Nội nha dựa vào hình ảnh X quang để chẩn đoán, lập kế hoạch điều trị và đánh giá quá trình lành thương. Tuy nhiên, chụp ảnh X quang thông thường có một số hạn chế được lập hồ sơ, có thể làm giảm năng suất chẩn đoán và có khả năng ảnh hưởng đến việc lập kế hoạch điều trị. Trong những năm gần đây, chụp cắt lớp vi tính chùm tia hình nón (CBCT) đã trở nên phổ biến và được sử dụng rộng rãi hơn trong mọi lĩnh vực nha khoa, bao gồm cả nội nha. CBCT khắc phục được nhiều hạn chế của chụp X quang thông thường và được chứng minh là cần thiết cho việc chẩn đoán và xử trí các vấn đề phức tạp về nội nha. Các biên tập viên của Cone Beam Computed Tomography in Endodontics đều là những người có kinh nghiệm sử dụng CBCT. Trong thực hành lâm sàng và vai trò học thuật giảng dạy, họ nhận thấy sự cần thiết của một hướng dẫn để minh họa các ứng dụng của CBCT trong nội nha bằng cách sử dụng các bằng chứng và nguyên tắc mới nhất. Mục đích của cuốn sách là hai phần; thứ nhất, cung cấp cho người đọc một tài khoản tường tận về các khía cạnh cảm xạ học của CBCT; và thứ hai, minh họa một cách toàn diện các ứng dụng của CBCT trong nội nha. Cuốn sách nhấn mạnh một thực tế rằng, vốn có trong việc sử dụng CBCT có trách nhiệm là sự hiểu biết rằng, vì CBCT có liên quan đến liều bức xạ bệnh nhân hiệu quả cao hơn so với chụp ảnh X quang thông thường, nên việc kê đơn CBCT phải được chứng minh và mức độ tiếp xúc với bức xạ liên quan được giữ nguyên. thấp nhất có thể đạt được một cách hợp lý. Cuốn sách này cung cấp cho người đọc một nền tảng vững chắc về trường nhìn nhỏ, CBCT độ phân giải cao và các ứng dụng của nó trong nội nha. Tuy nhiên, người ta không thể nhấn mạnh quá mức thực tế rằng X quang nha khoa đang liên tục phát triển. Do đó, điều cần thiết là người sử dụng CBCT phải bám sát các phát triển trong X quang nha khoa và duy trì kiến thức cốt lõi hiện thời về cả X quang nha khoa và cụ thể là CBCT.
Cone Beam Computed Tomography in Endodontics Shanon Patel · Simon Harvey · Hagay Shemesh · Conor Durack www.ajlobby.com Shanon Patel · Simon Harvey · Hagay Shemesh · Conor Durack Cone Beam Computed Tomography in Endodontics Contributors Francesca Abella Sans DDS, PhD Program Co-ordinator of Restorative Dentistry and Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain Bhavin Bhuva BDS, MFDS RCS, MClinDent, MRD RCS (Edin) Consultant in Endodontics, Endodontic Postgraduate Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK and Specialist practice, London, UK Conor Durack BDS, MFD RCSI, MClinDent, MEndo RCS (Edin) Specialist in Endodontics, Limerick, Ireland Simon C Harvey BDS, MA (MedLaw), MFDS RCS (Edin) Specialist Registrar in Dental and Maxillofacial Radiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK Shalini Kanagasingam BDS, MClinDent, MFDS RCS (Eng), MRD RCS (Edin) Head of Operative Dentistry, National University of Malaysia, Kaula Lumpur, Malaysia Shanon Patel BDS, MSc, MClinDent, FDS RCS (Edin), MRD RCS (Edin), PhD Consultant/Honorary Senior Lecturer in Endodontics, King’s College London Dental Institute, London, UK and Specialist practice, London, UK Navid Saberi BDS, MFDS RCS (Edin), MSc Private practice (limited to Endodontics), Brighton, UK Hagay Shemesh DMD, PhD Associate Professor and Chair, Division of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands Mitsuhiro Tsukiboshi DDS, PhD General Practitioner and Chairperson of Tsukiboshi Dental Clinic, Aichi, Japan and Clinical Professor, Tohoku University, Graduate School of Dentistry, Japan Cindy Verdegaal DMD Postgraduate in Endodontics, Division of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands Eric Whaites MSc, BDS, FDS RCS (Edin), FDS RCS (Eng), FRCR, DDR RCR Senior Lecturer/Honorary Consultant in Dental and Maxillofacial