• CONVENTIONAL TOMOGRAPHY

• COMPUTED TOMOGRAPHY

• CONE-BEAM COMPUTED TOMOGRAPHY

• MAGNETIC RESONANCE IMAGING

• Computed tomography has been available, its application in
dentistry has been limited because of

• Dose
• Cost
• Access
• Scan time
• Claustrophobia
• Cone -beam computed tomography (CBCT) is a new imaging
technique that generates 3-D images at

• Lesser time

• Lower cost

• Absorbed dose

compared with conventional computed tomography (CT).

• First Cone Beam CT (CBCT) scanner was built by Robles RA in
1982 for angiography purpose.

• This imaging technique is based on a cone-shaped X-ray beam

centered on a 2-D detector that performs one rotation around
the object, producing a series of 2-D images.

• CBCT was introduced in oral and maxillofacial imaging

between the years of 1998 and 1999
KODAK

I-CAT

3D ACCUITOMO
NEWTOM-5G
• In the broadest definition of the term, "3D" would describe any
object that occurs on a three-axis
• X ,Y AND THE Z AXIS

IVertical
• The presence or absence of cortical bone around the mandibular
canal, the bucco lingual relationship between the mandibular canal
and the lower third molar, and the detailed shape of the root might
not be clearly evident on a panoramic radiography

• Localization of inferior alveolar nerve

• Provides better image quality of teeth and their surrounding

structures

• 2D or OPG radiograph cannot show the exact location of the

anatomical structures
• LABIOLINGUAL:- Anterior
region
• MESIODISTAL:- Posterior
region
• SUPERO-INFERIOR:- Both
anteriorly & posteriorly
• MESIO-DISTAL:- Anterior region
• BUCCO-LINGUAL:- Posterior
region
• SUPERO-INFERIOR:- Both
anteriorly & posteriorly
• MESIO-DISTAL :- Both anteriorly &
posteriorly
• LABIO-LINGUAL/BUCCO-LINGUAL:-
Both anteriorly & posteriorly
• ROTATE THE SECTIONS
• SKIMMING CAN ALSO BE DONE
• Evaluation of odontogenic lesions
• Proximity of an impacted mandibular third molar to the
inferior alveolar canal
• Endodontic evaluation
• Trauma (suspected root fracture)
• Implant placement
• Fabrication of surgical stents
• Invasion of oral carcinoma
• Assessment of maxillary sinus and airways
• Orthodontic traction of an impacted canine into
normal occlusion
• Orthodontic / surgical management of complex
skeletal abnormality
• CBCT has benefits for patients with 3D deformities,
such as craniofacial anomalies, orofacial clefts or
orthognathic cases
• Evaluation of the temporomandibular joints (TMJs)
• FORAMEN: variations in number position, size should be
considered because any damage to this during administration
of LA and implant placement can cause neurovascular damage
and sensory defects
• COURSE OF NERVES:-
• Variation in the course, the shape, curve, and direction of the
nerve and its proximity to the tooth especially during 3rd
molar extraction and implant placement.
• Any injury to nerve can cause sensory changes and sometimes
excessive bleeding
• Diagnostic imaging of lower third molars should give
information not only about the tooth but also about the
surrounding bone, inferior alveolar nerve (IAN) and the lower
second molar .
• Three-rooted lower third molars was much higher when
estimated using CBCT than panoramic radiography
• The risk of nerve damage increases when the roots of the tooth
and the IAN are in direct contact
• Cross section, panoramic view, multiplanar views, volume renderings

• For implant planning purposes, the cross section is the primary

diagnostic image used for the assessment of bucco-lingual width of
bone
• Main goal of implant placement is to adequately position the
implant within the bone offering the best function without surgical
complications and/or esthetic compromise

• Accurate measurements to avoid damage to vital structures.

