[Oradlist] Fw: Guidelines for CT/CBCT
shdesch at aol.com
shdesch at aol.com
Sat Jan 9 06:26:06 PST 2010
Hello All,
I read all the posts that appear on this board. Being in complex imaging
for 30 years, first panoramic and periapical, tomography and now CBCT I've
heard all the objections from clinicians. The best one is they hold up
their two fingers, as if they were measuring the thickness of bone with
them,and say" I know what I'm feeling and seeing and if there is enough bone for
an implant." Maybe so....., I've never placed one. What I do see is that
guidelines are needed for this technology. Users tend to think that more
is better. Taking a full volume for every records patient in ortho is way
too much information, especially if you want only one slice for the ceph and
one slice for the pan. What about the rest of the volume?
Having these data sets read by you guys is the right thing to do for the
patient's sake.
Interestingly enough, when asked if the scans are sent out to be read by a
professional, the response is,,,why?
I too have kept out of the discussion mainly because I subscribe to this
list to learn and contribute in anyway possible to the profession.
One question to Axel:
May I borrow this?
Question: What do you call people who use only periapicals and
pantomographs for their implant planing?
Answer: Defendants
Steve Desch
In a message dated 1/8/2010 2:32:48 P.M. Eastern Standard Time,
axel-ruprecht at uiowa.edu writes:
Hello
Like Johan, I have kept out of this discussion, and like him, I am
concerned about overuse of CBCT. Also, like him, I am on Allan's side of this
argument. Unless you have done many CBCTs, and CTs before that, and tomographs
before that, you really do not have much of a concept of what the
cross-sections of bones in the jaws are really shaped like. And, like Allan, I have
seen implants in places where one can but shake one's head. Usually these
come from surgeons who have been asked by the original implant placer to
help rescue the case.
We have riddle around here, mainly from me.
Question: What do you call people who use only periapicals and
pantomographs for their implant planing?
Answer: Defendants.
I shall also sign off here from snowy Iowa, where the snow is between 1
foot and 6 feet, (30 cm and 180 cm) and the temperature is warmer today,
around 0'F (~-15'C). Schools are closed. Many highways impassable, and the sun
is shining brightly, waiting for the next storm to arrive.
Rgds
Axel
Axel Ruprecht D.D.S., M.Sc.D., F.R.C.D.(C)
Diplomate of the American Board of Oral and Maxillofacial Radiology
Gilbert E. Lilly Professor of Diagnostic Sciences
Professor and Director of Oral and Maxillofacial Radiology
Director of Advanced Education in Oral and Maxillofacial Radiology
Professor of Radiology
Professor of Anatomy and Cell Biology
http://ruprecht.radiology.uiowa.edu
319-335-7341
-----Original Message-----
From: oradlist-bounces at lists.ucla.edu
[mailto:oradlist-bounces at lists.ucla.edu] On Behalf Of Johan Aps
Sent: Friday, January 08, 2010 12:44 PM
To: Oral Radiology Discussion Group
Subject: Re: [Oradlist] Fw: Guidelines for CT/CBCT
Dear Friends,
I kept quiet for some time around this discussion, but I can't anymore...
;-)
I agree 100% with Allan's arguments (for those who know me...that's rare
as
I usually have some comments on how some of us overuse CBCT - sorry if my
self-sarcasm doesn't suit you-)
At our university, the implantologist in charge hardly ever asks for a 3D
image. He also claims implants can be easily placed in many cases. He
"relies" on his experience.
His assistants, younger and maybe more keen on new technology and perhaps
also more afraid of making mistakes as they have far more less experience
than the 'guru', do ask more often for 3D imaging.
I have seen several cases so far, in which on a 2D image there seemed to
be
enough bone, but where the patient came back complaining about pain,
discomfort and so on. Implants perforating the lingual or buccal cortex,
implants in or too close to the inferior alveolar canal -also in the
incisor
area-,...
I recognize the situation Ann Wenzel described, where experienced
implantologists think they can "see" enough on a 2D image. And also here
in
Ghent, our 'guru' is encouraging undergraduate and postgraduate students
to
do the same.
Luckily for the patients, the students (who are also taught by me) do not
always agree and ask for 3D imaging right away.