Radiology, King’s College London Dental Institute, London, UK Berlin, Chicago, Tokyo, Barcelona, Bucharest, Istanbul, London, Milan, Moscow, New Delhi, Paris, Beijing, Prague, Riyadh, São Paulo, Seoul, Singapore, Warsaw and Zagreb www.ajlobby.com A CIP record for this book is available from the British Library ISBN: 978-3-86867-333-3 (ebook) 978-1-85097-291-4 (print) Quintessence Publishing Co Ltd, Grafton Road, New Malden, Surrey KT3 3AB, United Kingdom www.quintpub.co.uk Copyright © 2016 Quintessence Publishing Co Ltd All rights reserved This book or any part thereof may not be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, or otherwise, without prior written permission of the publisher Editing: Quintessence Publishing Co Ltd, London, UK Layout and Production: Quintessenz Verlags-GmbH, Berlin, Germany Index: Indexing Specialists (UK) Ltd Printed and bound in Germany www.ajlobby.com Acknowledgements To our families The editors would like to thank the following: Francesco Mannocci, per i tuoi saggi consigli; Andrew Dawood for being ahead of the game, and introducing me to the ‘third dimension’ in 2006; The endodontic staff and postgraduate team at King’s College London Dental Institute Shanon Patel Jackie Brown, Marta Varela, Eric Whaites and Georgina Harvey for their invaluable assistance Simon Harvey JA Baart, Department of Maxillofacial Surgery, and JA Castelijns, Head and Neck Radiology, of the VU Medical Centre, Amsterdam, Netherlands Hagay Shemesh Eilis Lynch at Ennis Periodontology and Implant Clinic, and my colleagues at Riverpoint Specialist Dental Clinic, Limerick Conor Durack www.ajlobby.com Foreword The primary objectives of Restorative Dentistry are to relieve pain, prevent tooth loss and restore lost oral and dental tissues to meet the aesthetic, psychological and functional needs of patients These key objectives often require the coordination of multi-professional teams, which in the context of this book include Endodontists The use of cone beam computed tomography (CBCT) in dentistry, and specifically endodontics, is controversial, and although several position statements and guidance documents have been published in recent years, there remains a lack of knowledge and a degree of misunderstanding about the benefits and risks associated with this diagnostic tool Without doubt, there has been a need for a comprehensive and authoritative textbook that covers all the elements of this subject in relation to diseases of the pulp and periapical region Thus, this new book on CBCT and endodontics is timely, and provides a rich resource for specialists in Endodontology and Maxillofacial Radiology It is also an excellent reference book for general dentists, trainees on clinical training pathways, as well as students on specialist postgraduate programmes and undergraduates using CBCT The book is user-friendly and is divided into two sections The initial chapters (1–4) cover the important and essential aspects of radiology in relation to CBCT, which is an area that is often underemphasised and misunderstood The remaining chapters (5–11) are dedicated to the various applications of CBCT in endodontics An essential focus running throughout the book is the understanding that, as CBCT is associated with a higher effective patient radiation dose, the ALARA principles are paramount Each chapter is written by subject specialists who have a wealth of research and clinical experience The book is extensively illustrated with conventional radiographic and CBCT images, all with comprehensive legends CBCT is a relatively modern imaging method that provides a substantial amount of clinically relevant information The book provides an excellent review of the subject, emphasises