Dentomaxillofacial imaging with panoramic views and cone beam CT

Abstract

Panoramic and intraoral radiographs are the basic imaging modalities used in dentistry. Often they are the only imaging techniques required for delineation of dental anatomy or pathology. Panoramic radiography produces a single image of the maxilla, mandible, teeth, temporomandibular joints and maxillary sinuses. During the exposure the x-ray source and detector rotate synchronously around the patient producing a curved surface tomography. It can be supplemented with intraoral radiographs. However, these techniques give only a two-dimensional view of complicated three-dimensional (3D) structures. As in the other fields of imaging also dentomaxillofacial imaging has moved towards 3D imaging. Since the late 1990s cone beam computed tomography (CBCT) devices have been designed specifically for dentomaxillofacial imaging, allowing accurate 3D imaging of hard tissues with a lower radiation dose, lower cost and easier availability for dentists when compared with multislice CT. Panoramic and intraoral radiographies are still the basic imaging methods in dentistry. CBCT should be used in more demanding cases. In this review the anatomy with the panoramic view will be presented as well as the benefits of the CBCT technique in comparison to the panoramic technique with some examples. Also the basics as well as common errors and pitfalls of these techniques will be discussed.Teaching Points• Panoramic and intraoral radiographs are the basic imaging methods in dentomaxillofacial radiology.• CBCT imaging allows accurate 3D imaging of hard tissues.• CBCT offers lower costs and asmaller size and radiation dose compared with MSCT.• The disadvantages of CBCT imaging are poor soft tissue contrast and artefacts.• The Sedentexct project has developed evidence-based guidelines on the use of CBCT in dentistry.

Morphology of the Temporomandibular Joints Regarding the Presence of Osteoarthritic Changes

“…In the CBCT images, the presence of the osteoarthritic changes was assessed. The radiographic symptoms of degenerative joint disease are [20,[24][25][26][27][28][29] as follows: flattening of the convex condylar head; erosion (the area of reduced density within the cortex and subcortical bone); osteophytes (bone outgrowths on the surface of the condyles); sclerosis (increased density of the cortical plate or bone tissue under the cortical plate); pseudocysts (osteolytic, well delimited, localized in the subcortical area, the cortical layer does not become destroyed in its course). Figure 1 presents the exemplary osteoarthritic changes found in the TMJ CBCT scans.…”

Case Report. Practical Advantages of CBCT in the Surgical Treatment of Impacted Lower Third Molar

“…[16] CBCT gives undistorted three-dimensional images with a very good resolution that allows visualization of anatomical structures shape and their real size. [21] CBCT exam permits to evaluate the buccolingual relationship between the mandibular canal and the roots of the third molar thus avoiding to push the tooth during surgical movements and to hurt the inferior alveolar nerve. In this way can be planned the appropriate interradicular section if it is evident that the inferior alveolar nerve crosses the roots.…”

3D reconstruction images of cone beam computed tomography in dental medicine application: A case study and mini-review

“…Radiographs are a commonly-used diagnosis tool in orthodontic treatment [23] . With the advent of CBCT, it is now possible for clinicians to evaluate the hard and soft tissues of the maxillofacial region in 3D and high spatial detail.…”