Imaging Sci Dent.  2019 Sep;49(3):179-190. 10.5624/isd.2019.49.3.179.

New evolution of cone-beam computed tomography in dentistry: Combining digital technologies

• Jain S
• Choudhary
• Nagi R
• Shukla S
• Kaur N
• Grover D

• KMID: 2458366
• DOI: http://doi.org/10.5624/isd.2019.49.3.179

Abstract

Panoramic radiographs and computed tomography (CT) play a paramount role in the accurate diagnosis, treatment planning, and prognostic evaluation of various complex dental pathologies. The advent of cone-beam computed tomography (CBCT) has revolutionized the practice of dentistry, and this technique is now considered the gold standard for imaging the oral and maxillofacial area due to its numerous advantages, including reductions in exposure time, radiation dose, and cost in comparison to other imaging modalities. This review highlights the broad use of CBCT in the dentomaxillofacial region, and also focuses on future software advancements that can further optimize CBCT imaging.

Keyword

Cone-Beam Computed Tomography; Image Quality, Perspectives; Radiography

MeSH Terms

Cone-Beam Computed Tomography*
Dentistry*
Diagnosis
Pathology
Radiography

Figure

• 

  Fig. 1 Cone-beam computed tomographic (CBCT) images depict condylar erosion as a small circular radiolucency in a patient with temporomandibular joint arthralgia.

Reference

1. White SC, Pharoah MJ. The evolution and application of dental maxillofacial imaging modalities. Dent Clin North Am. 2008; 52:689–705.

2. Miracle AC, Mukherji SK. Conebeam CT of the head and neck, part 1: physical principles. AJNR Am J Neuroradiol. 2009; 30:1088–1095.

3. American Academy of Oral and Maxillofacial Radiology. Clinical recommendations regarding use of cone beam computed tomography in orthodontics. [corrected]. Position statement by the American Academy of Oral and Maxillofacial Radiology. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013; 116:238–257.

4. Jung YH, Liang H, Benson BW, Flint DJ, Cho BH. The assessment of impacted maxillary canine position with panoramic radiography and cone beam CT. Dentomaxillofac Radiol. 2012; 41:356–360.

5. Akgül N, Caglayan F, Durna N, Sümbüllü MA, Akgül HM, Durna D. Evaluation of enamel pearls by cone-beam computed tomography (CBCT). Med Oral Patol Oral Cir Bucal. 2012; 17:e218–e222.

6. Villaca-Carvalho MF, Manhaes LR Jr, de Moraes ME, Lopes SL. Prevalence of bifid mandibular canals by cone beam computed tomography. Oral Maxillofac Surg. 2016; 20:289–294.

7. Deeb G, Antonos L, Tack S, Carrico C, Laskin D, Deeb JG. Is cone-beam computed tomography always necessary for dental implant placement? J Oral Maxillofac Surg. 2017; 75:285–289.

8. Lo Giudice R, Nicita F, Puleio F, Alibrandi A, Cervino G, Lizio AS, et al. Accuracy of periapical radiography and CBCT in endodontic evaluation. Int J Dent. 2018; 2018:2514243.

9. Shweel M, Amer MI, El-shamanhory AF. A comparative study of cone-beam CT and multidetector CT in the preoperative assessment of odontogenic cysts and tumors. Egypt J Radiol Nuclear Med. 2013; 44:23–32.

10. Nah KS. Condylar bony changes in patients with temporomandibular disorders: a CBCT study. Imaging Sci Dent. 2012; 42:249–253.

11. Nunes LF, Santos KC, Junqueira JL, Oliveira JX. Prevalence of soft tissue calcifications in cone beam computed tomography images of the mandible. Rev Odonto Ciênc. 2011; 26:297–303.

12. Bertin H, Bonnet R, Delemazure AS, Mourrain-Langlois E, Mercier J, Corre P. Three-dimensional cone-beam CT sialography in non tumour salivary pathologies: procedure and results. Dentomaxillofac Radiol. 2017; 46:20150431.

13. de Moraes ME, Hollender LG, Chen CS, Moraes LC, Balducci I. Evaluating craniofacial asymmetry with digital cephalometric images and cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2011; 139:e523–e531.