case selection and is supported by key references to provide an evidence-based approach and a framework for the use of CBCT in endodontics Professor Paul MH Dummer BDS, MScD, PhD, DDSc, FDS RCS (Edin), FHEA Professor of Restorative Dentistry, Dean of Education and Students, Cardiff University Secretary of the European Society of Endodontology Cardiff October 2015 www.ajlobby.com Preface Endodontics relies on radiographic imaging for diagnosis, treatment planning and the assessment of healing However, conventional radiographic imaging has several welldocumented limitations, which can result in an impaired diagnostic yield, and potentially influence treatment planning In recent years, cone beam computed tomography (CBCT) has become much more widely available and utilised in all aspects of dentistry, including endodontics CBCT overcomes many of the limitations of conventional radiography and has been shown to be essential for the diagnosis and management of complex endodontic problems The editors of Cone Beam Computed Tomography in Endodontics are all experienced users of CBCT In their clinical practice and academic/teaching roles, they recognised the need for a guide to illustrate the applications of CBCT in endodontics using the latest evidence and principles The aim of the book is two-fold; firstly, to give the reader a thorough account of the radiological aspects of CBCT; and secondly, to comprehensively illustrate the applications of CBCT in endodontics The book emphasises the fact that, inherent in the responsible use of CBCT is the understanding that, as CBCT is associated with a higher effective patient radiation dose than conventional radiographic imaging, the prescription of CBCT must be justified, and the associated radiation exposure be kept as low as reasonably achievable This book gives the reader a sound foundation on small field of view, high resolution CBCT and its applications in endodontics However, one cannot overemphasise the fact that dental radiology is continuously evolving As such, it is essential that CBCT users keep abreast of developments in dental radiology and maintain a contemporaneous core knowledge of both dental radiology and of CBCT, specifically Shanon Patel Simon C Harvey Hagay Shemesh Conor Durack www.ajlobby.com Contents Chapter 1 The Limitations of Conventional Radiography and Adjunct Imaging Techniques Introduction Limitations of conventional radiographic imaging Superimposition of three-dimensional anatomy Geometric distortion Anatomical noise Follow-up radiographs Advanced radiographic techniques for endodontic diagnosis Magnetic resonance imaging Ultrasound Tuned aperture computed tomography Computed tomography Cone beam computed tomography Conclusions Acknowledgement References Chapter 2 Radiation Physics Introduction The electromagnetic wave Individual photons or continuous waves? X-ray production Bremsstrahlung Characteristic radiation Heat Spectrum profile Filtering Altering the mA or kV Summary Interaction with matter Absorbed X-rays www.ajlobby.com Scattered X-rays Transmitted X-rays Further reading Chapter 3 Cone Beam Computed Tomography The differences and similarities between multidetector computed tomography and cone beam computed tomography Multidetector computed tomography CBCT Detector types Image intensifier Indirect digital flat panels Direct digital flat panels Comparing the three detector types Detective quantum efficiency Image reconstruction methods Filtered back projection Problems with filtered back projection and iteration Image quality Contrast resolution Spatial resolution Testing contrast and spatial resolution Noise Unsharpness Ideal machine characteristics Further reading Chapter 4 Using CBCT: