that the benefits outweigh the risks.
•CBCT examinations should potentially add new information to aid the
patient’s management.
•CBCT should not be repeated routinely on a patient without a new
risk/benefit assessment having been performed.
•All those involved with CBCT must have received adequate
theoretical and practical training for the purpose of radiological
practices and relevant competence in radiation protection.
•When accepting referrals from other dentists for CBCT examinations,
the referring dentist must supply sufficient clinical information (results
of a history and examination) to allow the CBCT practitioner to
perform the justification process.
•Continuing education and training after qualification are
required, particularly when new CBCT equipment or techniques
are adopted.
•CBCT should be used only when the question for which imaging is
required cannot be answered adequately by lower dose conventional
(traditional) radiography.
•CBCT images must undergo a thorough clinical evaluation (radiological
report) of the entire image dataset.
•Where it is likely that evaluation of soft tissues will be required as
part of the patient’s radiological assessment, the appropriate imaging
should be conventional medical CT or MRI, rather than CBCT.
•CBCT equipment should offer a choice of volume sizes, and examinations must use the smallest volume that is compatible with the clinical
situation if this provides a lower radiation dose to the patient.
•Where CBCT equipment offers a choice of resolution, the resolution
compatible with adequate diagnosis and the lowest achievable
radiation dose should be used.
•A quality assurance program must be established and implemented
for each CBCT facility, including equipment, techniques, and quality
control procedures.
•Aids to ensure accurate positioning (light beam markers) must always
be used.
•All new installations of CBCT equipment should undergo a critical
examination and detailed acceptance tests before use to ensure optimal
radiation protection for staff, patients, and members of the public.
While CBCT offers numerous
advantages over 2D radiography,
there are inherent limitations
requiring precise attention to selection criteria and indications. For
example, CBCT is susceptible to
motion artifacts (including artifacts
unique to CT technology) and beam
hardening around dense objects; in
addition, CBCT has low contrast
resolution and a limited ability to
visualize internal soft tissues. Many
new CBCT units contain flat-panel
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September/October 2012
•For staff protection from CBCT equipment, the guidelines detailed
in Section 6 of the European Commission document Radiation
protection 136. European guidelines on radiation protection in
dental radiology should be followed.
•Dentists responsible for CBCT facilities who have not previously
received “adequate theoretical and practical training” should
undergo a period of additional theoretical and practical training
that has been validated by an academic institution (university or
equivalent); where national specialist qualifications in dentomaxillofacial radiology exist, the design and delivery of CBCT training
programs should involve a dentomaxillofacial radiologist.
•For dentoalveolar CBCT images of the teeth, their supporting
structures, the mandible, and the maxilla up to the floor of the
nose (for example, 8 cm X 8 cm or smaller fields of view), the
clinical evaluation (radiological report) should be made by a
specially trained dentomaxillofacial radiologist or, when this is not
possible, an adequately trained general dental practitioner.
•For non-dentoalveolar small fields of view (for example, temporal
bone) and all craniofacial CBCT images (fields of view extending
beyond the teeth, their supporting structures, the mandible
[including the TMJ], and the maxilla up to the floor of the nose),
the clinical evaluation (radiological report) should be made by
a specially trained dentomaxillofacial radiologist or a clinical
(medical) radiologist.
(Reprinted with permission of the British Institute of Radiology.)
detectors that are less prone to beam
hardening artifacts, so they are able
to provide more detailed information. However, due to lack of
consistency between manufacturers,
CBCT cannot generate accurate HU
measurements and is therefore unreliable for quantifying bone density.4
In the authors’ opinion, it is
crucial to respect the as low as
reasonably achievable (ALARA)
radiation dose concept. This tenet
should not be misconstrued as a
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reason to avoid using CBCT units
with higher doses that will provide
the necessary information. There are
no strict protocols regarding when
the technology is to be used; rather,
individual dentists, oral radiologists,
and neuro-radiologists must actively
monitor their practice’s protocols.
Interpreting these images requires
extensive anatomical knowledge of
areas that have traditionally been in
the realm of dentistry and neuroradiology.4 Possessing the knowledge
and experience to interpret the
scanned data accurately is necessary to determine why the imaging
was required and to interpret the
incidental findings that appear in
the scan but are beyond the traditional scope of dentistry, such as
abnormalities that can be detected
in any neighboring region. Dentists
must determine on a case-by-case
basis if CBCT increases diagnostic
knowledge and improves the
patient’s standard of dental care.
Such evaluation requires continuous training and education on the
part of dentists and researchers.