14. Pinchi V, Pradella F, Buti J, Baldinotti C, Focardi M, Norelli GA. A new age estimation procedure based on the 3D CBCT study of the pulp cavity and hard tissues of the teeth for forensic purposes: a pilot study. J Forensic Leg Med. 2015; 36:150–157.

15. Tyndall DA, Rathore S. Cone-beam CT diagnostic applications: caries, periodontal bone assessment, and endodontic applications. Dent Clin North Am. 2008; 52:825–841.

16. Tu MG, Huang HL, Hsue SS, Hsu JT, Chen SY, Jou MJ, et al. Detection of permanent three-rooted mandibular first molars by cone-beam computed tomography imaging in Taiwanese individuals. J Endod. 2009; 35:503–507.

17. Kottoor J, Velmurugan N, Sudha R, Hemamalathi S. Maxillary first molar with seven root canals diagnosed with cone-beam computed tomography scanning: a case report. J Endod. 2010; 36:915–921.

18. La SH, Jung DH, Kim EC, Min KS. Identification of independent middle mesial canal in mandibular first molar using cone-beam computed tomography imaging. J Endod. 2010; 36:542–545.

19. Lauber R, Bornstein MM, von Arx T. Cone beam computed tomography in mandibular molars referred for apical surgery. Schweiz Monatsschr Zahnmed. 2012; 122:12–24.

20. Szabo BT, Pataky L, Mikusi R, Fejerdy P, Dobo-Nagy C. Comparative evaluation of cone-beam CT equipment with micro-CT in the visualization of root canal system. Ann Ist Super Sanita. 2012; 48:49–52.

21. Patel S. The use of cone beam computed tomography in the conservative management of dens invaginatus: a case report. Int Endod J. 2010; 43:707–713.

22. Young SM, Lee JT, Hodges RJ, Chang TL, Elashoff DA, White SC. A comparative study of high-resolution cone beam computed tomography and charge-coupled device sensors for detecting caries. Dentomaxillofac Radiol. 2009; 38:445–451.

23. Wang P, Yan XB, Lui DG, Zhang WL, Zhang Y, Ma XC. Detection of dental root fractures by using cone-beam computed tomography. Dentomaxillofac Radiol. 2011; 40:290–298.

24. Patel S, Dawood A, Wilson R, Horner K, Mannocci F. The detection and management of root resorption lesions using intraoral radiography and cone beam computed tomography - an in vivo investigation. Int Endod J. 2009; 42:831–838.

25. Takita T, Tsurumachi T, Ogiso B. Endodontic treatment of a maxillary lateral incisor with a perforating internal resorption by using cone beam computed tomography as a diagnostic aid: a case report. Quintessence Int. 2011; 42:745–752.

26. Oberoi S, Chigurupati R, Gill P, Hoffman WY, Vargervik K. Volumetric assessment of secondary alveolar bone grafting using cone beam computed tomography. Cleft Palate Craniofac J. 2009; 46:503–511.

27. Takane M, Sato S, Suzuki K, Fukuda T, Asano Y, Honda K, et al. Clinical application of cone beam computed tomography for ideal absorbable membrane placement in interproximal bone defects. J Oral Sci. 2010; 52:63–69.

28. Umetsubo OS, Gaia BF, Costa FF, Cavalcanti MG. Detection of simulated incipient furcation involvement by CBCT: an in vitro study using pig mandibles. Braz Oral Res. 2012; 26:341–347.

29. Peterson AG, Wang M, Gonzalez S, Covell DA Jr, Katancik J, Sehgal HS. An in vivo and cone beam computed tomography investigation of the accuracy in measuring alveolar bone height and detecting dehiscence and fenestration defects. Int J Oral Maxillofac Implants. 2018; 33:1296–1304.

30. Xu X, Xu L, Jiang JH, Wu JQ, Li XT, Jing WD. Accuracy analysis of alveolar dehiscence and fenestration of maxillary anterior teeth of angle class III by cone-beam CT. Beijing Da Xue Xue Bao Yi Xue Ban. 2018; 50:104–109.