Dose, Risks and Artefacts Introduction Dose and risk Ionising biological tissue Stochastic risk Measuring dose UK background dose Age and risk Estimating risk www.ajlobby.com Dose-reducing measures Justification Ensure patient is set up correctly Raise kV and reduce mA Dose-reduction feature Larger voxels Low mA Correct filtering mA modulation Physical collimation 180-degree views Pulsed beam Average dose for CBCT scanners Artefacts in CBCT Extinction artefacts Beam-hardening artefacts Partial volume effect Aliasing artefacts Ring artefacts Motion artefacts Noise Summary of artefacts Viewing and storing images PACS DICOM Viewing monitor Lighting conditions Storage of images Training requirements CBCT-specific regulations Assessment of images Further reading Chapter 5 Dentoalveolar Anatomy Introduction The anatomy of the maxilla and palatine bone The anatomy of the nose and nasal cavity The anatomy of the maxillary sinus The anatomy of the alveolar bone www.ajlobby.com Neves FS, Sampaio F, Freitas FQ, Campos PSF, Ekestubbe A, Lofthag-Hansen S Evaluation of cone-beam computed tomography in the diagnosis of vertical root fractures: the influence of imaging modes and root canal materials J Endod 2014;40:1530–1536 Nicopoulou-Karayianni K, Bragger U, Lang NP Patterns of periodontal destruction associated with incomplete root fractures Dentomaxillofac Radiol 1997;26:321–326 Özer SY Detection of vertical root fractures of different thicknesses in endodontically enlarged teeth by cone beam computed tomography versus digital radiography J Endod 2011;36:1245–1249 Özer SY, Ünlü G, Değer Y Diagnosis and treatment of endodontically treated teeth with vertical root fracture: three case reports with two-year follow-up J Endod 2011;37:97–102 Patel S, Brady E, Brown J, Wilson R, Mannocci F The detection of vertical root fractures in root filled teeth with periapical radiographs and CBCT scans Int Endod J 2013;46:1140–1152 Patel S, Durack C, Abella F, Shemesh H, Roig M, Lemberg K Cone beam computed tomography in Endodontics—a review Int Endod J 2015;48:3–15 Pitts DL, Natkin E Diagnosis and treatment of vertical root fractures J Endod 1983;9:338–346 Rivera EM, Walton EM Longitudinal tooth fractures: findings that contribute to complex endodontic diagnoses Endod Topics 2007;16:82–111 Rud J, Omnell KA Root fractures due to corrosion Diagnostic aspects Scand J Dent Res 1970;78:397–403 Scarfe WC, Farman AG What is cone-beam CT and how does it work? Dent Clin N Am 2008;52:707–730 Schulze R, Heil U, Grob D, Breullmann DD, Dranischnikow E, Schwanecke U, Schoemer E Artefacts in CBCT: a review Dentomaxillofac Radiol 2011;40:265–273 Tamse A, Fuss Z, Lustig J, Kaplavi J An evaluation of endodontically treated vertically fractured teeth J Endod 1999;25:506– 508 Tamse A, Kaffe I, Lustig J, Ganor Y, Fuss Z Radiographic features of vertically fractured endodontically treated mesial roots of mandibular molars Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:797–802 Testori T, Badino M, Castagnola M Vertical root fractures in endodontically treated teeth: a clinical survey J Endod 1993;19:87–91 Tofangchiha M, Bakshi M, Fakhar MB, Panjnoush M Conventional and digital radiography in vertical root fracture diagnosis: a comparison study Dent Traumatol 2011;27:143–146 Tsesis I, Kamburoğlu K, Katz A, Tamse A, Kaffe I, Kfir A Comparison of digital with conventional radiography in detection of vertical root fractures in endodontically treated maxillary premolars: an ex vivo study Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:124–128 Tsesis I, Rosen E, Tanse A, Taschieri S, Kfir A diagnosis of vertical root fractures in endodontically treated teeth based on clinical and radiographic indicies: a systemic review