The increasing popularity of
CBCT has led to a large number of
units with minor (but sometimes
important) variations, which in
turn has led to uncontrolled and
non-evidence-based reporting of
radiation values. This unconfirmed
reporting can be attributed to the
limited technical knowledge of
medical imaging devices among new
units; in response, the European
Academy of Dental and Maxillofacial Radiology has developed basic
principles for the use of CBCT in
dental applications (Table 2).126
Summary
Based on the literature, the majority
of CBCT applications in dental
practice relate to the specialties
of oral and maxillofacial surgery,
endodontics, implants, and orthodontics. CBCT examinations must
not be performed unless they are
necessary and the benefits clearly
outweigh the risks. When utilizing
CBCT, the entire image dataset
(that is, a radiological report generated by an oral surgeon, neurologist, or general radiologist familiar
with the head and neck region)
must be evaluated thoroughly to
maximize the clinical data obtained
and ensure that medically serious
incidental findings are reported.
Additional research should focus
on obtaining accurate data regarding the radiation doses of CBCT
systems, as these systems have a
small detector size and limited field
of view and scanned volume. CBCT
systems with larger fields of view
with higher resolution and fewer
metallic artifacts for orthodontic
and orthognathic surgery are not yet
available. Additional investigation
is necessary to better determine
CBCT applications in forensic dentistry and prosthodontics.
Author information
Dr. Alamri is a demonstrator
(teaching assistant), Department
of Endodontics, Salman Bin
Abdulaziz University, Al-Kharj,
Saudi Arabia. Dr. Alshalhoob
is a general dentist in private
practice, Riyadh, Saudi Arabia.
Dr. Mitra Sadrameli is an oral and
maxillofacial radiology resident,
Department of Dental Diagnostic
Science, University of Texas Health
Science Center at San Antonio.
Dr. Mahtab Sadrameli is in private
practice in San Francisco. Dr.
Alshehri is an assistant clinical professor, Department of Restorative
Dental Sciences, College of Dentistry, King Saud University, Riyadh.
References:
1. Scarfe WC, Farman AG. What is cone-beam CT
and how does it work? Dent Clin North Am
2008;52(4):707-730.
2. Tyndall DA, Rathore S. Cone-beam CT diagnostic applications: Caries, periodontal bone assessment, and endodontic applications. Dent
Clin North Am 2008;52(4):825-841.
3. Zoller JE, Neugebauer J. Cone-beam volumetric
imaging in dental, oral and maxillofacial medicine: Fundamentals, diagnostics and treatment
planning. Chicago: Quintessence Publishing;
2008.
4. De Vos W, Casselman J, Swennen GR. Conebeam computerized tomography (CBCT) imaging of the oral and maxillofacial region: A
systematic review of the literature. Int J Oral
Maxillofac Surg 2009;38(6):609-625.
5. Feldkamp LA, Davis LC, Kress JW. Practical conebeam algorithm. J Opt Soc Am 1994;1:612-619.
www.agd.org
6. Tetradis S, Anstey P, Graff-Radford S. Cone beam
computed tomography in the diagnosis of dental
disease. J Calif Dent Assoc 2010;38(1):27-32.
7. Ito K, Gomi Y, Sato S, Arai Y, Shinoda K. Clinical
application of a new compact CT system to assess 3-D images for the preoperative treatment
planning of implants in the posterior mandible:
A case report. Clin Oral Implants Res 2001;
12(5):539-542.
8. Araki M, Kameoka S, Mastumoto N, Komiyama
K. Usefulness of cone beam computed tomography for odontogenic myxoma. Dentomaxillofac
Radiol 2007;36(7):423-427.
9. Closmann JJ, Schmidt BL. The use of cone beam
computed tomography as an aid in evaluating
and treatment planning for mandibular cancer.
J Oral Maxillofac Surg 2007;65(4):766-771.
10. Fullmer JM, Scarfe WC, Kushner GM, Alpert B,
Farman AG. Cone beam computed tomographic
findings in refractory chronic suppurative osteomyelitis of the mandible. Br J Oral Maxillofac
Surg 2007;45(5):364-371.
11. Macleod I, Heath N. Cone-beam computed tomography (CBCT) in dental practice. Dent Update 2008;35(9):590-598.
12. Nakagawa Y, Kobayashi K, Ishii H, Mishima A,
Ishii H, Asada K, Ishibashi K. Preoperative application of limited cone beam computerized tomography as an assessment tool before minor
oral surgery. Int J Oral Maxillofac Surg 2002;
31(3):322-326.