So, Allan does not have to fear that the Europeans will not accept
"change"....on the contrary.
But I also understand, that if one has no access to CBCT or Dentascan or
other ways of getting cross sectional images, one has to rely on the 2D
information alone, with all disadvantages and risks involved. But this
should not be an argument not to believe one does not really need 3D
information...
I wish you all a nice weekend (7.40 PM - I am going home now....)
Greetings from a snow covered and cold 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: "Allan G Farman" <agfarm01 at louisville.edu>
To: "Oral Radiology Discussion Group" <oradlist at lists.ucla.edu>
Sent: Friday, January 08, 2010 6:52 PM
Subject: Re: [Oradlist] Fw: Guidelines for CT/CBCT
>I continue to disagree with these assertions. A panoramic radiograph or
> periapical is totally unacceptable as it merely provides a 2-D view. I
> will concur that there might be some instances where no radiographs are
> needed whatsoever. The cross-sectional anatomy is needed and we have
> the ability to create this with comparatively low dose in folk who are
> usually those least affected by radiation - namely the elderly. Yes,
> implants were placed prior to 3D imaging availability... but even then
> linear tomography was possible. Viewing where implants that were
> apparently acceptable on panoramic or periapical radiographs are
> actually placed shows that many are marginal at best in 3D. I have seen
> too many cases of fractured jaw, penetrated nerve canals, sectioning
> roots of of an adjacent tooth, and even implants resting on or
> penetrating the inferior conchae, or severasl mm past the lingual or
> buccal plate of the mandible to accept that we should stick to imaging
> procedures that are now outmoded for the purpose of implant placement
> planning. The anterior mandible can be much narrower facio-lingually
> than would ever be GUESSED on 2D images. I have also seen maxillary
> sinus complications from membranes being raised above the sinus ostea.
>
> It has been my experience that clinicians who place a good number of
> dental implants and previously used 2D imaging start slowly with CBCT
> for implants, but soon find that there are no "simple" cases and that
> what they had previously felt satisfactory was far from optimal. Such
> clinicians usually quickly transfer the rest of their implant cases from
> 2D to 3D. There are few Luddites against change, except Perhaps (?) the
> European OM Radiology Community.
>
> AGF
>
> 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
>
>
>>>> Leif Kullman <leikul at yahoo.com> 01/08/2010 12:04 PM >>>
> Dear Oradlisters
> I also believe there are implant cases without need for tomography, not
> at least in the anterior area of the upper and lower jaw. Intraoral and
> panoramic radiographs can be enough.
> We can use different other tools in such cases, at least in the
> clinically simple cases: Like *poor man*s tomography* using our
> fingers to get knowledge about the buccal-lingual dimension and
> reducting estimated soft tissue thickness or we can use an
> *osteometer* see my attachment!
> A useful tool for measuring is also a metallic grid (1mm between each
> line), put in close relationship to the film/sensor during exposure, see
> my other attachments.
> Best regardsLeif
>
> Leif Kullman DDS, PhD
> Assoc. Professor
> Oral and Maxillofacial Radiology
> Faculty of Dentistry
> Kuwait University
>
> --- On Fri, 1/8/10, Ann Wenzel <awenzel at odont.au.dk> wrote:
>
>
> From: Ann Wenzel <awenzel at odont.au.dk>
> Subject: [Oradlist] Fw: Guidelines for CT/CBCT
> To: "Oral Radiology Discussion Group" <oradlist at lists.ucla.edu>
> Date: Friday, January 8, 2010, 5:37 AM
>
>
>
>
>
>
> ----- Original Message -----
> From: Ann Wenzel
> To: SDGIMPLANT at aol.com
> Sent: Friday, January 08, 2010 11:10 AM
> Subject: Re: [Oradlist] Guidelines for CT/CBCT
>
>
> hello all
> It would be really interesting if surgeons would take part in this
> discussion.
> What about all of you in the Oradlist who are also surgeons? Ralf
> Schulze and others?
>
> One of the surgeons here is now 60, and during approximately 30 years,
> he has inserted 20700 implants.
> He is one of the few who has kept a very detailed record on all events
> before, during and after the operation.