J Endod 2010;36:1455–1458 Wang P, Yan XB, Lui DG, Zhang WL, Zhang Y, Ma XC Detection of dental root fractures by using cone-beam computed tomography Dentomaxillofac Radiol 2011;40:290–298 Zadik Y, Sandler V, Bechor R, Salehrabi R Analysis of factors related to extraction of endodontically treated teeth Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:31–35 Index 3D Accuitomo 180 scanners 34, 35 180-degree views 34, 35, 47–48 A abrasion 114, 115 absorbed dose 44 absorbed X-rays 30–31 Accuitomo test devices 34, 35, 40 advanced radiographic techniques computed tomography 21–23 cone beam computed tomography 23–25 endodontic diagnosis 17–24 magnetic resonance imaging 17–19 tuned aperture computed tomography 20–21 ultrasound 19–20 age and risk 44, 45 aliasing artefacts 49, 50 alveolar bone 60–61, 65–66 alveolar process, fractures of 111, 113, 114 alveolar socket wall comminution/fractures 111, 113 anatomical noise 14, 16–17 anechoic tissues 19–20 ankylosis 116, 121 anodes 29–30 anomalous tooth forms 70–73 anterior nasal spine 55, 57 apical periodontitis (AP) 79–88 CBCT 86–87 conventional periapical radiography 79–80, 81 conventional radiography 82–86 detection 80–82, 83 radiographic appearance 82–87 treatment outcomes 82 artefacts 43, 48–51 avulsion 107, 110, 114 B beam hardening artefacts 48 bone alveolar 60–61, 65–66 dentoalveolar anatomy 55–58 ethmoid 55, 56, 58, 59, 60 maxilla 55–58 palatine 55–58 sphenoid 56, 59 traumatic dental injuries 113–114 vomer 58, 59, 60 X-ray production 31 zygomatic 55, 58, 59 Bremsstrahlung X-ray production 28, 30 C calcifications 61, 62 canine teeth 67–68 cathodes 29–30, 35–36 CBCT see cone beam computed tomography cell damage 43–44 cementoenamel junction (CEJ) 110, 111, 112 cervical resorption (ECR) 123–127 chin rests 47 coil MRI 18 collimation, dose reduction 47 comminution 113 complex anatomy of root canal 67–70 complicated crown fractures 102 complicated crown–root fractures 102 Compton scattering 31, 32 computed tomography (CT) 21–23, 33 concussion 107–108 cone beam computed tomography (CBCT) 22, 23–24, 33–42 age and risk 44, 45 aliasing artefacts 49, 50 apical periodontitis 86–87 artefacts 48–51 average dose 48 beam hardening artefacts 48 contrast resolution 39–40 dentoalveolar anatomy 55–66 detective quantum efficiency 37 detector types 34–37 DICOM files 51 direct digital flat panel 36–37 dose 43–48 estimating risk 45–46 external cervical resorption 123–127 external inflammatory resorption 120–122 external replacement resorption 121–122 external surface resorption 120 extinction artefacts 48 filtered back projection 37–38 ideal machine characteristics 42 image intensifiers 35–37 image quality 39–41 image reconstruction 37–39 indirect digital flat panels 36–37 internal root resorption 128 ionising of biological tissues 43–44 lighting conditions 52 measuring dose 44 motion artefacts 49, 50 multidetector computed tomography 33–34 noise 40–41, 50, 51 PACS 51 partial volume effect 48–49 periodontal tissues 107–110 ring artefacts 49, 50 risk 43–46 soft tissue injuries 115 spatial resolution 39–40 stochastic risk 44, 45 storing images 51, 52 supporting bone 113–114 training requirements 53 UK background radiation dose 44 unsharpness 41 vertical root fractures 135–138 viewing images 51–52 X-ray production 29 cone-shaped X-ray beams 34, 35 contrast resolution 39–40 contusion 114, 115 conventional radiographic imaging 2D 13 anatomical noise 14, 16–17 apical periodontitis 79–80, 81, 82–86 dental pulp injuries 102–106 external cervical resorption 123–127 external inflammatory resorption 120–121 external replacement resorption 121, 122 external surface resorption 120 geometric distortion 14, 15 hard tissue injuries 102–106 internal root resorption 