13. Pawelzik J, Cohnen M, Willers R, Becker J. A
comparison of conventional panoramic radiographs with volumetric computed tomography
images in the preoperative assessment of impacted mandibular third molars. J Oral Maxillofac Surg 2002;60(9):979-984.
14. Schulze D, Blessmann M, Pohlenz P, Wagner KW,
Heiland M. Diagnostic criteria for the detection
of mandibular osteomyelitis using cone-beam
computed tomography. Dentomaxillofac Radiol
2006;35(4):232-235.
15. Yajima A, Otonari-Yamamoto M, Sano T, Hayakawa Y, Otonari T, Tanabe K, Wakoh M, Mizuta S,
Yonezu H, Nakagawa K, Yajima Y. Cone-beam CT
(CB Throne) applied to dentomaxillofacial region.
Bull Tokyo Dent Coll 2006;47(3):133-141.
16. Danforth RA, Peck J, Hall P. Cone beam volume
tomography: An imaging option for diagnosis
of complex mandibular third molar anatomical
relationships. J Calif Dent Assoc 2003;31(11):
847-852.
17. Liu DG, Zhang WL, Zhang ZY, Wu YT, Ma XC.
Localization of impacted maxillary canines and
observation of adjacent incisor resorption with
cone-beam computed tomography. Oral Surg
Oral Med Oral Pathol Oral Radiol Endod 2008;
105(1):91-98.
18. Liu DG, Zhang WL, Zhang ZY, Wu YT, Ma XC.
Three-dimensional evaluations of supernumerary
teeth using cone-beam computed tomography
for 487 cases. Oral Surg Oral Med Oral Pathol
Oral Radiol Endod 2007;103(3):403-411.
19. Mah J, Enciso R, Jorgensen M. Management of
impacted cuspids using 3-D volumetric imaging.
J Calif Dent Assoc 2003;31(11):835-841.
General Dentistry
September/October 2012
397
Information Technology/Computers Applications of CBCT in dental practice
20. Maverna R, Gracco A. Different diagnostic tools
for the localization of impacted maxillary canines: Clinical considerations. Prog Orthod 2007;
8(1):28-44.
21. Nakagawa Y, Ishii H, Nomura Y, Watanabe NY,
Hoshiba D, Kobayashi K, Ishibashi K. Third molar
position: Reliability of panoramic radiography.
J Oral Maxillofac Surg 2007;65(7):1303-1308.
22. Tantanapornkul W, Okouchi K, Fujiwara Y, Yamashiro M, Maruoka Y, Ohbayashi N, Kurabayashi
T. A comparative study of cone-beam computed
tomography and conventional panoramic radiography in assessing the topographic relationship
between the mandibular canal and impacted
third molars. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 2007;103(2):253-259.
23. Walker L, Enciso R, Mah J. Three-dimensional
localization of maxillary canines with conebeam computed tomography. Am J Orthod Dentofacial Orthop 2005;128(4):418-423.
24. Hamada Y, Kondoh T, Noguchi K, Iino M, Isono
H, Ishii H, Mishima A, Kobayashi K, Seto K. Application of limited cone beam computed tomography to clinical assessment of alveolar
bone grafting: A preliminary report. Cleft Palate
Craniofac J 2005;42(2):128-137.
25. Chiandussi S, Biasotto M, Dore F, Cavalli F, Cova
MA, Di Lenarda R. Clinical and diagnostic imaging of bisphosphonate-associated osteonecrosis
of the jaws. Dentomaxillofac Radiol 2006;35(4):
236-243.
26. Kumar V, Pass B, Guttenberg SA, Ludlow J, Emery RW, Tyndall DA, Padilla RJ. Bisphosphonaterelated osteonecrosis of the jaws: A report of
three cases demonstrating variability in outcomes and morbidity. J Am Dent Assoc 2007;
138(5):602-609.
27. Bassam HA. Reliability of periapical radiographs
and orthopantomograms in detection of tooth
root protrusion in the maxillary sinus: Correlation results with cone beam computed tomography. J Oral Maxillofac Res 2010;1(1):e6.
28. Naitoh M, Hirukawa A, Katsumata A, Ariji E.
Evaluation of voxel values in mandibular cancellous bone: Relationship between cone-beam
computed tomography and multislice helical
computed tomography. Clin Oral Implants Res
2009;20(5):503-506.
29. Ogawa T, Enciso R, Shintaku WH, Clark GT. Evaluation of cross-section airway configuration of
obstructive sleep apnea. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 2007;103(1):
102-108.
30. Cevidanes LH, Bailey LJ, Tucker GR Jr, Styner MA,
Mol A, Phillips CL, Proffit WR, Turvey T. Superimposition of 3D cone-beam CT models of orthognathic surgery patients. Dentomaxillofac Radiol
2005;34(6):369-375.
