GOOD MORNING

BY
DR M GREESHMA HARINI
3RD YEAR POST GRADUATE
DEPT. OF ORTHODONTICS
NARAYANA DENTAL
CBCT IN ORTHODONTICS
 CONTENTS:
1. Introduction
2. History
3. CBCT vs. CT
4. Classification of CBCT
5. Indications ,limitations & Errors in CBCT
6. Application of CBCT in
• Orthodontic diagnosis
• Treatment planning
• Assessing treatment progress and outcome
• Risk assessment
7. Radiation safety
8. Radiation Guidelines
9. Conclusion
10. References

3
 INTRODUCTION :

 The key of a successful orthodontic treatment is an accurate

diagnosis, growth evaluation and treatment planning.
 Diagnostic records for an orthodontic treatment planning generally
begin with history, intraoral and extraoral examination of the
patient.
 Dental casts, intraoral and extraoral photographs are also routine
diagnostic materials.

Presentation title 4
 INTRODUCTION :

 Imaging is a necessary diagnostic tool in the practice of orthodontics.

 For radiographic evaluation, panoramic radiograph, periapical
views, upper occlusal radiograph and lateral cephalometric
radiograph are obtained if indicated.
 Imaging should answer the questions that cannot be solved clinically.
 By using radiographic examination, it is possible to confirm or rule
out clinical findings

Presentation title 5
 INTRODUCTION :

 In recent years, orthodontists have begun to use three‐

dimensional (3D) cone beam computed tomography (CBCT)
images to overcome the inadequateness of two‐dimensional (2D)
radiographic records.
.

Presentation title 6
 History :

• In 1931,Holly Broadbent was the pioneer in evaluating Holly Sir Godfrey

Broadbent Hounsfield 
The dentofacial structures in three dimensions (3D)
• Sir Godfrey Hounsfield invented the computed tomography (CT) in the early
1970s, and this starts the true era of 3D imaging.
• Modern medical grade CT scans, with the assistance of computers, will
compile these 2D image slices and reformat them into true 3D images.
• In April 2001 ,NewTom (Quantitative Radiology, Verona,Italy) was the first
commercially distributed CBCT system for head and neck imaging.
• It was sanctioned by the Food and Drug Administration (FDA) and in its fourth
generation as the NewTom VG.

CBCT IN ORTHODONTICS
7
Presentation title 8
2.CBCT VS CT
 CBCT VS CT

Presentation
Presentation title title 10
 Types of CT scanners

 CT scanners can be divided into two categories based on

acquisition X-ray beam geometry:
1.FAN BEAM
2.CONE BEAM.
 In fan beam scanners, an X-ray source and solid-state detector
are mounted on a rotating gantry.
 Data is acquired using a narrow fan-shaped Xray beam
transmitted through the patient.
  The patient is imaged slice by-slice, usually in the axial plane, and
interpretation of the images is achieved by stacking the slices to
obtain multiple 2D representations.
 The linear array of detector elements used in conventional helical fan-
beam CT scanners is a multi-detector array.
 This configuration allows multi-detector CT (MDCT) scanners to
acquire up to 64 slices simultaneously, compared with single-slice
systems thereby allowing generation of 3D images at substantially
lower doses of radiation than single detector fan-beam CT arrays.

Presentation title 12
• Acc to Sukovic et al., 2001; A CBCT scan with a single revolution of the
radiation source is sufficient to scan the entire maxillofacial region.
• CBCT technology is based on the use of a cone-shaped X-ray beam that
is directed through the patient and the remnant beam is captured on a flat
two-dimensional (2D) detector.
• The X-ray source and detector are able to revolve about a patient’s head,
and a sequence of two-dimensional (2D) images is generated.
• These 2D images are then converted into a 3D image using computer
software.
• The rapid movement of the X-ray tube and digital detector through 180°,
or more frequently through 360°, produces essentially instantaneous and
precise 2D and 3D radiographic images of an anatomical structure.

13
Presentation title 14
  Advantages of CBCT over conventional CT:

1) It is less expensive and involves a smaller system.