• Preoperative assessment of bone quality and bone quantity in order

to reduce implant failure
• For post-treatment evaluation and to assess the success of bone
grafts

• Assessment of the vital structure in their vicinity to avoid possible

complications like nerve injury, resulting in hemorrhage and
sensory problems
• Detection of apical lesions

• Detecting fractured roots( Vertical and horizontal)

• Inflammatory root resorption

• Determine root morphology, the number of roots, canals and

lateral/accessory canals, as well as to establishing the working
length and angulations of roots and canals

• Disadvantages of CBCT compared with periapical radiography:

the technique is expensive, higher radiation dose and limited
availability, Quality of root canal fills cannot be assessed
• Facial asymmetry analysis
• Orthodontic assessment and cephalometric analysis
• Facial soft tissue analysis
• Presence of any impacted teeth
• Assessment of facial growth, age, airway function and
disturbances in tooth eruption
• Assessment of the proximity to vital structures that may
interfere with orthodontic treatment
• Assess the bone density before, during and after treatment
• To assess individual
teeth, such as impacted
teeth, root morphology,
supernumeraries.
• Sites for placement of
dental implants, and
temporary anchorage
devices
• Provides single jaw anatomy

• Maxillo mandibular FOV gives the

clinician an understanding of two-
jaw anatomy, temporo mandibular
joint (TMJ), and occlusion

• Used for additional information on

occlusal relationships, facial
asymmetries, and bilateral TMJ
evaluations
• include the cranium, cranial base, and all
associated structures.

• Help clinicians to visualize relationships

between skeletal bases, between teeth and
skeletal bases, and significant anomalies in
patients requiring orthognathic surgery or
those with craniofacial anomalies orthodontic
analysis to adequately diagnose the skeletal
jaw relationship

• Identification of Class II and Class III skeletal

malocclusions and increased or decreased
vertical facial height and asymmetry
• Airway volume can be extracted in sleep apnea patients by
evaluating the airway, which can be “traced” through the hard
tissue boundaries.

• This boundary is often composed of the cranial base superiorly,

the spine posteriorly, nasal septum and jaws antero superiorly,
and anteriorly the hyoid bone.

• The soft tissue boundaries are soft palate, epiglottis, and

tongue.
Volumetric air way analysis
• Periapical pathology
• Fractures of teeth
• Determine the extent and condition of the internal structure of
pathologic lesions in detail and establish the relationship
between adjacent structures
CORONAL SAGITAL
 Sagittal

Coronal Axial
• CBCT is superior to panoramic radiography as condylar and
coronoid fractures and the anterior part of the mandible were
more difficult to detect due to superimposition
• CBCT have a high capacity for detection of mandibular bone
tissue invasion in patients
• Deviated nasal septum

• Evaluate the paranasal sinuses

• Fractures of orbital wall, zygomaic arch

• Pathologies affecting the sinuses

• CBCT can define the true position of the condyle in the fossa

• With its accuracy, measurements of the cortical thickness of roof

of the glenoid fossa can be done easily

• CBCT is the imaging device of choice in cases of trauma, pain,

dysfunction, fibro-osseous ankylosis and in detecting condylar
cortical erosion and cysts

• TMJ conditions include developmental disorders such as condylar

hyperplasia, hypoplasia, or aplasia, and patients with moderate
to severe arthritic degeneration.
Left Right
CORONAL
• Assessment of furcation involvements
• Can be used to detect buccal and lingual defects
• Measurement of intra-bony defects
• Assessment of dehiscence, fenestration defects and periodontal
cysts
• Evaluating the outcome of regenerative periodonal therapy
SAGITAL

RECONSTRUCTED

AXIAL
• In 2D since there is magnification and
superimposition ,CBCT can be considered
as a potential tool for age estimation in
forensic dentistry
• Rapid scan time -12-21 secs
• Image accuracy(1:1ratio)
• CBCT units provide choices for field of view (FOV),
which allows irradiation of particular area of
interest to dentists, while limiting irradiation of
other tissues
• Reduced patient radiation dose compared to
conventional CT
• Interactive display modes(implant window,TMJ)
which are user friendly
• Detection and evaluation of soft tissue lesions are not as clear as
desired

• Limited contrast resolution, mainly due to relatively high scatter

radiation during image acquisition and inherent flat panel
detector related artifacts.

• Image artifact such as streaking, shading, rings and distortion

which further gets enhanced if patient has metallic restorations or
metallic objects in the area of interest.
• Though CBCT has emerged as a 3D imaging modality with
features which can refine the diagnostic capability and can
improvize the treatment options its use should be optimised to
avoid unnecessary exposure to patient----
• Further research is required to explore the potential benefits of
CBCT technology to expand the domain where it can be further
used