31. Cevidanes LH, Bailey LJ, Tucker SF, Styner MA,
Mol A, Phillips CL, Proffit WR, Turvey T. Threedimensional cone-beam computed tomography
for assessment of mandibular changes after orthognathic surgery. Am J Orthod Dentofacial
Orthop 2007;131(1):44-50.
32. Blessmann M, Pohlenz P, Blake FA, Lenard M,
Schmelzle R, Heiland M. Validation of a new
training tool for ultrasound as a diagnostic
398
September/October 2012
modality in suspected midfacial fractures. Int J
Oral Maxillofac Surg 2007;36(6):501-506.
33. Heiland M, Schulze D, Rother U, Schmelzle R.
Postoperative imaging of zygomaticomaxillary
complex fractures using digital volume tomography. J Oral Maxillofac Surg 2004;62(11):
1387-1391.
34. Zizelmann C, Gellrich NC, Metzger MC, Schoen
R, Schmelzeisen R, Schramm A. Computerassisted reconstruction of orbital floor based on
cone beam tomography. Br J Oral Maxillofac
Surg 2007;45(1):79-80.
35. Heiland M, Schulze D, Blake F, Schmelzle R. Intraoperative imaging of zygomaticomaxillary
complex fractures using a 3D C-arm system. Int
J Oral Maxillofac Surg 2005;34(4):369-375.
36. Mischkowski RA, Zinser MJ, Ritter L, Neugebauer J, Keeve E, Zoller JE. Intraoperative navigation
in the maxillofacial area based on 3D imaging
obtained by a cone-beam device. Int J Oral Maxillofac Surg 2007;36(8):687-694.
37. Pohlenz P, Blessmann M, Blake F, Heinrich S,
Schmelzle R, Heiland M. Clinical indications and
perspectives for intraoperative cone-beam computed tomography in oral and maxillofacial surgery. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 2007;103(3):412-417.
38. Bianchi A, Muyldermans L, Di Martino M, Lancellotti L, Amadori S, Sarti A, Marchetti C. Facial
soft tissue esthetic predictions: Validation in
craniomaxillofacial surgery with cone beam
computed tomography data. J Oral Maxillofac
Surg 2010;68(7):1471-1479.
39. Swennen GR, Mollemans W, De Clercq C, Abeloos J, Lamoral P, Lippens F, Neyt N, Casselman J, Schutyser F. A cone-beam computed
tomography triple scan procedure to obtain a
three-dimensional augmented virtual skull
model appropriate for orthognathic surgery
planning. J Craniofac Surg 2009;20(2):297-307.
40. Swennen GR, Mommaerts MY, Abeloos J, De
Clercq C, Lamoral P, Neyt N, Casselman J,
Schutyser F. A cone-beam CT based technique
to augment the 3D virtual skull model with a
detailed dental surface. Int J Oral Maxillofac
Surg 2009;38(1):48-57.
41. Korbmacher H, Kahl-Nieke B, Schollchen M, Heiland M. Value of two cone-beam computed tomography systems from an orthodontic point of
view. J Orofac Orthop 2007;68(4):278-289.
42. Miyamoto J, Nagasao T, Nakajima T, Ogata H.
Evaluation of cleft lip bony depression of piriform margin and nasal deformity with cone
beam computed tomography: “Retruded-like“
appearance and anteroposterior position of the
alar base. Plast Reconstr Surg 2007;120(6):
1612-1620.
43. Wortche R, Hassfeld S, Lux CJ, Müssig E, Hensley FW, Krempien R, Hofele C. Clinical application of cone beam digital volume tomography in
children with cleft lip and palate. Dentomaxillofac Radiol 2006;35(2):88-94.
44. Christiansen R, Kirkevang LL, Gotfredsen E,
Wenzel A. Periapical radiography and cone
beam computed tomography for assessment of
the periapical bone defect 1 week and 12
General Dentistry
www.agd.org
months after root-end resection. Dentomaxillofac Radiol 2009;38(8):531-536.
45. Cotton TP, Geisler TM, Holden DT, Schwartz SA,
Schindler WG. Endodontic applications of
cone-beam volumetric tomography. J Endod
2007;33(9):1121-1132.
46. de Paula-Silva FW, Santamaria M Jr, Leonardo
MR, Consolaro A, da Silva LA. Cone-beam computerized tomographic, radiographic, and histologic evaluation of periapical repair in dogs’
post-endodontic treatment. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 2009;108(5):
796-805.