2) The X-ray beam is limited.
3) Accurate images are obtained.
4) The scan time is rapid.
5) A lower radiation dose is used.
6) The display modes are exclusive to dentofacial imaging.
7) There are fewer imaging artifacts

Presentation title 15
  Classification of CBCT scanners :

 Based on the patient positioning :

1. Supine position
2. Sitting position
3. Standing position

Presentation
Presentation title title 16
 Operational principles of CBCT

The Four Components Of CBCT Image Production Are:

(I) Acquisition Configuration

(Ii) Image Detection,
(Iii) Image Reconstruction
(Iv) Image Display.

17
FIGURE : In CBCT, a complete or partial rotation of gantry around subject
head produces the multiple sequential base images. From these base
images, volumetric dataset composed of isotopic voxels is reconstructed by
software programmes.
Presentation
Presentation title title 19
 Field of view(FOV) : Area of interest to be covered during the scanning
procedure.

FIGURE : Field of view (FOV).

(A) The cylindrical shape and
measurement characteristics of FOV.
(B) FOV range of iCat Next Generation
CBCT machine.

Presentation
Presentation title title 20
Presentation title 21
 • The desired FOV is determined by the region of interest.

• The FOV may be small (individual teeth or quadrant), medium (both

arches, including TMJ) or large (full head).

1. The smaller FOV is used for assessing individual teeth.

2. The Medium FOV includes the mandible, the maxilla or both. These
are indicated when extra information regarding occlusal relationships and
facial asymmetries are needed.
3. The largest FOV includes the whole head and helps clinicians to
visualize relationships among skeletal bases, between teeth and skeletal
bases, etc.

Presentation title 22
The size of the FOV depends on:

• The size and shape of the detector,

• The geometry of beam
• The ability to collimate the beam.

The FOV are :

1. Localised region: FOV less than 5 cm
2. Single arch: FOV 5 cm to 7 cm for single upper or lower arch scanning
3. Interarch: FOV 7 cm to 10 cm
4. Maxillofacial: FOV 10 cm to 15 cm for mandible to nasion
5. Craniofacial: FOV more than 15 cm for the lower border of the mandible
to the vertex of the head

23
Indications of CBCT imaging in orthodontics:

24
 Application of CBCT in orthodontics.

Orthodontic situation CBCT application

 Diagnosis  Assessment of skeletal structures
and dental structures
 • Skeletal jaw relation
 • Symmetry/asymmetry
 3D evaluation of impacted tooth
position and anatomys
 Growth assessment
 Pharyngeal airway analysis
 Assessment of the TMJ complex in
three dimensions
 Cleft palate assessment

 Treatment progress  Assessment of dentofacial

orthopedics
 Outcomes of alveolar bone grafts in
cleft palate cases

Presentation title
 Orthognathic Surgery 26
superimposition
  Risk assessment  Investigation of orthodontic-
associated paraesthesia
 Assessment of orthodontics induced
root resorption
 Post treatment TMD

 Treatment planning  Orthognathic surgery treatment

planning in true 1:1 imaging
 Planning for placement of temporary
anchorage devices (TADs)
 Accurate estimation to space
requirement for unerupted/
impacted teeth
 Used in association with CAD/ CAM
technology for construction of
custom appliances. (Lingual
orthodontic appliance)

Machado G. L. (2015). CBCT imaging - A boon to orthodontics. The Saudi dental journal, 27(1), 12–21.
Presentation title 27
 • Assessment of skeletal and dental structures:

• Landmark identification is also greatly enhanced in CBCT images with

magnification and adjustments in contrast.
• Van Vlijmen et al.2008; stated that the reproducibility of measurements on
cephalometric radiographs obtained from CBCT scans was better than that
achieved with conventional cephalograms.
• Ludlow et al., 2009 Multiplanar views are especially advantageous in
identifying bilateral landmarks such as condylion, gonion, and orbitale, which
are frequently superimposed in conventional radiographs .
• However, CBCT imaging need not replace conventional radiography,
although additional conventional imaging is generally not necessary when
CBCT scans are acquired for an orthodontic diagnosis.

