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We share informative articles and news.


Dr. Eddy Loo
20/Feb/2016

Our new CBCT, OPG and Lat Ceph X-Ray unit
Our new CBCT, OPG and Lat Ceph X-Ray unit

Cone Beam CT (CBCT) is an X-ray based imaging technique that, like a conventional medical CT scan, provides fast and accurate visualisation of bony anatomical structures in three dimensions. In another words, CBCT produces a 3-dimensional images of your teeth and jaws.

It is also sometimes called “Digital Volumetric Tomography” (DVT) or other alternative names.

Unlike CT-scan, CBCT scanning resolution is higher, with less artefact and scatter. The scan field of view can also be reduced to image smaller volumes and lower the radiation dose associated with each scan.

CBCT
CBCT image in 3D, with vertical, coronal and axial cross-section plane

CBCT scans are useful in many different types of dentistry, especially for dental implant planning, managing impacted teeth and root canal treatments, basically to get the 3D images of the teeth and jaws. It is used by general dentists and specialists to improve diagnosis and treatment planning in the following cases:

Dental implants

  • Size and shape of ridge, quantity and quality of bone
  • Position and orientation of implants insertion
  • Location of anatomic structures: mandibular canal, submandibular fossa, incisive canal, maxillary sinus
  • Need for bone graft, sinus lift
  • Acquire for implant planning software

CBCT5

Oral and maxillofacial surgery

  • Orthognathic surgery planning
  • Localization of impacted teeth, foreign objects
  • Relationship of third molar roots to mandibular canal
  • Evaluation of facial fractures and asymmetry
  • Oral and maxillofacial pathology
  • Localization and characterization of lesions in the jaws
  • Effect of lesion on jaw in 3rd dimension: expansion, cortical erosion, bilateral symmetry
  • Relationship of lesion to teeth and other structures

Orthodontics

  • Treatment planning for complex cases when 3D information needed to supplement (or substitute for) other imaging
  • Patients with cleft palate
  • Impacted/missing teeth
  • Root angulation, root resorption
  • Temporomandibular joint
  • Osseous structures of TMJ
  • Relationship of condyle and fossa in 3D
ID-nerve
CBCT image can be used to determine the position of the ID nerve in the jaw bone

FAQ on CBCT

When should CBCT be used?
  • Whenever information in the 3rd dimension is needed for the diagnosis, treatment planning, or management of conditions in the jaws and the maxillofacial complex.
What does the scan look like when it is done?
  • The CBCT examination produces 3-dimensional pictures of the hard and soft tissue of your face. The size of the volume depends on the scanner and your particular clinical needs. The information can be viewed on a computer screen in different cross-section plane and can be rotated by the dentist to help plan treatment.
What is the difference between ordinary X-ray pictures and CBCT?
  • Ordinary X-ray images (such as OPG) are 2-dimensional, flat, pictures. Your teeth and jaws are 3-dimensional, so 2-dimensional images may not give the best information.
CBCT-3D-image
3D image of the jaw bones
Where do I go for a scan?
  • You can come to us for CBCT scan
  • or certain hospital X-ray Department in Klang Valley with CBCT unit
What are the advantages of CBCT?
  • Lower radiation dose than medical CT
  • Equivalent to ~1 Full mouth series of intra-oral radiographs or 6-7 panoramic radiographs
  • Comfortable for patient
  • Patient standing
  • Only 20 second scan
  • Wheelchair accessible
  • Images available almost immediately on screen
  • Images can be imported into other software
What will happen when I attend for the scan?
  • First, you will be asked to wear a lead apron to protect your body from radiation. Next, you will be positioned carefully in a standing position. You will then be ready for the scan itself.
  • The machine will move around your head in a circular motion, but will not touch you. Once the scan is finished, you will be asked to stay in the chair until the images are checked.

CBCT4

How long does the scan take?
  • The scan itself takes only a minute or so but, in most cases, the preparation and positioning will mean that the complete scan will take about 20 minutes.
Is there anything I need to do before I come for my appointment?
  • If you have earrings or other facial jewellery or piercings, these may need to be removed before the scan, so doing this in advance of your visit will save time. If you wear dentures, you will probably be asked to remove these before the scan.

CBCT-remove-earrings

Should the amount of X-rays I will receive worry me?
  • No. All CBCT referrals should be justified and only carried out when it is judged that the scan is appropriate. Although the X-ray exposure with CBCT is greater than with a traditional dental X-ray examination, it is almost always much less than you would get with a “medical” CT scan that might be the only alternative.
Other Radiograph Modalities…

 


Dr. Tham
20/Feb/2011

Lateral cephalometric is a radiograph of the head taken with the x-ray beam perpendicular to the patient’s sagittal plane. This radiography image is useful for studying the dental and facial growth of a patient.

 

LatCeph01
Position of patient from the X-ray source to produce a standard Lateral cephalometric radiograph

 

In orthodontic treatment, clinician/orthodontist use this radiograph to identified dental and skeletal deformity; the relationship between upper and lower teeth and jaw bone. By doing so, he  can create a treatment plan to correct the teeth misalignment. This radiograph is also useful in monitoring the progress of braces treatment and to compare before and after treatment.

 

Cephlo
Patient’ head is in ‘natural head position’

 

During radiograph taking, the patient’s head is positioned in the most relax position — natural head position — is a standardized orientation of the head that is reproducible for each individual and is used as a means of standardization during analysis of dentofacial morphology both for photos and radiographs.

 

Lat-Cephalo
An example of a standard Lateral Cephalometric Radiograph

 

Cephalometric Tracing

Cephalometric tracing is an overlay drawing produced from a cephalometric radiograph by digital means and a computer program or by copying specific outlines from it with a lead pencil onto acetate paper, using an illuminated view-box. Tracings are used to facilitate cephalometric analysis, as well as in superimpositions, to evaluate treatment and growth changes.