47. de Paula-Silva FW, Wu MK, Leonardo MR, da
Silva LA, Wesselink PR. Accuracy of periapical
radiography and cone-beam computed tomography scans in diagnosing apical periodontitis
using histopathological findings as a gold standard. J Endod 2009;35(7):1009-1012.
48. Estrela C, Bueno MR, Azevedo BC, Azevedo JR,
Pecora JD. A new periapical index based on
cone beam computed tomography. J Endod
2008;34(11):1325-1331.
49. Estrela C, Bueno MR, Leles CR, Azevedo B, Azevedo JR. Accuracy of cone beam computed tomography and panoramic and periapical
radiography for detection of apical periodontitis.
J Endod 2008;34(3):273-279.
50. Garcia de Paula-Silva FW, Hassan B, Bezerra da
Silva LA, Leonardo MR, Wu MK. Outcome of root
canal treatment in dogs determined by periapical
radiography and cone-beam computed tomography scans. J Endod 2009;35(5):723-726.
51. Lofthag-Hansen S, Huumonen S, Grondahl K,
Grondahl HG. Limited cone-beam CT and intraoral radiography for the diagnosis of periapical
pathology. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 2007;103(1):114-119.
52. Nakata K, Naitoh M, Izumi M, Inamoto K, Ariji E,
Nakamura H. Effectiveness of dental computed
tomography in diagnostic imaging of periradicular lesion of each root of a multirooted tooth: A
case report. J Endod 2006;32(6):583-587.
53. Nesari R, Rossman LE, Kratchman SI. Conebeam computed tomography in endodontics:
Are we there yet? Compend Contin Educ Dent
2009;30(6):312-318.
54. Patel S. New dimensions in endodontic imaging:
Part 2. Cone beam computed tomography. Int
Endod J 2009;42(6):463-475.
55. Simon JH, Enciso R, Malfaz JM, Roges R, BaileyPerry M, Patel A. Differential diagnosis of large
periapical lesions using cone-beam computed
tomography measurements and biopsy. J Endod
2006;32(9):833-837.
56. Nair MK, Nair UP. Digital and advanced imaging
in endodontics: A review. J Endod 2007;33(1):
1-6.
57. Ozer SY. Detection of vertical root fractures of
different thicknesses in endodontically enlarged
teeth by cone beam computed tomography versus digital radiography. J Endod 2010;36(7):
1245-1249.
58. Hassan B, Metska ME, Ozok AR, van der Stelt P,
Wesselink PR. Comparison of five cone beam
computed tomography systems for the detection
of vertical root fractures. J Endod 2010;36(1):
126-129.
59. Hassan B, Metska ME, Ozok AR, van der Stelt P,
Wesselink PR. Detection of vertical root fractures in endodontically treated teeth by a cone
beam computed tomography scan. J Endod
2009;35(5):719-722.
60. Estrela C, Bueno MR, De Alencar AH, Mattar R,
Valladares Neto J, Azevedo BC, De Araujo Estrela CR. Method to evaluate inflammatory root
resorption by using cone beam computed tomography. J Endod 2009;35(11):1491-1497.
61. Patel S, Dawood A, Ford TP, Whaites E. The potential applications of cone beam computed
tomography in the management of endodontic
problems. Int Endod J 2007;40(10):818-830.
62. Michetti J, Maret D, Mallet JP, Diemer F. Validation of cone beam computed tomography as a
tool to explore root canal anatomy. J Endod
2010;36(7):1187-1190.
63. Rouas P, Nancy J, Bar D. Identification of double
mandibular canals: Literature review and three
case reports with CT scans and cone beam CT.
Dentomaxillofac Radiol 2007;36(1):34-38.
64. Tu MG, Huang HL, Hsue SS, Hsu JT, Chen SY, Jou
MJ, Tsai CC. Detection of permanent three-rooted mandibular first molars by cone-beam computed tomography imaging in Taiwanese
individuals. J Endod 2009;35(4):503-507.
65. Liedke GS, da Silveira HE, da Silveira HL, Dutra V,
de Figueiredo JA. Influence of voxel size in the
diagnostic ability of cone beam tomography to
evaluate simulated external root resorption.
J Endod 2009;35(2):233-235.
66. Patel S, Dawood A. The use of cone beam computed tomography in the management of external cervical resorption lesions. Int Endod J 2007;
40(9):730-737.
67. Siraci E, Cem Gungor H, Taner B, Cehreli ZC.
Buccal and palatal talon cusps with pulp extensions on a supernumerary primary tooth. Dentomaxillofac Radiol 2006;35(6):469-472.
