[Oradlist] Input for maxillary implant imaging request

[Paquette Manon]

Dear Elaine and colleagues, 
 
I have experienced the same situation a month ago as well as today, as a referring dentist asked me to call him back pertaining to two scans of the maxilla that I protocoled using an FOV of 6 cm (mid-sinus region approximately) instead of an 8 or 10 cm to cover the requested supra-orbital region.  I received the same explanation given to Elaine.  My answer to these referring dentists was to explain how the different sinuses are connected and drain and as Elaine puts it, determine the impact of sinus pathology on pre-surgical implant planning.  Besides CBCT, I have a small private practice in a medical imaging center with MDCT, and every request is protocoled by a radiologist, the use or not of contrast, the area to be irradiated, the proper exam according to the reason for consultation, signs and symptoms.  This is what we were trained for and this should also be the approach in oral and maxillofacial radiology.  When in doubt, I call the referring dentist.  
 
Manon Paquette
Montreal, Canada
 

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From: oradlist-bounces at lists.ucla.edu on behalf of eorpe at aim.com
Sent: Thu 3/26/2009 4:04 PM
To: oradlist at lists.ucla.edu
Subject: [Oradlist] Input for maxillary implant imaging request


One of my former students suddenly has started requesting that I image all implant planning cases for the maxilla superiorly to include the orbits. I have always used the approach of "as small a field of view as will encompass the region of interest".  None of my other referrers, including OMF surgeons and periodontists, have objected to this scan volume previously (I usually try to include the bottom half of the maxillary sinuses).  I assumed that this person had not independently derived the protocol, and contacted him to find out the source.  He informed me that the very well known "institute" he is studying with requires that the entire osteomeatal complex be imaged. This seems to me to violate the current guidelines our academies have published and circulated.  Furthermore this would exclude the use of moderate or limited field of view CBCT (which I prefer and recommend).  The opinion that I gave to him is that a more moderate scan would be adequate to determine whether sinus pathology will impact the treatment protocol, and if such pathology is detected it should be left to our medical colleagues to determine whether additional imagin g is ne eded. 

Has any one else encountered this?  Any comments on how to proceed?
 
Elaine Orpe
Private practice, Vancouver Canada

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