 

The landmarks on the radiograph are identified and marked.

 

LatCeph-tracing

Lines are made to join the markings and the angles where the lines intercept will be recorded. The values of the angle will be compared to the norm value according to the patient’s race. And finally, a conclusion will be depends on the deviation of the patient’s value to the norm value.

 

LatCeph-Analysis

 

Sometimes, lateral cephalometric radiograph can be use to compare before and after treatment or the growth pattern of a child. For example, in the image below, the green line represent before treatment and the black will be after treatment. From here, we can appreciate how the teeth and jaws move during treatment. Doctor use this radiograph to evaluate if he has achieve his treatment objective!!

 

LatCeph-compare

 

Other Radiograph Modalities…

 


Avatar
20/Feb/2011

Dental Panoramic Tomogram or OPG is a sophisticated x-ray machine used to take radiographic images of the teeth and jaws bone which is in a arch position. We used to call this machine as OPG (which stands for ORTHOPANTOGRAM), which was named after the first x-ray unit.
OPG performed by using a technique called “tomography”.

The X-ray tube moves around the head, the x-ray film moves in the opposite direction behind your head. This generates an image slice where the mandible and teeth are in focus, and the other structures are blurred.

OPG
Our OPG unit in Bandar Puteri
OPG-03
Patient is in the standing position when taking OPG

 

Anatomy
The anatomy consists of the body, ramus and angle of mandible, coronoid process, mandibular notch, condyle of mandible, alveolar ridge, symphysis menti, maxillary sinuses, nasal fossae and 16 upper and 16 lower teeth, as shown in the image below.

OPG-image
An OPG image with the anatomical landmark

 

 

Reasons for OPG requests

Dental Disease

  • Caries – appear as different shaped areas of radiolucency in the crowns or necks of teeth.
  • Peridontioiditis – when inflammation extends into the underlying alveolar bone and there is a loss of attachment.
  • Peridontal Abscess – Radiolucent area surrounding the roots of the teeth.

Impacted or  embedded teeth (eg. wisdom teeth)

  • OPG shows angulation, shape of roots, size and shape of crown, effect on other teeth.
  • To look for impacted canine

Teeth Abnormalities

  • Eg. Developmental, to show size, number, shape and position.

Lesions in the jaw bone

  • Cyst of jaw bone – shape, size, extension, involving nearby structure
  • Tumour/growth – benign, malignant

Trauma to teeth and facial skeleton

  • Mandible fractures are often bilateral.
  • Panoramic view of mandible to view the fracture.
  • Determine site and direction of fracture lines.
  • Relationship of teeth to fracture lines.
  • Alignment of bone fragments after healing.
  • Evidence of infection or other complications post intervention.
  • Follow up to assess healing.

Planing for implant placement

  • To identify the position and location for implant placement
  • Bone quality and quantity
  • Anatomical structure that should be avoided such as the maxillary sinus and the inferior dental nerve
Other Radiograph Modalities…

 


Dr. Janice Ng
20/Feb/2011

Dental intra-oral radiographs a.k.a X-rays. Dentists use radiographs for multiple reasons: to find hidden dental structures, malignant or benign masses, bone loss, and cavities.

 

How does x-ray of your teeth formed?

X-ray of your teeth is formed by a controlled burst of X-ray radiation which penetrates oral structures at different levels, depending on varying anatomical densities, before striking the film or sensor.

  • Teeth appear lighter because less radiation penetrates them to reach the film.
  • Dental caries, infections and other changes in the bone density, and the periodontal ligament, appear darker because X-rays readily penetrate these less dense structures.
  • Dental restorations (fillings, crowns) may appear lighter or darker, depending on the density of the material.

Should Patients Have Concerns About Radiation Exposure?

The dosage of X-ray radiation for dental is typically safe, around 0.150 mSv for a full mouth series, according to the American Dental Association website. It is equivalent to a few days’ worth of background environmental radiation exposure, or similar to the dose received during a cross-country airplane flight (concentrated into one short burst aimed at a small area).

Incidental exposure is further reduced by the use of a lead shield, lead apron, sometimes with a lead thyroid collar. Operator exposure is reduced by stepping out of the room, or behind adequate shielding material, when the X-ray source is activated.

Types of intra-oral radiographs

  1. Bitewing
  2. Periapical

Bitewing radiograph

Bitewings

Bitewing radiograph designed the placement of the film packet to reveal the coronal halves of the maxillary and mandibular teeth, inter-proximal contacts and portions of the interdental septa.

It is indicated primarily to detect or monitor interproximal caries if the proximal surfaces of the teeth cannot be visually or tactilely examined.

Occlusal caries, crestal alveolar bone level and secondarily for eruption patterns, caries and restoration proximity to pulp spaces, primary molar furcation pathology and developmental anomalies may also be detected with bitewing radiographs.

Periapical Radiograph

PA radiography describes intra-oral techniques designed to show individual teeth and the tissues around the apices. Each image usually shows two to four teeth and provides detailed information about the teeth and the surrounding alveolar bone.

Anterior PA

Posterior PA

Indications for PA radiograph are:

  • Detection of apical infection/inflammation
  • Assessment of the periodontal status
  • After trauma to the teeth and associated alveolar bone
  • Assessment of the presence and position of unerupted teeth
  • Assessment of root morphology before extractions
  • During endodontics
  • Preoperative assessment and postoperative appraisal of apical surgery
  • Detailed evaluation of apical cysts and other lesions within the alveolar bone
  • Evaluation of implants postoperatively.
Other Radiograph Modalities…

 






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