Presentation title 28
 3D evaluation of impacted teeth:
• CBCT is commonly used to assess an impacted tooth and its position .
• Research has shown that enhanced precision in the localization of
canine teeth and improved estimations of the space conditions in the
arch can be obtained with CBCT, and this can greatly affect diagnosis
and treatment planning to facilitate a more clinically- orientated approach.
• Acc to Wriedt et al., 2012 ;Small volume CBCT is also justified as a
supplement to routine panoramic X-rays in the following cases: when
canine inclination in the panoramic X-ray exceeds 30°, when root
resorption of adjacent teeth is suspected, and/or when the canine apex is
not clearly discernible in the panoramic X-ray, implying dilaceration of the
canine root

Presentation title 29
 Acc to Katheria et al. (2010) ;When comparing conventional radiography
and CBCT, found that CBCT provides more information regarding the
location of pathology, the presence of root resorption, and treatment
planning.
However, the benefits of CBCT imaging must be weighed against the
radiation risk to pediatric patients and the complexity of the pathology
involved.
Presentation title 30
re-treatment images derived from CBCT of a patient with retained mandibular primary second molars and
impacted second premolars. (a) Reconstructed panoramic radiograph shows a distally impacted mandibular
right second premolar and mesially impacted mandibular left second premolar. The precise spatial positions
of the mandibular second premolars and their relationships to neighbouring structures can be determined
from axial
Presentation title (b, c), sagittal (d, e) and three-dimensional volumetric (f) reconstructions to develop a virtual 31
treatment and biomechanical plan. Reproduced from Kapila and Nervina48, Copyrightª2014, John Wiley and
Son
Growth assessment:
Joshi et al., 2012; CBCT scans can be used to reliably assess cervical
vertebrae maturity, which provides a consistent evaluation of skeletal
maturity
Pharyngeal airway analysis:
Vizzotto et al., 2012; Lateral cephalograms have been routinely used to
assess the airway .
Conventional radiography and reconstructed 2D CBCT images provide
similar assessments of the airway.
In comparison, axial cuts of 3D CBCT scans provide soft tissue points that
are derived from the projection of shaded areas, which are more clearly
visible in axial CBCT cuts compared with conventional radiographs, thereby
enhancing airway assessment.

32
 • Three-dimensional CBCT-assisted airway analysis also facilitates the
diagnosis and treatment planning of complex anomalies including
enlarged adenoids and obstructive sleep apnea (OSA).
• Acc to Ogawa et al.2007;
• The apnea-affected subjects showed a significant decrease in airway
volume, area, and distance, thereby highlighting the importance of CBCT
in the diagnosis of this condition.

Presentation title 33
Airway measurement with CBCT: anatomic boundaries of the upper pharyngeal air-
way (pink) (A). Segmentation of the upper airways: nasopharynx (green), oropharynx
(red) andhypopharynx (lower yellow) (B)

Presentation title 34
  Assessment of the temporomandibular joint (TMJ) complex in three
dimensions
• Honey et al. (2007) compared CBCT imaging of the TMJ complex with
panoramic radiography and linear tomographic views, and found that the
CBCT images were more accurate and showed superior reliability in
diagnosing condylar morphology disturbances and erosion.
• For a complete bilateral TMJ exam, an average of four tomographic cuts in
both the lateral and frontal planes are needed for each TMJ.
• When validating the use of CBCT for TMJ analysis, the clinician should
deliberate whether the information acquired will affect the management of
the patient.

Presentation title 35
 • Findings such as hard tissue erosions, remodeling, or the presence
of any structural deformities may be absolutely documentary and
may have no bearing on treatment protocol.
• In general, CBCT is not the imaging of choice for TMJ disorders such
as myofacial pain dysfunction or internal disk derangements.

Presentation title 36
 • 6.6. Cleft palate assessment
• CBCT for patients with cleft lip and palate is useful for both preoperative
and therapeutic evaluations.
• The real-time creation of images in several planes and parasagittal
sections through the imaging volume has broad applications in the
assessment of cleft palate cases.
• Schneiderman et al., 2009;Three-dimensional reconstructions of images in
association with 3D navigation systems allow preoperative evaluations of
the cleft palate regarding the volume of the bone defect, the location of the
bone defect, the presence of supernumerary teeth, and an appraisal of
permanent teeth and alveolar bone morphology

Presentation title 37
 • In a study by Albuquerque et al. (2011), CBCT was found to be
equivalent to multi-slice CT in both the volumetric assessment of bone
defects in alveolar and palatal regions and in establishing donor area
and the volume of the bone graft to be used in the rehabilitation of cleft
patients.

