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What is a CBCT scan?
CBCT (cone-beam computed tomography) scan is a type of medical imaging technique that produces precise 3D images of the bones and soft tissues in the maxillofacial region. As the name suggests, CBCT uses a cone-shaped beam of x-rays to capture a wider field of view (FOV). The images obtained from CBCT have high resolution.
CBCT scans are a type of dental imaging technique, used for the imaging of the teeth, jaws, and surrounding structures. CBCT captures a series of cross-sectional images of a specific area of the mouth. The images obtained are very accurate. CBCT can be used to view individual teeth or the roots of the teeth. It is used for diagnosing jaw lesions (cysts & tumors) with their extent. It is highly recommended for implant planning, to assess the quality of the bone in the jaw, and for making guides for dental implants.
CBCT scans are also used in other medical fields such as otolaryngology (ear, nose, and throat medicine), maxillofacial surgery, and radiation therapy.
What does CBCT stand for?
CBCT is an abbreviation for Cone Beam Computed Tomography. CBCT is similar to a traditional CT (computed tomography) scan but differs from CT in the type of x-ray beam it uses. In a traditional CT scan a cylindrical beam is used to capture the images of hard and soft tissues, whereas in CBCT a cone-shaped beam is used instead.
What is Cone Beam
While scanning, an x-ray beam is projected toward an object or part of the human body. The shape of this x-ray beam varies according to the used x-ray scanner: For computed tomography (CT) scanners it is cylindrical, whereas for cone beam computed tomography (CBCT) scanners it is cone shaped. Thus, “cone bean” is the cone-shaped beam used with CBCT scanner. The cone shape of the-ray been enables to yield good quality of scans while significantly reducing the radiation level the patient is exposed to.
What does a CBCT scan look like
CBCT scans are a type of dental imaging technique that produces 3D images of the 3D structures including teeth, jaws, TMJ, airways, sinuses, nasal cavity, and other surrounding Maxillofacial structures. The CBCT scan has a series of cross-sectional images in 3 planes axial, sagittal, and coronal, while some additional planes such as oblique can be added with the help of different algorithms.
What does a CBCT scan show?
CBCT scan can give a detailed picture (2D sections and 3D structures) of teeth, jaws, TMJ, airways, sinuses, nasal cavity, orbits, and other surrounding anatomical structures of the head and neck region. A single CBCT scan can show any pathology related to maxillofacial structures in a detailed format. The CBCT scan can be used for the diagnosis of teeth and jaw pathologies, pre- and post-surgical assessment, with great accuracy, as well as for dental implant planning.
CBCT scan can be used to measure the bony quality and dimensions for implant planning. In addition, it can give an idea to the surgeon about the surrounding vital structures, such as nerves, before surgery. Thus, CBCT allows the identification of possible complications ahead of time, so that the necessary steps can be taken to avoid or minimize these complications.
What is a CBCT scan used for
Cone beam CT (CBCT) is a type of dental imaging technique that uses a cone-shaped beam of X-rays to create images of the head and neck, as well as the spine and other surrounding areas.
CBCT can be used to investigate various maxillofacial conditions, such as:
- Detection of pathologies: CBCT can be used to detect lesions involving the jaws and teeth, such as tumors, cysts, or other abnormalities in the head and neck region.
- Sinus conditions: CBCT can be used to evaluate the pathologies of the sinuses, such as sinusitis, mucositis, or nasal polyps.
- Dental implant planning: CBCT is often used for dental implant planning. It can provide detailed images of the alveolar bone and surrounding structures, which can be used to measure the quantity of bone and evaluate the bone quality (to assist, for example, in deciding which implant to use, how, and is a dental bone graft required).
- Orthodontic treatment planning: CBCT can be used to plan orthodontic treatment, such as braces or aligners, by providing detailed images of the teeth and jaws. It can also be used to demonstrate (e.g., via 3D models and videos generated from the CBCT scan) the treatment plan and the predicted results, to patients and colleagues.