128–129 limitations 13–17 periodontal tissues 107–108 soft tissue injuries 114–115 superimposition of three-dimensional anatomy 13, 14 supporting bone 113 temporal perspective 17 vertical root fractures 135–137 crown fractures 102, 103, 106–107 crown–root fractures 102–103, 104, 105, 107 C-shape root morphology 93, 95 CT see computed tomography curvature, root canal anatomy 74–75 D delayed replantation 116, 117 dens invaginatus 70, 71 dental pulp chamber parameters 73 stones 62 traumatic dental injuries 102–107 dentine, enamel–dentine fractures 102 dentoalveolar anatomy 55–66 alveolar bone 60–61, 65–66 mandible 62–64 mandibular canal 64–65, 66 maxilla bone 55–58 maxillary sinus 59–60 maxillary teeth 61–62 mental foramen 65 nasal cavity 58–59 nose 58–59 palatine bone 55–58 detective quantum efficiency (DQE) 37 Digital Imaging and Communications in Medicine (DICOM) files 51 digital sensors 14 direct cell damage 43–44 direct digital flat panel 36–37 distortion, geometric 14, 15 Doppler effect 19–20 dose 43–48 reduction 46–48 DQE see detective quantum efficiency DTI see traumatic dental injuries E ECR see external cervical resorption electromagnetic waves 27–28 electronic noise 41 electrons 28–32 enamel, CEJ 110, 111, 112 enamel fractures/infraction 102 energy, X-rays 28–31 equivalent dose 44 ERR see external replacement resorption estimates of risk 45–46 ethmoid bone 55, 56, 58–60 external root resorption 120–126 external cervical resorption 123–127, 138–139 external inflammatory resorption 117, 120–121, 122 external replacement resorption 121–123 external surface resorption 120 extinction artefacts 48 extrusive luxation 107, 108, 111 ex vivo CBCT studies 135–137 F fan beam on multidetector computed tomography 33, 34 FBP see filtered back projection fillings 13, 92–93, 94 filtered back projection (FBP) 37–38 filtering dose reduction 46–47 X-ray production 30 flat detectors 34, 35 foramen of major palatine 55, 57 fractures alveolar process 111, 113, 114 alveolar socket wall 111, 113 complicated crown 102 complicated crown–root 102 crown 102, 103, 106–107 crown–root 102–103, 104, 105, 107 enamel 102 enamel–dentine 102 horizontal root 103–106, 107 traumatic dental injuries 102–107, 113–14 uncomplicated crown 102 uncomplicated crown–root 102 vertical root fractures 90–91, 92, 133–140 CBCT 135–138 conventional radiographic imaging 133–135 conventional radiography 133–135 ex vivo CBCT studies 135–137 in vivo CBCT studies 137–138 periapical lesions 92 fused teeth 71–73 G geometrical unsharpness 41 geometric distortion 14, 15 gingival injury 114, 115 H hard tissues MRI 17–18 radiopaque bands/islands 127 traumatic dental injuries 102–107 head supports 47 heat, X-ray production 29–30 helical CT scanners 33 high frequency generators 29 horizontal parallax 13 horizontal root fractures (HRFs) 103–106, 107 hydrogen atoms 17 hyperechoic tissues 19–20 I i-CAT scanners 34, 35 image intensifiers 35–37 image quality 39–41 image receptors 14 www.ajlobby.com image reconstruction 37–39 immobilisation devices 46, 47 incisor teeth 67–68, 90–92 indirect cell damage 43 indirect digital flat panels 36–37 inflammation apical periodontitis 79–88 resorption 115, 117, 122–123, 124 infraction 102 internal root resorption (IRR) 119, 128–129 intrusive luxation 107, 108, 110, 111–112 in vivo CBCT studies 137–138 ionising of biological tissues 43–44 J justification, dose reduction 46 K kV values dose reduction 46–47 X-ray production 30, 31 L laceration 114, 115 lateral luxation 107, 108–111 lead casing, X-ray tube components 29 lesions anatomical noise 16 non-surgical treatment 91–92 ultrasound 19–20 vertical parallax 13, 14 lighting conditions 52 lingual foramen 63–64 low mA values 47 luxation 101, 103, 