Presentation title 38
 Volume rendering of CBCT scans of an individual with a unilateral cleft lip
and palate (a) before and (b) after alveolar bone grafting . With CBCT
imaging, assessing the morphology, locating the position and determining the
developmental stage of the unerupted maxillary left canine (arrow)

Presentation title 39
 Applications of CBCT in treatment planning

 Orthognathic surgical planning

• CBCT imaging in tandem with appropriate software and virtual patent-
specific models enables the examination of hard and soft craniofacial
tissues and their spatial relationships.
• Virtual anatomical models can be fabricated from CT volumes and co-
registered with other available 3D image data.
• Thus, the virtual models that are generated can be used to recreate or
check treatment options, to create anatomically correct substitute grafts,
and can be a critical aid during the surgical procedure.
• In addition, databases may be interfaced with the anatomical models to
provide characteristics of the displayed tissues to reproduce tissue
reactions.
40
• 7.2. Planning for placement of temporary anchorage devices (TADs)
• The placement of TADs can greatly enhance the information derived
from CBCT imaging.
• Kim et al., 2009. Three-dimensional scans are especially useful in
evaluating the amount and quality of bone available in the desired site of
placement
• Therefore, with this single diagnostic imaging method, information about
surrounding structures, root proximity, and the morphology of maxillary
sinuses and the inferior alveolar nerve canal can be obtained, all of
which are important in determining TAD stability and success.

41
 • Kim et al., 2007; Surgical guides that have been developed using a
method employing high resolution CBCT scans and rapid prototyping
have been shown to provide accurate placement of TADs on the buccal
aspect of the jaws
• Qiu et al., 2012; Three-dimensional CBCT image-based stereo
lithographic surgical stent guides have also been found to be more
accurate than 2D surgical guides in micro implant placement.

Presentation title 42
 (a) Cone-Beam Computed Tomography (CBCT) image with virtual mini-
implant in place. (b) Digital model A: Digital Imaging and
Communications in Medicine (DICOM) and stereolithography (.stl) files
combined. (c) Design of the surgical guide on the digital model.
(d,e) .stl model of the surgical guide.

Georgeos et al;Accuracy of Mini-Implant Placement Using a Computer-Aided

Designed Surgical Guide, with Information of Intraoral Scan and the Use of a Cone-
Beam CT, Dent. J. 2022, 10(6), 104; https://doi.org/10.3390/dj10060104
Presentation title 43
Presentation title 44
 (a) Mini-implant inserted through the guiding hole of the surgical
guide. (b) Guide’s small part beyond the mini-implant broken to
pieces under screwing pressure. (c) Broken pieces of the guide
removed. (d) The guide released from the mouth.
Presentation title 45
 (a) Mini-implant in final place. (b) Digital model B (Ιnitial .stl model and post-
surgical DICOM files combined)

Presentation title 46
 • 7.3. Accurate estimation of the space requirement for unerupted/impacted
teeth
• CBCT scans enable the accurate localization of impacted and/or transposed
teeth, and this helps determine the best method for surgical access and bond
placement.
• It also helps delineate the ideal and most efficient path for extrusion into the
oral cavity to circumvent or decrease collateral damage.
• This information can then be used to place adjacent teeth and their roots away
from the traction path of the impacted tooth so as to avoid untoward changes
in these teeth.
• Another advantage of CBCT over conventional radiographs is its capacity to
obtain precise dimensions of an impacted tooth, which aids in estimating and
creating the necessary space to accommodate the tooth within the arch

Presentation title 47
  Fabrication of custom orthodontic appliances
• Ye et al., 2011;The fabrication of custom lingual orthodontic
appliances has been demonstrated using CBCT image data with
existing technology to virtually plan a patient’s treatment and the
manufacturing of custom appliances with 3D printing technology