- Temporomandibular joint (TMJ) disorders: CBCT can be used to evaluate the TMJ and surrounding structures for signs of disorders or injuries.
- Airways analysis: CBCT can be used to evaluate the pathologies related to airways, which for example helps treating sleep apnea.
Is a CBCT scan painful?
Some radiological procedures require interventional approaches where various small tools, such as catheters, probes, or wires are inserted into the patient’s body during the scan. Even for the intraoral radiographic procedure, x-ray films are placed inside the patient’s mouth. These techniques are sometimes not comfortable for patients and might even be somewhat painful.
However, CBCT is an extraoral radiographic technique, where there is no contact between the patient and the film. Moreover, the time taken by the technique is only 2-3 minutes, which further adds up to the ease of the technique, rather than it being painful. The bottom line is that a CBCT scan is noninvasive, seamless to the patient, and not painful at all.
In terms of exposure, the CBCT scans do use radiation. However, the amount is significantly less than the traditional CT scanners and is safe. There is a term known as background radiation and at any given time, we are all exposed to this background radiation. The traditional CT scanner produces radiation which is equivalent to 63-154 days of background radiation, whereas a CBCT scan produces only 6-30 days of background radiation, which is relatively much less.
But it should be strictly noted that despite a lower radiation exposure, the potential benefits and risks of CBCT scan should be compared and it should be used only when it is needed.
CBCT Procedure: How CBCT scan is done
Cone beam computed tomography (CBCT) is a dental imaging technique that uses cone beam x-rays to produce detailed 3D images of the teeth, jaw and surrounding structures with very high resolution.
Steps for performing a CBCT scan:
- Patient preparation: Before the scan, the patient is asked to remove any metal objects, jewellery or eyeglasses if wearing, since all these can interfere with the imaging. To shield the body from unnecessary radiation the patient may be asked to wear a protective lead apron and may also be given earplugs to wear to protect their hearing from the noise of the machine
- Machine preparation: the machine is turned on and the rotating component of the machine, comprising the x-ray source and receptor, are tuned to the start point. Projection parameters are set on the machine based on area of interest, age of patient and reason for scan. Height of the machine is set to the approximate height of the patient.
- Patient positioning: The patient is seated in the CBCT machine and asked to hold very still, with his/her face resting on a small shelf in front. Then the patient must bite gently on a mouthpiece to keep the head steady during the scan and hold the togue back while the scan is made. Throughout the scanning, patient positioning is very critical because the quality of the image very much depends on it.
- Scanning: During the scan, the machine rotates around the patient’s head and emits a low dose of x-rays which are directed onto the teeth, bones as well as soft tissues inside the mouth. The emitted x-rays are captured by the machine’s detectors to form images. A CBCT scan typically takes about 2-3 minutes to complete, depending on the speed of the machine and the field of view (FOV).The body structures absorb x-rays based on their composition, the denser ones like teeth and jaws absorb more x-rays and appear clearer on the image whereas the less dense ones like soft tissues and the areas where infections or decay are present absorb fewer X-rays and appear as dark spaces on the image. This helps the radiologist diagnose the medical condition.
- Image processing: After the scan is completed, the raw data collected by the detectors of the machine is used to create detailed 3D images of the teeth, jaw, and surrounding structures by using various algorithms on a computer. The processing stage at DentQ and CTdent typically includes verifying that the scan is successful by the radiographer, and adding measurements, observations and recommendations by a radiologist (written in a radiologist report) and sometimes by an artificial intelligence (AI) application as well
How to take a CBCT scan
The patient is asked to stand still with his/her face resting on a small shelf in front. Then they must bite gently on a mouthpiece to keep the head steady during the scan, and hold the tongue back, while the scan is being made. The height of the machine is set to the approximate height of the patient. During the scan, patient positioning (posture) is very critical because the quality of the image directly depends on it.