31. Leung CC, Palomo L, Griffith R, Hans MG. Accuracy and reliability of cone-beam computed tomography for measuring alveolar bone height and detecting bony dehiscences and fenestrations. Am J Orthod Dentofacial Orthop. 2010; 137:4 Suppl. S109–S119.

32. Angelopoulos C, Thomas SL, Hechler S, Parissis N, Hlavacek M. Comparison between digital panoramic radiography and cone-beam computed tomography for the identification of the mandibular canal as part of presurgical dental implant assessment. J Oral Maxillofac Surg. 2008; 66:2130–2135.

33. Ghaeminia H, Meijer GJ, Soehardi A, Borstlap WA, Mulder J, Bergé SJ. Position of the impacted third molar in relation to the mandibular canal. Diagnostic accuracy of cone beam computed tomography compared with panoramic radiography. Int J Oral Maxillofac Surg. 2009; 38:964–971.

34. Lee JS, Yoon SJ, Kang BC. Mandibular canal branches supplying the mandibular third molar observed on cone beam computed tomographic images: reports of four cases. Korean J Oral Maxillofac Radiol. 2009; 39:209–212.

35. Lofthag-Hansen S, Gröndahl K, Ekestubbe A. Cone-beam CT for preoperative implant planning in the posterior mandible: visibility of anatomic landmarks. Clin Implant Dent Relat Res. 2009; 11:246–255.

36. Spector L. Computer-aided dental implant planning. Dent Clin North Am. 2008; 52:761–775.

37. Loubele M, Maes F, Schutyser F, Marchal G, Jacobs R, Suetens P. Assessment of bone segmentation quality of cone-beam CT versus multislice spiral CT: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 102:225–234.

38. Ferreira MC, Garib DG, Cotrim-Ferreira F. Methodology standardization for measuring buccal and lingual alveolar bone plates using cone beam computed tomography. Dental Press J Orthod. 2010; 15:49–52.

39. Bornstein MM, Balsiger R, Sendi P, von Arx T. Morphology of the nasopalatine canal and dental implant surgery: a radiographic analysis of 100 consecutive patients using limited cone-beam computed tomography. Clin Oral Implants Res. 2011; 22:295–301.

40. Jung J, Yim JH, Kwon YD, Al-Nawas B, Kim GT, Choi BJ, et al. A radiographic study of the position and prevalence of the maxillary arterial endosseous anastomosis using cone beam computed tomography. Int J Oral Maxillofac Implants. 2011; 26:1273–1278.

41. Kruse C, Spin-Neto R, Wenzel A, Kirkevang LL. Cone beam computed tomography and periapical lesions: a systematic review analysing studies on diagnostic efficacy by a hierarchical model. Int Endod J. 2015; 48:815–828.

42. Kruse C, Spin-Neto R, Reibel J, Wenzel A, Kirkevang LL. Diagnostic validity of periapical radiography and CBCT for assessing periapical lesions that persist after endodontic surgery. Dentomaxillofac Radiol. 2017; 46:20170210.

43. Sogur E, Baksi BG, Gröndahl HG, Lomcali G, Sen BH. Detectability of chemically induced periapical lesions by limited cone beam computed tomography, intra-oral digital and conventional film radiography. Dentomaxillofac Radiol. 2009; 38:458–464.

44. Sirin Y, Guven K, Horasan S, Sencan S. Diagnostic accuracy of cone beam computed tomography and conventional multislice spiral tomography in sheep mandibular condyle fractures. Dentomaxillofac Radiol. 2010; 39:336–342.

45. Yendreka VC, Fonseca GM. A “borderline” dental trauma with 12 y of evolution justifying CBCT as diagnostic method. Biomed Res. 2018; 29:2800–2805.

46. Ersan N, Ilguy M. Diagnosis of unusual mandibular split fracture with cone-beam computed tomography. J Oral Maxillofac Radiol. 2015; 3:67–69.

47. Lewis EL, Dolwick MF, Abramowicz S, Reeder SL. Contemporary imaging of the temporomandibular joint. Dent Clin North Am. 2008; 52:875–890.