68. Tsurumachi T, Honda K. A new cone beam computerized tomography system for use in endodontic surgery. Int Endod J 2007;40(3):224-232.
69. Moore J, Fitz-Walter P, Parashos P. A micro-computed tomographic evaluation of apical root
canal preparation using three instrumentation
techniques. Int Endod J 2009;42(12):1057-1064.
70. Nagaraja S, Sreenivasa Murthy BV. CT evaluation of canal preparation using rotary and hand
NI-TI instruments: An in vitro study. J Conserv
Dent 2010;13(1):16-22.
71. Howerton WB Jr, Mora MA. Advancements in
digital imaging: What is new and on the horizon?
J Am Dent Assoc 2008;139 Suppl:20S-24S.
72. Kim TS, Caruso JM, Christensen H, Torabinejad
M. A comparison of cone-beam computed tomography and direct measurement in the examination of the mandibular canal and adjacent
structures. J Endod 2010;36(7):1191-1194.
73. Rigolone M, Pasqualini D, Bianchi L, Berutti E,
Bianchi SD. Vestibular surgical access to the palatine root of the superior first molar: “Low-dose
cone-beam” CT analysis of the pathway and
its anatomic variations. J Endod 2003;29(11):
773-775.
74. Cohenca N, Simon JH, Mathur A, Malfaz JM.
Clinical indications for digital imaging in dentoalveolar trauma. Part 2: Root resorption. Dent
Traumatol 2007;23(2):105-113.
75. Cohenca N, Simon JH, Roges R, Morag Y, Malfaz
JM. Clinical indications for digital imaging in
dento-alveolar trauma. Part 1: Traumatic injuries. Dent Traumatol 2007;23(2):95-104.
76. Dreiseidler T, Mischkowski RA, Neugebauer J,
Ritter L, Zoller JE. Comparison of cone-beam
imaging with orthopantomography and computerized tomography for assessment in presurgical implant dentistry. Int J Oral Maxillofac
Implants 2009;24(2):216-225.
77. Fortin T, Champleboux G, Bianchi S, Buatois H,
Coudert JL. Precision of transfer of preoperative
planning for oral implants based on cone-beam
CT-scan images through a robotic drilling machine. Clin Oral Implant Res 2002;13(6):651-656.
78. Garg AK. Dental implant imaging: TeraRecon‘s
Dental 3D Cone Beam Computed Tomography
System. Dent Implantol Update 2007;18(6):
41-45.
79. Hatcher DC, Dial C, Mayorga C. Cone beam CT
for pre-surgical assessment of implant sites.
J Calif Dent Assoc 2003;31(11):825-833.
80. Hua Y, Nackaerts O, Duyck J, Maes F, Jacobs R.
Bone quality assessment based on cone beam
computed tomography imaging. Clin Oral Implants Res 2009;20(8):767-771.
81. Lofthag-Hansen S, Grondahl K, Ekestubbe A.
Cone-beam CT for preoperative implant planning in the posterior mandible: Visibility of anatomic landmarks. Clin Implant Dent Relat Res
2009;11(3):246-255.
82. Abboud MF. Cone beam CT based guided implant placement—Benefits and risks. J Oral
Maxillofac Surg 2009;67(9):59.
83. Sato S, Arai Y, Shinoda K, Ito K. Clinical application of a new cone-beam computerized tomography system to assess multiple two-dimensional
images for the preoperative treatment planning
of maxillary implants: Case reports. Quintessence Int 2004;35(7):525-528.
84. Ganz SD. CT scan technology: An evolving tool
for avoiding complications and achieving predictable implant placement and restoration. Int
Mag Oral Implant 2001;1:6-13.
85. Sforza NM, Franchini F, Lamma A, Botticelli S,
Ghigi G. Accuracy of computerized tomography
for the evaluation of mandibular sites prior to
implant placement. Int J Periodontics Restorative Dent 2007;27(6):589-595.
86. Terakado M, Hashimoto K, Arai Y, Honda M,
Sekiwa T, Sato H. Diagnostic imaging with newly
developed ortho cubic super-high resolution
computed tomography (Ortho-CT). Oral Surg
Oral Med Oral Pathol Oral Radiol Endod 2000;
89(4):509-518.
87. Tischler M. In-office cone beam computerized
tomography: Technology review and clinical examples. Dent Today 2008;27(6):102-106.
88. Van Assche N, van Steenberghe D, Guerrero ME,
Hirsch E, Schutyser F, Quirynen M, Jacobs R. Accuracy of implant placement based on pre-surgical planning of three-dimensional cone-beam
www.agd.org
images: A pilot study. J Clin Periodontol 2007;
34(9):816-821.