There are two phases in CBCT scanning:
- Image acquisition phase
- Image reconstruction phase
During the acquisition phase, the patient is positioned in the machine with the head stabilized to avoid any movement during the acquisition of the data volume. After positioning the patient, a scout image is taken to verify that the area of interest is within the field of view (FOV). This step is highly recommended, especially for small FOV scans to verify that the area of interest area is included, thus helping to avoid the repetition of scans and the exposure of the patient to additional radiation doses.
After verifying the scout image, the actual scan can be taken. During the scan, the beam and the receptor rotate simultaneously around the patient’s head during the acquisition. The machine is rotated around the patient’s head, at either 180 or 360 degrees, and a ray of the cone-shaped beam is directed through the center of the area of interest.
There are two types of image reconstruction depending on the type of detector used:
- Spherical reconstruction, obtained with a CCD/II detector. This type of reconstruction results a peripheral distortion.
- Cylindrical reconstruction, obtained with a flat panel detector. This type of reconstruction does not result any distortion.
During the reconstruction phase, hundreds of basic images are obtained and sent to a dedicated software application, for creating 3D volume for the reconstruction of the data volume and multiplanar (MPR) images – in axial, coronal, and sagittal orientations.
How long does a CBCT scan take?
CBCT scan is a very quick imaging technique. The patient’s positioning may take a few minutes, but, when it comes to the scanning itself, it only takes 10-30 seconds for a full scan to be taken. The traditional CT scan takes around 15-30 minutes for a scan, whereas on CBCT scan can be done in less than 2-3 minutes, thus significantly reducing the overall scanning time and waiting time for the patient.
Cone-beam computed tomography (CBCT) scanners are a variation of traditional computed tomography (CT) devices. CBCT scanners rotate around the patient, capturing data using a cone-shaped X-ray beam. These data are used to reconstruct a three-dimensional (3D) image of the following regions of the patient’s anatomy: dental (teeth); oral and maxillofacial region (mouth, jaw, and neck); and ears, nose, and throat (“ENT”). The images obtained from the CBCT scanner for oral and Maxillofacial structures have high resolution and are very detailed.
Cone beam CT scanners are square-shaped machines that have a rotating C-arm, with an x-ray image intensifier that contains an x-ray source and detector. They also usually include either a vertical pilar for standing or an upright chair for sitting during the examination. During a cone beam CT examination, the C-arm rotates around the head in a complete 360-degree rotation while capturing multiple images from different angles that are reconstructed to create a single 3-D image.
The x-ray source and detector are mounted on opposite sides of the revolving C-arm and rotate in unison. In a single rotation, the detector can generate hundreds of high resolution two-dimensional (2-D) images, which are then digitally combined to form a 3D model that can provide your dentist or oral surgeon with valuable information about your oral and craniofacial health.
The CBCT scanner is one of the most advanced devices in the dental imaging world and has the capability of producing high-quality images in less time, and with up to 80% less radiation, when compared to traditional CT scanners. A few of the best and top brands of CBCT Scanner include Planmeca, MyRay and NewTom (by Cefla), Acteon, Carestream, iCAT and Kavo (by KaVo Kerr), Dentsply Sirona, Morita and others.
CBCT scanners can also create two-dimensional panoramic scans (OPG), thus provide a 2-in-1 functionality (or even 3-in-1 when a CEPH arm is added to them). At DentQ and CTdent dental imaging centers, we use top-of-the-line CBCT scanners (New MyRay and Planmeca models, for example), often coupled with a CEPH arm, thus we are are equipped to provide high-quality scans for a wide variety of needed exams: CBCT (3D), OPG (2D) and CEPH (2D and 3D).
Mobile CBCT scan
A mobile CBCT scan is a kind of setup where the scanner is housed within a specially designed trailer that resembles a big 18-wheeler, which allows it to move from one medical center to the other.
Since CBCT scanners are expensive and their installation requires a lot of regulations, often there aren’t enough patients to justify the expense of a fixed machine. In such cases, when the demand is not big enough for one specific location, but 3D dental scans are still needed, mobile CBCT scanners are ideal for providing service in multiple locations: each location is being served only several days every month, and the mobile CBCT scan rotates from one location to another.