48. Librizzi ZT, Tadinada AS, Valiyaparambil JV, Lurie AG, Mallya SM. Cone-beam computed tomography to detect erosions of the temporomandibular joint: effect of field of view and voxel size on diagnostic efficacy and effective dose. Am J Orthod Dentofacial Orthop. 2011; 140:e25–e30.

49. Al-Saleh MA, Alsufyani NA, Lagravere M, Nebbe B, Lai H, Jaremko JL, et al. MRI alone versus MRI-CBCT registered images to evaluate temporomandibular joint internal derangement. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016; 122:638–645.

50. Januário AL, Barriviera M, Duarte WR. Soft tissue cone-beam computed tomography: a novel method for measurement of gingival tissue and the dimensions of the dentogingival unit. J Esthet Restor Dent. 2008; 20:366–374.

51. Pette GA, Norkin FJ, Ganeles J, Hardigan P, Lask E, Zfaz S, et al. Incidental findings from a retrospective study of 318 cone beam computed tomography consultation reports. Int J Oral Maxillofac Implants. 2012; 27:595–603.

52. Tward DJ, Siewerdsen JH, Daly MJ, Richard S, Moseley DJ, Jaffray DA, et al. Soft-tissue detectability in cone-beam CT: evaluation by 2AFC tests in relation to physical performance metrics. Med Phys. 2007; 34:4459–4471.

53. Kabashima H, Mizobe K, Nakamuta H, Fujiwara H, Okamura K, Unemori M, et al. The usefulness of three-dimensional imaging in the diagnosis and treatment of clinically ambiguous gingival swelling. J Oral Sci. 2011; 53:257–261.

54. Drage NA, Brown JE. Cone beam computed sialography of sialoliths. Dentomaxillofac Radiol. 2009; 38:301–305.

55. Jadu FM, Hill ML, Yaffe MJ, Lam EW. Optimization of exposure parameters for cone beam computed tomography sialography. Dentomaxillofac Radiol. 2011; 40:362–368.

56. Hechler SL. Cone-beam CT: applications in orthodontics. Dent Clin North Am. 2008; 52:809–823.

57. Merrett SJ, Drage NA, Durning P. Cone beam computed tomography: a useful tool in orthodontic diagnosis and treatment planning. J Orthod. 2009; 36:202–210.

58. 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.

59. Hwang HS, Choe SY, Hwang JS, Moon DN, Hou Y, Lee WJ, et al. Reproducibility of facial soft tissue thickness measurements using cone-beam CT images according to the measurement methods. J Forensic Sci. 2015; 60:957–965.

60. von See C, Bormann KH, Schumann P, Goetz F, Gellrich NC, Rücker M. Forensic imaging of projectiles using cone-beam computed tomography. Forensic Sci Int. 2009; 190:38–41.

61. Pauwels R, Jacobs R, Bosmans H, Schulze R. Future prospects for dental cone beam CT imaging. Imaging Med. 2012; 4:551–563.

62. Pauwels R, Araki K, Siewerdsen JH, Thongvigitmanee SS. Technical aspects of dental CBCT; state of the art. Dentomaxillofac Radiol. 2015; 44:20140224.

63. Hiraiwa T, Ariji Y, Fukuda M, Kise Y, Nakata K, Katsumata A, et al. A deep-learning artificial intelligence system for assessment of root morphology of the mandibular first molar on panoramic radiography. Dentomaxillofac Radiol. 2019; 48:20180218.

64. Noel PB, Walczak AM, Xu J, Corso J, Hoffmann KR, Schafer S. GPU-based cone beam computed tomography. Comput Methods Programs Biomed. 2009; 98:271–277.

65. Ma L, Xu T, Lin J. Validation of a three-dimensional facial scanning system based on structured light techniques. Comput Methods Programs Biomed. 2009; 94:290–298.

66. Lata S, Mohanty SK, Vinay S, Das AC, Das S, Choudhury P. Is cone beam computed tomography (CBCT) a potential imaging tool in ENT practice? A cross-sectional survey among ENT surgeons in the State of Odisha, India. Indian J Otolaryngol Head Neck Surg. 2018; 70:130–136.

67. Liu J, Cai W, Ning R. Evaluation of differential phase contrast cone beam CT imaging system. J Xray Sci Technol. 2017; 25:357–372.