Cone Beam in the Modern Dental Office Better Imaging, Better Outcomes Incorporation of CBCT Data into Treatment Planning

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2 Cone Beam in the Modern Dental Office Better Imaging, Better Outcomes Incorporation of CBCT Data into Treatment Planning Rick Ferguson DMD Clinical Assistant Professor University of Florida Diplomate ICOI Associate Fellow AAID 2

3 AAOMR Position Paper Dimensional Imaging should be used for all Dental Implant Planning Cone Beam in Dentistry Endodontic Periodontal Orthodontic Pathology Trauma Oral Surgery Implants TMJ How we use CBCT Diagnosis Case Presentation Pre-surgical Assessment Intra-surgical Assessment Post Surgical Assessment Computer Guided Surgery 3

4 Why Use Cone Beam CT To accurately assess volume of alveolus and implant site pre-surgically More accurate than 2D imaging Lower Radiation dosage compared to conventional CT Use of CBCT leads to a lower complication rate Used to assess the success of grafting and implant position CBCT self corrects for magnification yielding a 1:1 ratio for accurate measurements Predictability Alamri, H. M., Sadrameli, M., Alshalhoob, M. A., & Alshehri, M. A. (2012). Applications of CBCT in dental practice: A review of the literature. General dentistry, 60(5), 390. Predictability = Profitability Cone Beam Safety Rapid Scan (8.7 seconds / 260 projections) 32 microsieverts High Def Scan (16.8 seconds / 512 projections) 59 microsieverts Ultra High Def Scan (33.6 seconds / 1,024 projections) 139 microsieverts 4

5 Friedberg, Wallace, and Kyle Copeland. What aircrews should know about their occupational exposure to ionizing radiation. No. DOT/FAA/AM- 03/16. FEDERAL AVIATION ADMINISTRATION OKLAHOMA CITY OK CIVIL AEROMEDICAL INST, millisievert =1000 microsieverts Natural radiation is equivalent to 50 HD Prexion scans Radiation Workers allowed 50,000/yr Advantages of Cone Beam CT How To Read CBCT Images Axial Top to Bottom 5

6 Advantages of Cone Beam CT How To Read CBCT Images Coronal Front to Back Advantages of Cone Beam CT How To Read CBCT Images Saggital Side to side Charles 31y.o. Healthy Male 6

7 Clinical Cases and Images Treatment Of Impacted Teeth Supernumerary Teeth Surgical Planning 7

8 Clinical Cases and Images Orthodontic Planning Presurgical Planning with views from different angles Orthodontic Application 8

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10 Pathology 10

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12 Radiology Report Cementifying Ossifying Dysplasia Multiple Benign Cementoblastomas 6 month P.O. 2.5 year P.O. Periodontal Application 12

13 William D visualization and treatment plan acceptance go hand in hand 13

14 Joe - 58 Joe 14

15 Endodontic Application 15

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18 Bud - 40 Cotton TP, Geisler TM, Holden DT, Schwartz SA, Schindler WG. Endodontic applications of cone-beam volumetric tomography. J Endod 2007;33:

19 When the Image is Clear There is Nothing to Fear The detection and assessment of the true nature of endodontic lesions and other relevant features may be impaired by adjacent anatomical noise. The effect of this anatomical noise is unique for each patient and is dependent on the degree of bone demineralization, size of the endodontic lesion and the physical nature of the anatomical noise (i.e. its thickness, shape and density of the overyling anatomy). In certain situations (for example resorptive lesions, periapical surgery assessment) three-dimensional visualization of the endodontic problem is desirable. In these circumstances, three-dimensional imaging provided by CBCT is extremely useful. Patel, S., Dawood, A., Ford, T. P. and Whaites, E. (2007), The potential applications of cone beam computed tomography in the management of endodontic problems. International Endodontic Journal, 40: doi: /j x 19

20 Bud Implant Restored Trauma Sarah

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22 2 months 8 months 22

23 Nora When the Image is Clear There is Nothing to Fear 23

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26 Nate - 75 Sinus Graft? 26

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28 Guided Surgery 28

29 Tapered 3.0, Tapered Internal & Plus MLV189 REV A APR 2014 guide manufacturers with BioHorizons drilling protocols and master cylinders VIP Treatment Planning Software MLV189 REV A APR 2014 Enid 80 29

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32 Evaluation of previous bone grafts Ashley - 12 Ashley

33 AAOMR Position Paper Dimensional Imaging should be used for all Dental Implant Planning When the Image is Clear There is Nothing to Fear 33

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38 Beautiful Things Don t ask for Attention The Secret Life of Walter Mitty 38

39 Contact Information Web Phone Fax (954) Facebook implanteducators 39

40 Post Course Evaluation: Cone Beam in the Modern Dental Office: Better Imaging, Better Outcomes Are you an AGD member? yes no If so please provide your number 1. To what extent did this webinar support the following learning objectives Better understanding of the technology and principles of CBCT in everyday dental office use Completely Mostly Moderately Hardly Not at all Able to better identify anatomy, pathology, hard and soft tissue on a CBCT scan Completely Mostly Moderately Hardly Not at all Understand the indications of CBCT in everyday practice Completely Mostly Moderately Hardly Not at all 2. Course material was up to date and well organized Completely Mostly Moderately Hardly Not at all 3. The presentation was informative and will impact my practice Strongly agree Agree No opinion Disagree Strongly disagree

41 4. Please rate each speakers knowledge and teaching effectiveness of discussion Dr Rick Ferguson Excellent Above Average Average Below average Dr Arthur Acker Excellent Above average Average Below average 5. Please rate the online format based on the appropriateness for the subject matter Excellent Above average Average Below average Overall this course met my expectations Strongly agree Agree No opinion Disagree Strongly disagree 6. What topics would you like to see in the future