No! 3D CBCT X-rays are not routine for dental diagnosis or assessment. This imaging modality has a slightly higher radiation dose effect than a conventional 2-dimensional panoramic radiograph. It is therefore only requested by the dentist when additional information is needed for diagnosis or treatment. It is mainly used for tooth implantation, microscopic root canal treatment and in cases where clinical examination or 2D radiographs are not sufficient to assess the retention of a tooth.
YES. In order to plan the surgery, it is essential that the surgeon can examine the bone in 3 dimensions and prepare for its anatomical difficulties. The anatomy of the maxillary sinus in the upper arch and the course of the sensory nerve in the mandible are the most difficult aspects of the operation. It is vital to know exactly how these anatomical formations are laid out. A 2-dimensional scan is not enough.
Not necessarily in all cases. This is up to the specialist to decide for the tooth in question. Incisors, for example, are less complicated than molars. But even these do not necessarily require a 3D CBCT scan. A 2D radiograph gives some guidance and is often sufficient for successful treatment. In more complicated cases, such as a broken instrument or a branched, tortuous root canal, the doctor often opts for a 3D CBCT, which provides more information. If there is inflammation on the tooth, 2D X-rays are often misleading as to its shape, and 3D scans can also provide useful information.
Once again, geoscience is a special subject. Even here the doctor does not necessarily start with a 3D CBCT scan. First a panoramic X-ray is taken. If there are teeth that have been root canal treated in the past, they are all considered potential foci. The 2D x-ray gives a rough idea of whether or not a single root canal tooth has healed. But this is often deceptive because the inflammation can extend into the 3rd dimension, i.e. the depth, which the 2D X-ray often does not show. So in the case of root canal treated teeth with underlying nodular disease, it may be necessary to take 3D CBCT radiographs to be sure.
We often perform root canal treatment with an operating microscope and in about 50-70% of cases we ask for 3D CBCT images. Accurate diagnosis and root canal work at high magnification leads to more successful treatments and can also lead to more successful solutions to problems that cannot be solved by general dental treatment.
In cases where 3D CBCT is requested by the dentist or the root canal is done with a microscope, microscopic root canal treatment combined with 3D CBCT is not a 100% guarantee of saving the tooth, but it can give a tooth a much better chance of success than traditional techniques.
State-of-the-art 3D CBCT X-ray machines are now accelerated (shorter exposure time), minimal exposure, environmentally friendly devices. This means excellent image quality with minimal radiation dose. ADC dose compensation optimises the irradiance for both 2 and 3D images. Radiation dose is present, but minimally more than in a conventional panoramic X-ray.
To give you an idea, travelling to New York by airplane is about six times the radiation dose of taking an X-ray.
It's a simple imaging procedure, there's no pain involved, you don't even have to open your mouth. The patient positions themselves in the machine, and after the adjustments are made, the machine rotates around the head in about 30 seconds. That's it.
The recording takes about 30 seconds. The 3D CBCT is a huge amount of information, so processing the resulting data takes a few minutes. The evaluation of the image takes the most time. The recording can be burned onto a CD and taken away.
The tooth is not a flat piece of paper, but a 3-dimensional body, most of which is located in the bone, invisible to clinical examination. The discovery and appearance of X-rays is a huge help to clinicians in making the correct diagnosis. Even today, traditional 2-dimensional radiography is sufficient in many cases in dentistry. But in special cases, we need to go much further!
One such special case is tooth implantation and related bone replacement surgery. If the doctor were to plan in 2 dimensions only and omit bone thickness measurements, he would make huge horn errors in the untested dimension. The anatomy in the area of the extracted tooth is also 3 dimensional, so the course of blood vessels and nerves can only be accurately examined with 3 dimensional imaging. 3D CBCT images can be used to make accurate measurements, reducing the risk of surgery.
Root canal treatment is the last attempt to save a tooth. The anatomy of the tooth is very complex, little of which can be seen on a 2-dimensional conventional X-ray, many failures can occur and unnecessary difficulties can be created for the dentist and the patient. 3D CBCT radiographs are an essential tool for assessing whether a tooth is worth saving or not, and for planning microscopic root canal treatment.
When planning a dental implantation, a 3D CBCT scan is essential. About 3 months after the tooth extraction, a 3D CBCT image of the extracted tooth is taken. The digital image is used by the doctor to take measurements and plan the size of the dental implant and the surgery. The 3D CBCT shows the bone anatomy to avoid nerve damage during surgery. In the case of sinus elevation surgery or tooth implantation with bone replacement, the anatomy of the sinus is also studied.
One of the wonders of modern dentistry is the possibility of root canal treatment with an operating microscope. This procedure can save teeth in many cases that traditional root canal treatment would unfortunately fail. 3D CBCT scans can help in many cases to diagnose and plan the treatment prior to microscopic root canal treatment. This is a low-volume, high-resolution image that allows the internal structure of the tooth root to be studied in real life. This allows the endodontist to be much better prepared for the difficulties of the treatment and more teeth can be saved!
We do not routinely take 3D CBCT images during a general dental assessment. For general planning, a 2-dimensional radiograph or a panoramic radiograph is sufficient for a general assessment of the condition of the teeth. If a specific problem is identified, only then will the dentist recommend a 3D CBCT. 3D CBCT X-rays use more radiation than conventional X-rays, so they can only be taken in justified cases!
We do not take 3D CBCT radiographs for general dental assessment. This is because we do not burden patients with unnecessary radiation dose. If there is a special problem, a tooth implantation or root canal treatment, or if it is not possible to be sure how to treat a tooth on the basis of 2D X-rays, and 3D CBCT X-rays provide additional information, we will only take a special X-ray in this case.
A dental 3D CBCT scan does not take much more time than a digital 2D dental panoramic X-ray. The computer processes a lot of data, which takes a few minutes to load after the image is taken. The longest time is the evaluation of the image. The dentist examines the teeth in 3 dimensions, each one separately, and takes measurements. So it is the diagnosis or treatment plan that takes the time, not the taking of the scan.
3D CBCT scans are not routinely required during general health check-ups or annual dental check-ups. This diagnostic aid is only ordered by the doctor in special cases. These cases are mainly tooth implantation or microscopic root canal treatment.
3D CBCT X-rays are an essential tool for successful tooth implant or bone graft surgery. Without it, no surgery can be planned. The doctor will take measurements from the digital images and choose the surgical technique and the size of the dental implant screw to be inserted accordingly.
Microscopic root canal treatment is a special branch of dentistry that attempts to save teeth with more complex anatomy. However, this requires the doctor to have a precise knowledge of the root canal structure. The exploration of curved or branched canals, the removal of intruded instruments all require 3D CBCT imaging.