• Larson, 2012;Such advances appear to be rapid, and they also

promise efficient and effective patient-specific treatments.
Correspondingly, Orametrix (Richardson, TX) is a company that has
been using CBCT technology for the last several years to provide the
data necessary for planning and executing technology-assisted
treatment through its SureSmile system

Presentation title 48
  8. Application of CBCT in assessing treatment progress and outcome:

• Dentofacial orthopedics
• Cevidanes et al. (2009) previously investigated the possibility of using CBCT
scans for evaluating treatment outcomes for Class III growing patients that
were treated with maxillary protraction using Class III inter-arch elastics
attached to mini-plates.
• They found that 3D overlays of superimposed models and 3D color coded
displacement maps provided visual and quantitative assessments of growth
and treatment changes.
• CBCT scans were able to identify maxillary and mandibular positional
changes and bone remodeling relative to the anterior cranial fossa.

Presentation title 49
 8.2. Orthognathic surgery superimposition

• Swennen et al.2009; recommended the following three-stage sequence for

imaging when evaluating surgical treatment outcomes using CBCT:
•Stage 1 (3–6 weeks post-operatively): imaging is used to verify the transfer
of bony parts. This time frame circumvents post-operative soft tissue swelling
which might interfere in occlusion and is prior to bony consolidation, thereby
providing proper visualization of osteotomy lines.
•Stage 2 (6 months to 1 year post-operatively: imaging at this stage
evaluates the soft tissue response and should preferably occur after the
removal of orthodontic brackets.
•Stage 3 (2 years or more post-operatively): this imaging is used to evaluate
long-term changes in surgical treatment.

Presentation title 50
51
 Application of CBCT in risk assessment:

 Investigation of orthodontic-associated sensory disturbances

• Sensory disturbances of the lower lip and chin area are commonly
reported after orthognathic surgery, after dentoalveolar surgery following
endodontic treatment, or following removal of the mandibular third molars.
In contrast, reports of sensory disturbances occurring secondary to
regular orthodontic treatment are extremely

• Chana et al. (2013) of orthodontic treatment-induced transient mental

nerve paresthesia demonstrated the importance of CBCT scans as the
sole aid in obtaining a definitive diagnosis of this clinical condition.
  Assessment of orthodontics-induced root resorption and periodontal tissues
• Sherrard et al., 2010 CBCT can potentially provide improved visualization of
roots, thereby making it a valuable method for evaluating pre-orthodontic or
post-orthodontic root resorption. Moreover, CBCT has been found to be
comparable to periapical radiography for surveys of root and tooth length
• CBCT is also a good method for assessing alveolar bone height, yet is
associated with a high number of false-positives in the detection of
fenestrations. Thus, caution must be used when gauging these types of defects
on CBCT images. 
• Misch et al. (2006) reported that CBCT imaging provides a significant
advantage over conventional radiographs for periodontal assessment since it
allows buccal and lingual defects to be measured, as well as interproximal
defects.

Presentation title 53
 • Dudic et al. (2009) compared the efficacy of orthopantograms versus
high-resolution CBCT scans in evaluating and estimating apical root
resorption secondary to orthodontic treatment.
• They found that the CBCT scans were useful diagnostic tools for
making a decision whether orthodontic treatment should be continued
or modified when orthodontic-induced root resorption is detected.

Presentation title 54
 9.3. Post treatment TMD
• By providing concurrent visualization of TMJs and maxillomandibular spatial
relationships and occlusion, CBCT images provide clinicians with the
opportunity to visualize and measure the local and regional effects associated
with TMJ abnormalities.
• Ferreira et al., 2009; cases involving centric occlusion versus centric relation
(CO/CR) discrepancies, unilateral Class II malocclusions, or a retrognathic
mandible may involve displacement of the TMJ in CO versus CR, and
additional diagnostic information derived from CBCT scans would be
beneficial in these cases

 Supplementary findings, overlooked findings, and medico-legal

implications
• Cha et al., 2007;The frequency of supplementary findings detected in
CBCT images, aside from the primary goal of the scans, has been
reported to be as high as 25%
Presentation title 55
  CBCT scans enable clinicians to mirror the normal side onto the
discrepant side to simulate and visualise the desired result and
plan surgery to facilitate correction.

