[Oradlist] Use of CBCT in Ortho

[Johan Aps]

Dear Colleagues, 

I tried to wait untill more came up, but as you can see I couldn't  ;-)

What I haven't read so far in these communications is the radiation dose related to the the age of the patients. One should never forget that most orthodontic treatments are performed in a young population (11-14y olds) and that using ionizing radiation may be more harmfull than usefull. 
We have to be carefull about this issue at all times. 
A CBCT image for orthodontic treatment planning does not make any sense to me! CBCT is not a screening tool and its use should be limited, as is the case with 2D imaging modalities. Also bare in mind that it is cummulative dose that, at the end, will be important. Taking into account all the dental exposures a patient receives, the stochastic effects may be considerable for some patients! Especially because many of them were exposed at young age. 

It is clear that we all have our opinions about it, but it is important to discuss these differences among colleagues, so we, as a profession, can come out with a "supported" guideline for the use of a certain radiological technique. If there are no guidelines and no discussions, chances are high that overuse will be the rule and economical issues become more important than what should be important, namely the best medical care we can provide to our patients, without causing them any harm (Hyppocrates oath).

I hope not to be lynched at the next radiology meeting, but I felt I had to react (again).

Kind regards from Belgium,

Johan 
______________________________________________________________________
Prof. Dr. Johan K.M. Aps 
(DDS, MSc Paed. Dent. & Special Care, MSc DMFR (King's College London, UK), PhD)
Head of Dental & Maxillofacial Radiology
Coordinator Postgraduate Teaching in Dentistry Ghent University (accreditation system Belgium)
Senior Clinical Consultant Ghent University Hospital, Dental School
UZG, P8, Dental School, De Pintelaan 185, 9000 Gent, Belgium
tel; + 32 9 332 5102
fax; +32 9 332 3851
secretary; +32 9 332 3857
  ----- Original Message ----- 
  From: Shdesch at aol.com 
  To: oradlist at lists.ucla.edu 
  Sent: Thursday, October 29, 2009 9:27 AM
  Subject: Re: [Oradlist] Use of CBCT in Ortho


  Dr. Farman,

  There are two issues that I feel should be addressed in this activity to develop guidelines for diagnostic imaging in Orthodontics:

  1. The two dozen or so standard orthodontic analysis that have been used for years to project growth during orthodontic treatment are all based on 2D imaging.  Does this now translate in a reliable form when using CBCT and 3D imaging?

  2.  Also, the volume needed for orthodontic information with CBCT is very large.  Caution should be addressed with large volume and the liability for the information in these scans.

  These issues might already have been addressed, if not, they should be considered.

  What is your opinion on this?

  Steve Desch

  In a message dated 10/28/2009 8:06:10 P.M. Eastern Daylight Time, agfarm01 at louisville.edu writes:
    One of my first actions as the new President of AAOMR has been to contact AAO to set up a joint activity to develop guidelines for use of diagnostic imaging in Orthodontics. The AAO responded positively to this joint initiative. Dr. Mansur Ahmad is the newly appointed AAOMR Position Paper Editor and will be setting up the task group for the AAOMR component of this activity. Use of CBCT in Ortho will be one of the issues to be addressed. The AAOMR anticipates several new position papers on a variety of topics will be developed and that existing guidelines will be updated. These activities have been designated as very high priority by the AAOOM Executive Council.

    Allan G. Farman, 
    President AAOMR (2009-11)

    Allan G. Farman, BDS, PhD, MBA, DSc, Diplomate ABOMR

    Prof. Radiology & Imaging Science
    Univ. Louisville School of Dentistry: SUHD
    501 South Preston Street,
    Louisville, Kentucky 40292, USA 

    Tel: +1(502) 852.1241
    Fax: +1(502)852.1626


    >>> "Friedland, Bernard" <bernard_friedland at hms.harvard.edu> 10/28/2009 10:51 AM >>>
    I'm sure many of you have seen the attached (it's a give-and-take from the March issue of Am J Orthod Dentofacial Orthop). For those of you who haven't read it, I thought you would find it interesting.


    Bernard Friedland, B.Ch.D., MSc., J.D.
    Department of Oral Medicine Infection & Immunity
    Harvard School of Dental Medicine
    188 Longwood Avenue
    Boston, MA 02115
    Tel: 617-432-4295
    Fax: 617-432-2463
    bernard_friedland at hms.harvard.edu


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