> He has had to give up on five patients in whom no implant could be
> installed after he had opened and displayed the bone. These five could
> have been avoided if CBCT was used. Some of the patients had a more
> comprehensive operation than expected with additional surgical
> procedures.These could have been warned of an increased operation time
> a
> nd the surgeon would have been more prepared if CBCT had been
> performed. All patients are however told before the operation that
> additional procedures may be needed.
>
> When balancing the weight, it is not only dose, but surely also all
> types of resources used for CBCT that should be considered.We are trying
> to analyze the data from that study, but even though the data are
> sampled in a standardized way, the study is stll retrospective.
> We are to do prospective, randomized trials to provide the evidence
> needed. And not only in one country. I am sure we agree on this. So why
> do we see so few RCTs in our literature?
>
> We will start a RCT on 3. molars; panoramic vs. CBCT. Maybe you will
> find this "alarming" or even unethical. In my opinion it is unethical
> not to do such studies - and the 3 surgeons involved have no problems in
> this since they have until now removed thousands of 3. molars based on
> panoramic images alone.
> We hope soon to be able to start a RCT on implants in the same way.
>
> And try to read the literature in e.g. Clin Oral Implant Res - in the
> RCTs on immediate implant placement, CBCT is never used, merely
> periapical radiography. To me this is both logical and ethical.
>
> The implants inserted by students in supervision of surgeons at my
> place are of course in very selected patients. No evidence can be
> deducted from this.
>
>
> all the best
> Ann
>
>
>
>
> ----- Original Message -----
>
> From: SDGIMPLANT at aol.com
> To: awenzel at odont.au.dk
> Cc: oradlist at lists.ucla.edu
> Sent: Thursday, January 07, 2010 11:55 PM
> Subject: Re: [Oradlist] Guidelines for CT/CBCT
>
>
> Hello Ann -
>
> Thank you for your thoughts. While I certainly understand your
> suggestion, I agree with Allan when he suggests that CBCT is important
> as a diagnostic tool for dental implant placement - due to the
> incredible variation in bone and root anatomy and clinical presentation.
>
>
> That stated, you are correct that the person placing the implant should
> have good training, and experience. As it is important to handle all
> situations which may arise, with a proper clinical / surgical skill set,
> wouldn't you agree that it is better to have an understanding of the
> anatomy prior to the scalpel ever touching the patient? In this way, we
> can plan ahead, and have everything ready, without the guesswork, and
> full knowledge and disclosure to the patient of what will be done. In
> my opinion, CT and CBCT imaging helps clinicians to appreciate these
> anatomical variations, as each patient is unique, allowing us to have a
> sound basis for our decision-making process.
>
> I, and perhaps many on this list, can cite a myriad of what appeared to
> be simple, single tooth cases - immediate extractions even, where the
> bone topography was completely different that what appeared on clinical
> exam, panoramic or periapical radiograph. In fact sometimes the single
> tooth application presents the most challenge - especially in the
> esthetic zone with convergent roots, or facial concavities.
>
> Perhaps discussions like this help us to understand what type of
> guidelines should be recommended - based upon sound clinical judgement
> which relates to the treatment at hand. The end result should be a more
> favorable outcome for the patient, the surgeon, and the restorative
> dentist.
>
> Best regards to Denmark!
>
> Scott
> ________________________________________________________
> Scott D. Ganz, DMD
> Prosthodontics, Maxillofacial Prosthetics & Implant Dentistry
> President Computer Aided Implantology Academy: CAI Academy
>
> 158 Linwood Plaza - Suite 204 Fort Lee, NJ 07024
> TEL:
>
>
>
>
> _______________________________________________
> Oradlist mailing list
> Oradlist at lists.ucla.edu
> http://lists.ucla.edu/cgi-bin/mailman/listinfo/oradlist
>
_______________________________________________
Oradlist mailing list
Oradlist at lists.ucla.edu
http://lists.ucla.edu/cgi-bin/mailman/listinfo/oradlist
_______________________________________________
Oradlist mailing list
Oradlist at lists.ucla.edu
http://lists.ucla.edu/cgi-bin/mailman/listinfo/oradlist
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://lists.ucla.edu/cgi-bin/mailman/private/oradlist/attachments/20100109/8d364a32/attachment-0001.htm>
More information about the Oradlist
mailing list