The advantages of a mobile CT scanner, when compared to fixed CBCT scan, include:
- A standardized, modular and scalable mobile CBCT fleet
- Installation is easier to apply, and requires simpler logistics
- Lower cost of installation and of operation (no rent, for example)
- Meeting more demand, which results more scans and income per CBCT machine
- Flexible collaboration opportunities, including shared costs and services
- Providing better dental care with the latest dental imaging technology even in less developed areas
- More convenient for the patients, saves then travel time to far-away places for a scan
CBCT machine and OPG
The CBCT and OPG machines are different in their basic composition. OPG is a 2D radiographic technique in which the source of x-rays is a wide beam, whereas CBCT is a 3D radiographic technique in which the source of x-rays is a cone-shaped beam.
The second basic component is the receptor, in CBCT the receptor can produce high-quality cross-sectional images as compared to OPG.
On a routine basis, OPGs are used for dental assessments for the initial stage due to their cost effectiveness, whereas CBCTs give a 3-dimensional view that is very detailed, and the CBCT scan is costly too.
As mentioned above, usually CBCT machine include built-in OPG functionality, and therefore can replace a stand-alone OPG machine, and be used both for CBCT (3D) scans and Panoramic (2D) images.
How to open a CBCT scan
For opening a CBCT scan (e.g. – in a DICOM file format, the standard format for storing and transmitting medical imaging data), the data which is to be opened or viewed off-line, must be saved on your computer or device. After saving the data file to the local computer, it can be opened with a dedicated (free or paid-for) software application.
Software solutions that can open and display CBCT scan data, include., for example:
- Online tools: There are some websites where DICOM files (Digital Imaging and Communications in Medicine) can be uploaded and viewed – including, for example: PostDicom, Horos (for Mac), RadiAnt and 3DimViewer.
- Offline DICOM viewers: There are many free (or freemium) DICOM viewer applications available, that can open and display CT scan data – including: OsiriX, MicroDicom and Sidexis 4.
- Commercial software: Many commercial software programs exist that can open and display CT scan data, as well as plan surgical procedures with, including for example: 3D Slicer, Amira, Avizo, Mimics, and ImFusion.
How to read CBCT scan?
For reading a CBCT data set – DICOM files (Digital Imaging and Communications in Medicine) are used, which is the standard for handling, storing, and transmitting information in medical imaging.
There are around 150-600 DICOM files in a scan which form the volume when they are merged. There are many software viewers available that can be used to view these files. There are some basic options that all the viewers have, such as: zoom, magnification, brightness/contrast, rotation, nerve tracing, etc. MPR images can be viewed and oriented at different angles, and a panoramic reformatted image can be created. Some viewers have the options for linear measurements, which allows a clinician to measure dimensions of anatomical structures and lesions.
Steps for reading a CBCT scan include:
- Re-orientation: In the first step, to evaluate the symmetry of structures and to avoid misinterpretation the scan is re-oriented until the arch is in a suitable position and the head is not tilted, the occlusal plane is aligned with the horizontal plane, and the midline is aligned with the patient’s midline.
- Reading: After re-orientation is done, the MPR images can be read. The MPR images are in 3 planes: coronal, axial, and sagittal. The coronal MPR images are used to view the structures which are in an anteroposterior orientation, such as paranasal sinuses, and nasal cavity. The axial MPR images are helpful to analyze anatomical structures which have a vertical orientation, and the sagittal MPR images are used for analyzing structures which have latero-medial orientation.The entire series of MPR images must be read systematically. The most important criterion is to assess for symmetry and continuity of osseous borders. Certain areas have complex anatomy such as the skull base, cervical vertebrae, nasal cavity, etc. – which require thorough knowledge when reading it
- Reconstruction: In the next step, the CBCT image is reconstructed based on a focal layer or trough, similar to a panoramic projection, which gives a reformatted panoramic image. This is a very important step. The reformatted panoramic image is used for the teeth numbering, and for giving a wide view of the whole scan.