 The mirroring technique is applied only after virtual correction of

positional asymmetry of the mandible.
 Pre-surgical models, in grey and white, of a patient with right hemi-
mandibular hypertrophy.
 Virtually simulated correction of mandibular yaw and roll is shown in
purple. In the virtual simulation, the mandible was reoriented with
the left condyle as the centre of rotation before mirroring to correct
asymmetrical mandibular yaw and roll, to place the chin in a
clinically acceptable location while preserving the facial width.

Presentation title 56
  The mandible was rotated 6 degrees counterclockwise in the frontal plane
and 5 degrees clockwise in the axial plane.
 After the virtual correction of yaw and roll of the mandible, the teal model
is the mirror model using the mid-sagittal plane.
 Note the overlays between the purple/grey and teal/grey models to help
plan surgical displacements. Images courtesy Dr. Lucia H.S. Cevidanes

Presentation title 57
 ASSESSMENT OF TREATMENT OUTCOMES:

CBCT is now considered as a tool for determining treatment outcomes in

patients undergoing :

Maxillary expansion

Patients after alveolar bone graft placement

Treated cleft lip/palate patients

Those who underwent orthopaedic corrections

Those who underwent orthognathic surgery.

Presentation title 58
 van Bunningen 2022; conducted a study to analyze differences in variation of
orthodontic diagnostic measurements on lateral cephalograms reconstructed
from ultra low dose-low dose (ULD-LD) cone beam computed tomography
(CBCT) scans (RLC) as compared to variation of measurements on standard
lateral cephalograms (SLC), and to determine if it is justifiable to replace a
traditional orthodontic image set for an ULD-LD CBCT with a reconstructed
lateral cephalogram
Result: Based on the lower radiation dose and the small differences in variation
in cephalometric measurements on reconstructed LC compared to standard
dose LC, ULD-LD CBCT with reconstructed LC should be considered for ortho-
dontic diagnostic purposes.

van Bunningen, R.H., Dijkstra, P.U., Dieters, A. et al. Precision of orthodontic cephalometric
measurements on ultra low dose-low dose CBCT reconstructed cephalograms. Clin Oral Invest 26,
1543–1550 (2022). https://doi.org/10.1007/s00784-021-04127-9
Presentation title 59
 • Assessment of treatment outcomes CBCT is now considered as a tool for
determining treatment outcomes in patients undergoing maxillary expansion;
patients after alveolar bone graft placement and treated cleft lip/palate patients;
and those who underwent orthopaedic corrections and orthognathic surgery.

• Repeated CBCT acquisitions for assessment of treatment progress and/or

outcomes raise additional concerns of increased radiation exposure to
patients, and the routine clinical use of multiple CBCT is controversial

Presentation title 60
  RADIATION SAFETY :

 CBCT Published reports indicate that the effective dose varies for
various full FOV CBCT devices, ranging from 36.5 to 182.1 µSv,
depending on the type and model of CBCT equipment and FOV
selected.
 Comparing these doses with multiples of a single panoramic dose or
background equivalent radiation dose, CBCT provides an equivalent
patient radiation dose of 5–7.4 times that of a single film-based
panoramic X-ray, or 3–48 days of background radiation.


Presentation title 61
 Acc to Govt. of India, Atomic board of energy.

Presentation title 63
 LIMITATIONS OF CBCT:

• CBCT scanners have higher cost and limited accessibility when

compared to conventional radiographic imaging techniques.
• Inherent artifacts that may be present in CBCT images include beam
hardening .
• CBCT images can display noise, cupping artifacts, or scatter .
• It is possible to acquire CBCT during orthodontic treatment, but the
images may include beam hardening and scatter around
orthodontic appliances. (metal artifacts)
• Other limitations may include motion artifacts, especially in young
orthodontic patients who are more likely to move during long CBCT
scans .