89. Almog DM, LaMar J, LaMar FR, LaMar F. Cone
beam computerized tomography-based dental
imaging for implant planning and surgical guidance, Part 1: Single implant in the mandibular
molar region. J Oral Implantol 2006;32(2):77-81.
90. Ganz SD. CT-derived model-based surgery for
immediate loading of maxillary anterior implants. Pract Proced Aesthet Dent 2007;19(5):
311-318.
91. Nickenig HJ, Eitner S. Reliability of implant
placement after virtual planning of implant positions using cone beam CT data and surgical
(guide) templates. J Craniomaxillofac Surg 2007;
35(4-5):207-211.
92. Nickenig HJ, Wichmann M, Hamel J, Schlegel
KA, Eitner S. Evaluation of the difference in accuracy between implant placement by virtual
planning data and surgical guide templates versus the conventional free-hand method—A
combined in vivo-in vitro technique using conebeam CT (Part II). J Craniomaxillofac Surg 2010;
38(7):488-493.
93. Aranyarachkul P, Caruso J, Gantes B, Schulz E,
Riggs M, Dus I, Yamada JM, Crigger M. Bone
density assessments of dental implant sites: 2.
Quantitative cone-beam computerized tomography. Int J Oral Maxillofac Implants 2005;20(3):
416-424.
94. Song YD, Jun SH, Kwon JJ. Correlation between
bone quality evaluation by cone-beam computerized tomography and implant primary stability. Int J Oral Maxillofac Implants 2009; 24(1):
59-64.
95. Farman AG, Scarfe WC. Development of imaging
selection criteria and procedures should precede
cephalometric assessment with cone-beam
computed tomography. Am J Orthod Dentofacial
Orthop 2006;130(2):257-265.
96. Lagravere MO, Major PW. Proposed reference
point for 3-dimensional cephalometric analysis
with cone-beam computerized tomography. Am
J Orthod Dentofacial Orthop 2005;128(5):657660.
97. Aboudara CA, Hatcher D, Nielsen IL, Miller
A. A three-dimensional evaluation of the upper
airway in adolescents. Orthod Craniofac Res
2003;6 Suppl 1:173-175.
98. King KS, Lam EW, Faulkner MG, Heo G, Major
PW. Predictive factors of vertical bone depth in
the paramedian palate of adolescents. Angle
Orthod 2006;76(5):745-751.
99. Shi H, Scarfe WC, Farman AG. Three-dimensional
reconstruction of individual cervical vertebrae
from cone-beam computed-tomography images.
Am J Orthod Dentofacial Orthop 2007;131(3):
426-432.
100. Mussig E, Wortche R, Lux CJ. Indications for digital volume tomography in orthodontics. J Orofac Orthop 2005;66(3):241-249.
101. Erickson M, Caruso JM, Leggitt L. Newtom QRDVT 9000 imaging used to confirm a clinical
diagnosis of iatrogenic mandibular nerve paresthesia. J Calif Dent Assoc 2003;31(11):843-845.
102. Peck JL, Sameshima GT, Miller A, Worth P,
Hatcher DC. Mesiodistal root angulation using
General Dentistry
September/October 2012
399
Published with permission by the Academy of General Dentistry.
© Copyright 2013 by the Academy of General Dentistry. All rights reserved.
panoramic and cone beam CT. Angle Orthod
2007;77(2):206-213.
103. Kim SH, Choi YS, Hwang EH, Chung KR, Kook
YA, Nelson G. Surgical positioning of orthodontic mini-implants with guides fabricated on
models replicated with cone-beam computed
tomography. Am J Orthod Dentofacial Orthop
2007;131(4 Suppl):S82-S89.
104. Kim SH, Kang JM, Choi B, Nelson G . Clinical application of a stereolithographic surgical guide for
simple positioning of orthodontic mini-implants.
World J Orthod 2008;9(4):371-382.
105. Poggio PM, Incorvati C, Velo S, Carano A. “Safe
zones”: A guide for miniscrew positioning in the
maxillary and mandibular arch. Angle Orthod
2006;76(2):191-197.
106. Gracco A, Lombardo L, Cozzani M, Siciliani G.
Quantitative evaluation with CBCT of palatal
bone thickness in growing patients. Prog Orthod 2006;7(2):164-174.
107. Rungcharassaeng K, Caruso JM, Kan JY, Kim J,
Taylor G. Factors affecting buccal bone changes
of maxillary posterior teeth after rapid maxillary
expansion. Am J Orthod Dentofacial Orthop
2007;132(4):428.e1-e8.