105–111 M magnetic resonance imaging (MRI) 17–19 magnetic spectra 27–28 major palatine foramen 55, 57 mandible alveolar process fractures 111, 113, 114 alveolar socket wall www.ajlobby.com comminution/fractures 111, 113 anatomy 62–64 canal anatomy 64–65, 66 fractures 102–107, 113–114 mandibular first molar 90–91 mandibular left first molar 90–91 mandibular left second molar 93, 95 mandibular posterior teeth 95 mandibular right first molar 92–93, 94 mA values dose reduction 46–47 X-ray production 30, 31 maxilla alveolar process fractures 111, 113, 114 alveolar socket wall 111, 113 anatomical noise 16 bone anatomy 55–58 fractures 102–107, 113–114 maxillary first molars 95, 96, 97 maxillary left first molar 94, 96 maxillary left incisor tooth 90–91, 92 maxillary left second molar 90–93 maxillary posterior teeth 95 maxillary right central incisor 91–92 maxillary right central and lateral incisors 94, 97 maxillary right second premolar 92, 93 maxillary sinus 16, 59–60 maxillary teeth anatomy 61–62 MDCT see multidetector computed tomography median palatine suture 55, 56, 57 mental foramen 65 missed root canals 92–94 modulation, mA values 47 Moiré patterns 49, 50 molar teeth 69–70 monitors 51–52 motion artefacts 49, 50 movement unsharpness 41 MRI see magnetic resonance imaging MSCT see multislice computed tomography mucosal thickening 60, 61 multidetector computed tomography (MDCT) 33–34 multislice computed tomography (MSCT) 20 www.ajlobby.com N nasal cavity 58–59 nasal spine 55, 57 noise 40–41 artefacts 50, 51 CBCT 50, 51 conventional radiographic imaging 14, 16–17 non-surgical re-retreatment 89–94 nose 58–59 O oil, X-ray tube components 29 oral mucosa, injury 114, 115 orbit 55, 57, 58, 59 P PACS see picture archiving and communication systems palatal luxation 108, 109, 110 palatine bone anatomy 55–58 parallax 13, 14 partial volume effect 48–49 patient set up 46, 47 penumbra effect diagram 41 perforations 90–91 periapical lesions anatomical noise 16 non-surgical treatment 91–92 ultrasound 20 vertical parallax 13, 14 periodontal tissues injury classification 107 see also apical periodontitis phantom Accuitomo test devices 40 photocathodes 35–36 photoelectric absorption 31, 32 photons 28 physical collimation 47 picture archiving and communication systems (PACS) 51 piezoelectric effect 19 polyps 60, 61 posterior nasal spine 55, 57 premolar teeth 68–69 pulp see dental pulp www.ajlobby.com pulsed beam, dose reduction 48 pyramid-shaped X-ray beams 34 Q quality assurance (QA) 39–41 contrast/spatial resolution 40 dose reduction 46–47 noise 50, 51 non-surgical treatment 92 quantum noise 40, 50, 51 R radiation physics 27–32 electromagnetic wave 27–28 interaction with matter 30–32 X-ray production 28–30 absorbed X-rays 30–31 Bremsstrahlung 28, 30 characteristic radiation 28–29 filtering 30 heat 29–30 interaction with matter 30–31 kV values 30, 31 mA values 30, 31 scatter 31, 32 spectrum profile 30 transmitted 31–32 see also dose radiographic techniques computed tomography 21–23 cone beam computed tomography 23–25 endodontic diagnosis 17–24 magnetic resonance imaging 17–19 traumatic dental injuries 101–115, 116, 117 tuned aperture computed tomography 20–21 ultrasound 19–20 see also conventional radiographic imaging radiopaque bands/islands 127 Rayleigh scattering 31 replacement resorption (ERR) 121–123 replantation 115, 116, 117 re-treatment 89–99 non-surgical 89–94 www.ajlobby.com surgical 89, 94–97 resolution 39–40 resorption 90–91, 92, 115, 117 see also root resorption ring artefacts 49, 50 risk 43–46 root canal anatomy 67–78 anomalous tooth forms 70–73 canine teeth 67–68 complex anatomy 67–70 curvature 74–75 dens invaginatus 70, 71 fused teeth 71–73 incisor teeth 67–68 length 74–75 