[Oradlist] Guidelines for CT/CBCT

[Ruprecht, Axel]

From: oradlist-bounces at lists.ucla.edu [mailto:oradlist-bounces at lists.ucla.edu] On Behalf Of asma al-ekrish
Sent: Thursday, January 14, 2010 3:48 AM
To: Oral Radiology Discussion Group
Subject: Re: [Oradlist] Guidelines for CT/CBCT

Greetings all.
      I'm very pleased to see this spirited discussion on the need for CBCT imaging prior to implant placement.
     But what has been missing from the discussion is consideration of the prosthodontic aspect. It has been my experience that prosthodontists are more keen on 3-D imaging prior to implant placement than surgeons are. And that is because they are the ones who have to deal with "successfully" placed implants in the wrong area or in a wrong orientation. 3-D imaging is important not just because of the actual placement of the implant but also for the planning, especially in areas of multiple missing teeth. Prosthodontists want to know the areas of the ridge which may support an appropriately sized implant at a suitable angulation and in accordance with the prosthodontic need of the patient. Having cross-sectional views of the jaws allows us to inform them of the feasibility of their treatment plan, so they may modify it accordingly.
     I also agree with Dr. Farman that 3-D imaging is very important regardless of how many implants will be placed and regardless of the experience of the surgeon. For, undercuts and a thin or angulated ridge don't just appear when multiple implants are to be placed, they may be present even in areas of a single missing tooth (whether anterior or posterior). Furthermore "experience" is a relative term. For, with all due respect to truly experienced surgeons, many beginners think they are "experienced" after placement of a relatively few number of implants and arrogantly assert that they only use 2-D imaging because they can feel the ridge with their fingers or view it after flap reflection. So even if we (hypothetically) agreed that experienced surgeons can get by with just 2-D imaging, where do we draw the line of who is experienced and who is not? Also, thousands of inserted implants do not necessarily mean thousands of successful therapies, whether from a surgical or prosthodontic view.
     Having said all of the above, I am also seriously concerned regarding radiation dose to patients. That is why I feel it is our obligation to work towards reducing the dose by conducting studies on our individual CBCT devices regarding the accuracy of the images obtained with dose reduction protocols and using the appropriate collimation with each individual case (and not just for implants site assessment).

--
Asma'a Al-Ekrish, MDS
Demonstrator, OMFRadiology
King Saud University
Riyadh, Saudi Arabia
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