Presentation title 64
 LIMITATIONS OF CBCT:

• The evaluation of soft tissue is not excellent using CBCT imaging due to
poor soft tissue resolution.
• Presentation of CBCT images through volume rendering or Maximum
Intensity Projection (MIP) may increase the likelihood of false findings.
• These illustrations are created based on sophisticated software
algorithms, and therefore they may not always be accurate.
• Therefore, evaluation of the volume through axial, sagittal, and coronal
views is required.
• These limitations inherent to CBCT should be considered because they
can affect the image quality.

Presentation title 65
 IMAGE ARTEFACTS:

 An image artefact may be defined as a visualised structure in the

reconstructed data that is not present in the object under investigation.
 Artefacts relating to CBCT can be categorised into three groups:
1. Physics-based
2. Patient-based
3. Scanner-based

• FIGURE : (A) Beam hardening artefact (due to the presence of metal with low
atomic number the lower energy radiations are absorbed leaving the higher energy
photons (harder)). This can be seen as hypodense streaks.
• (B) Proton starvation artefact (alternated hypo/hyperdense streaks, arousing from
Presentation title 66
metal with high atomic number due to complete absorption of photons).
  RADIATION GUIDELINES :

 The radiation dose of CBCT imaging is influenced by several factors

such as kVp, mAs, FOV, voxel size, scanning time, receptor sensitivity,
number and degree of rotations, collimators, and filters used.
 Each types of CBCT scanners uses a different kind of geometries and
protocol for scanning purpose, therefore the amount of radiation
exposure also varies.
 Although radiation dose of CBCT scanning is lower than MDCT, using
CBCT as a screening purpose in orthodontics is strictly contraindicated.

Presentation title 67
  Clinicians should strictly adhere to the ALARA (as low as reasonably
achievable) principle while prescribing CBCT to a patient.
 The Image Gently Campaign suggested six-step plan to minimize
radiation exposure to children. It strongly advises the use of CBCT
imaging on an individual basis with clinical justification and only when
the conventional low dose radiographs are unable to provide sufficient
information (Fig. 29.16).
 International guidelines such as SEDENTEXCT , American guidelines
are available and should be followed for the use of CBCT imaging in
orthodontics

Presentation title 68
 • The Swiss Association of Dentomaxillofacial Radiology recommends
that CBCT in orthodontics be used only if it brings additional
information compared to conventional two-dimensional imaging .
• The DIMITRA (Dentomaxillofacial paediatric imaging: an investigation
towards low-dose radiation induced risks),
• A European multicenter and a multidisciplinary project, released a
position statement encouraging practitioners to follow the principle of
ALADAIP—keeping radiation As Low as Diagnostically Acceptable
being Indication-oriented and Patient-specific.
• The clinically relevant ALADAIP directive is especially relevant for
young orthodontic patients.

Presentation title 69
 CONCLUSION:

• Generally, the risks of CBCT in orthodontics are outweighed by the benefits.

• CBCT is justified only when it brings a benefit to the patient or
changes the outcome of the orthodontic treatment when compared with
conventional imaging techniques.
• In these selected cases, the recommendation is to use the smallest
possible FOV, with the lowest radiation exposure.
• The clinician should be able to justify the reason for CBCT acquisition.
• Prescribing CBCT regularly for all patients increases the collective dose for
orthodontic patients and is not consistent with international guidelines for an
appropriate use of ionizing radiation in orthodontics.
• Consequently, CBCT in orthodontics requires judicious and sound
clinical judgement.

Presentation title 71
 REFERENCES:
• Om P Karbandha;Textbook of Diagnosis and Management of Malocclusion
and Dentofacial Deformities in Orthodontics,3rd edition,

• Sunil D Kapila,Textbook of Cone Beam Computed Tomography in

Orthodontics,indications ,insights,and innovations,

• Machado G. L. (2015). CBCT imaging - A boon to orthodontics. The Saudi

dental journal, 27(1), 12–21.

• van Bunningen, R.H., Dijkstra, P.U., Dieters, A. et al. Precision of

orthodontic cephalometric measurements on ultra low dose-low dose CBCT
reconstructed cephalograms. Clin Oral Invest 26, 1543–1550 (2022).
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