molar teeth 69–70 premolar teeth 68–69 pulp chamber parameters 73 taurodontism 70–71, 72 root canal treatment failure 89 horizontal parallax 13 periapical lesions 92 root fractures 102 horizontal 103–106, 107 vertical 90–91, 92, 135–142 CBCT 137–140 conventional radiography 135–137 ex vivo CBCT studies 137–139 in vivo CBCT studies 139–140 periapical lesions 92 root resorption 119–130 external 120–127 internal 124, 127–129 root-treated mandibular first molar 90–91 root-treated mandibular left second molar 93, 95 root-treated mandibular posterior teeth 95 root-treated maxillary left second molar 92–93 root-treated maxillary posterior teeth 95 root-treated maxillary right central incisor 91–92 root-treated maxillary right second premolar 92, 93 root-treated symptomatic mandibular left first molar 90–91 rotating motors, X-ray tube components 29 www.ajlobby.com S scatter 31, 32 scintillators 35–36 SENDENTEXCT guidelines 46 septa 58, 59, 60 signal-to-noise ratio (SNR) 41 sinus anatomical noise 16 maxillary 59–60 SMPTE test patterns 40, 52 SNR see signal-to-noise ratio socket wall fractures 113 soft tissues injury classification 115 traumatic dental injuries 114–115 X-ray production 31 spatial resolution 39–40 spectrum profiles 30 sphenoid bone 56, 59 stochastic risk 44, 45 stones, pulp 61, 62 storing of images 51, 52 structural noise 40, 50, 51 subluxation 102, 105, 107–108 superimposition of three-dimensional anatomy 13, 14 supporting bone, traumatic dental injuries 113–114 T TACT see tuned aperture computed tomography taurodontism 70–71, 72 temporal perspectives 17 tissues injury classification 107, 115 ionising 43–44 MRI 17–18 radiopaque bands/islands 127 traumatic dental injuries 102–107, 114–115 ultrasound 19–20 X-ray production 31 transducers 19 transmitted radiation 31–32 traumatic dental injuries dental pulp 102–107 hard tissues 102–107 periodontal tissues 107–112 radiographic assessment 101–117 www.ajlobby.com soft tissues 114–115 supporting bone 113–114 traumatic dental injuries (TDI) 101–118 tube windows 29 tuned aperture computed tomography (TACT) 20–21 Tungsten atoms 28–29 tungsten filaments 29 U UK background radiation dose 44 ultrasound (US) 19–20 uncomplicated crown fractures 102 uncomplicated crown–root fractures 102 V vacuum, X-ray tube components 29 vertical parallax 13, 14 vertical root fractures (VRF) 90–91, 92, 133–140 CBCT 135–138 conventional radiography 133–135 ex vivo CBCT studies 135–137 in vivo CBCT studies 137–138 periapical lesions 92 viewing of images 51–52 void-free root canal filling 92 vomer bone 58, 59, 60 VRF see vertical root fractures W water, indirect cell damage 43 waves, electromagnetic 27–28 X X-ray production 28–30 absorbed X-rays 30–31 Bremsstrahlung 28, 30 characteristic radiation 28–29 components and purpose 29 film 14 filtering 30 heat 29–30 interaction with matter 30–31 kV values 30, 31 mA values 30, 31 www.ajlobby.com scatter 31, 32 spectrum profiles 30 transmitted 31–32 X-ray beams 33, 34, 35 Z zero artefacts 48 zygomatic bone 55, 58, 59 zygomatic buttress 16 www.ajlobby.com ... Further reading Chapter 3 Cone Beam Computed Tomography The differences and similarities between multidetector computed tomography and cone beam computed tomography Multidetector computed tomography. .. magnetic resonance imaging ultrasound tuned aperture computed tomography computed tomography cone beam computed tomography Magnetic resonance imaging Magnetic resonance imaging (MRI) is a specialised technique that utilises hydrogen atoms (one... Chapter 3 Cone Beam Computed Tomography Simon C Harvey, Shanon Patel The differences and similarities between multidetector computed tomography and cone beam computed tomography Multidetector computed tomography