108. Lagravere MO, Hansen L, Harzer W, Major PW.
Plane orientation for standardization in
3 dimensional cephalometric analysis with computerized tomography imaging. Am J Orthod
Dentofacial Orthop 2006;129(5):601-604.
109. Harrell WE Jr. Three-dimensional diagnosis and
treatment planning: The use of 3D facial imaging and 3D cone beam CT in orthodontics and
dentistry. Australasian Dent Pract 2007;18(4):
102-113.
110. Vandenberghe B, Jacobs R, Bosmans H. Modern
dental imaging: A review of the current technology and clinical applications in dental practice.
Eur Radiol 2010;20(11):2637-2655.
111. Tsiklakis K, Syriopoulos K, Stamatakis HC. Radiographic examination of the temporomandibular
400
September/October 2012
joint using cone beam computed tomography.
Dentomaxillofac Radiol 2004;33(3):196-201.
112. Kijima N, Honda K, Kuroki Y, Sakabe J, Ejima K,
Nakajima I. Relationship between patient characteristics, mandibular head morphology and
thickness of the roof of the glenoid fossa in
symptomatic temporomandibular joints. Dentomaxillofac Radiol 2007;36(5):277-281.
113. Matsumoto K, Honda K, Sawada K, Tomita T,
Araki M, Kakehashi Y. The thickness of the roof
of the glenoid fossa in the temporomandibular
joint: Relationship to the MRI findings. Dentomaxillofac Radiol 2006;35(5):357-364.
114. Honda K, Matumoto K, Kashima M, Takano Y,
Kawashima S, Arai Y. Single air contrast arthrography for temporomandibular joint disorder using limited cone beam computed tomography
for dental use. Dentomaxillofac Radiol 2004;
33(4):271-273.
115. Honda K, Larheim TA, Johannessen S, Arai Y, Shinoda K, Westesson PL. Ortho cubic super-high
resolution computed tomography: A new radiographic technique with application to the temporomandibular joint. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 2001;91(2):239-243.
116. Nakajima A, Sameshima GT, Arai Y, Homme Y,
Shimizu N, Dougherty H Sr. Two- and three-dimensional orthodontic imaging using limited
cone beam-computed tomography. Angle Orthod 2005;75(6):895-903.
117. Sakabe R, Sakabe J, Kuroki Y, Nakajima I, Kijima
N, Honda K. Evaluation of temporomandibular
disorders in children using limited cone-beam
computed tomography: A case report. J Clin Pediatr Dent 2006;31(1):14-16.
118. Vandenberghe B, Jacobs R, Yang J. Diagnostic
validity (or acuity) of 2D CCD versus 3D CBCTimages for assessing periodontal breakdown.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104(3):395-401.
119. Misch KA, Yi ES, Sarment DP. Accuracy of cone
beam computed tomography for periodontal
General Dentistry
www.agd.org
defect measurements. J Periodontol 2006;77(7):
1261-1266.
120. Cha JY, Mah J, Sinclair P. Incidental findings in
the maxillofacial area with 3-dimensional conebeam imaging. Am J Orthod Dentofacial Orthop
2007;132(1):7-14.
121. Naitoh M, Yamada S, Noguchi T, Ariji E, Nagao J,
Mori K, Kitasaka T, Suenaga Y. Three-dimensional display with quantitative analysis in alveolar
bone resorption using cone-beam computerized
tomography for dental use: A preliminary study.
Int J Periodontics Restorative Dent 2006;26(6):
607-612.
122. Kasaj A, Willershausen B. Digital volume tomography for diagnostics in periodontology. Int J
Comput Dent 2007;10(2):155-168.
123. Ito K, Yoshinuma N, Goke E, Arai Y, Shinoda K.
Clinical application of a new compact computed
tomography system for evaluating the outcome
of regenerative therapy: A case report. J Periodontol 2001;72(5):696-702.
124. Yang F, Jacobs R, Willems G. Dental age estimation through volume matching of teeth imaged
by cone-beam CT. Forensic Sci Int 2006;159
Suppl 1:S78-S83.
125. Arai Y, Tammisalo E, Iwai K, Hashimoto K, Shinoda K. Development of a compact computed
tomographic apparatus for dental use. Dentomaxillofac Radiol 1999;28(4):245-248.
126. Horner K, Islam M, Flygare L, Tsiklakis T, Whaites
E. Basic principles for use of dental cone beam
computed tomography: Consensus guidelines of
the European Academy of Dental and Maxillofacial Radiology. Dentomaxillofac Radiol 2009;
38(4):187-195.
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