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Information Technology/Computers CDE 2 HOURS CREDIT 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. 390 September/October 2012 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 General Dentistry www.agd.org 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 www.agd.org 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 General Dentistry September/October 2012 391 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. 392 September/October 2012 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 General Dentistry www.agd.org 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 www.agd.org 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 General Dentistry September/October 2012 393 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 394 September/October 2012 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 General Dentistry www.agd.org 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 www.agd.org 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. General Dentistry September/October 2012 395 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 396 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 General Dentistry www.agd.org 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. Manufacturers Anatomage, San Jose, CA 408.885.1474, www.anatomage.com Dolphin Imaging & Management Solutions, Chatsworth, CA 800.548.7241, www.dolphinimaging.com