However, sometimes these reformatted images do not include all the teeth present in the jaw, since the selected curved image slice is not wide enough to include it. E.g., impacted 3rd molars, when they are present more towards the lingual or buccal side, they will fall apart from the panoramic view.
The reformatted panoramic image can also give a cross-sectional image, which is a perpendicular image through the mandibular or maxillary arch. Such cross-sectional images are utilized for measurements.
Who reads a CBCT scan?
A CBCT (Cone Beam Computed Tomography) scan is a dental imaging technology that produces detailed 3D images of the teeth, bones, and surrounding soft tissues. These images can be used for the diagnosis and treatment planning of a variety of maxillofacial problems.
Typically, a CBCT scan is read by a radiologist, who is trained specially in interpreting the CBCT scan. A radiologist can create a report after reviewing the CBCT images, for the presence of any abnormalities. The report is then provided to the dentist or the oral surgeon, helping them to diagnose the medical condition of the patient and planning the treatment plan.
How accurate is CBCT?
Cone beam computed tomography (CBCT) is an advanced imaging modality that uses X-rays to create detailed 3D images of the head, neck, and other surrounding areas of the body. It is generally considered to be a highly accurate method for producing detailed images of bones and teeth, and it can also be used to visualize soft tissues and blood vessels to a limited extent.
The accuracy of CBCT images depends on several factors, including the quality of the scanner and the technique used by the operator. The type of receptor used can also make a difference in the resolution of the image produced. The CCD/II receptor image shows a peripheral distortion whereas with a flat panel receptor there is no peripheral distortion.
All in all, CBCT is far more accurate than traditional 2D X-rays such as OPG, and other intra-oral radiographs, but less accurate than CT scans or MRI which can provide more detailed images of soft tissues and other structures.
How big is a CBCT scan?
DICOM (Digital Imaging and Communications in Medicine) files are used for storing and exchanging medical images, including for CBCT (3D) scans. The size of an oral or Maxillofacial DICOM file can vary significantly depending on the type and resolution of the image, as well as the amount of data that is included in the file (which, in turn, depends on the area which is scanned).
A typical DICOM file for CBCT scan can be several hundred megabytes (Mb) in size. However, some DICOM files for CBCT scans can be much larger, depending on the resolution, scope and complexity of the image.
Cone beam computed tomography (CBCT) is a type of advanced medical scan that uses a specialized X-ray machine to produce detailed 3D images of the head, neck, and spine. The images obtained are the cross-sectional image of the area scanned. A maxillofacial radiologist can review these images and interpret them.
The interpretation of a CBCT scan is taking into account the justification for performing the scan (e.g. – as a preparation for planning an implant surgery in a specific site), while nevertheless requires the radiologist or dentist to review the scan images thoroughly and look for any and all abnormalities or pathologies evident in the scan that may be affecting the jaws, teeth, and surrounding structures. They may look for impacted teeth, any lesion of the jaw, or signs of infection or inflammation. They may also look for any structural issues, such as deformities or fractures, and evaluate the overall health of the teeth and surrounding tissues.
The interpretation of a CBCT scan is a complex and non-intuitive process, and therefore it should be done by a qualified healthcare professional who has special training and experience in reading and interpreting these types of images.
For the interpretation of 3D images, the basic part is teeth numbering, which can be obtained from a reformatted panoramic image. MPR images are then oriented at different angles, to obtain a clear picture of the area of interest. The panoramic view and MPR images are then used for various measurements and for creating a 3D view for a specific part or the entire scan as per need.
Like any other imaging modality, some artifacts also are present in images generated from CBCT scans. Such artifacts can be caused by a variety of factors, such as patient movement during the scan, metallic objects in the scan (causing ray scattering), technical issues with the CBCT scanner, etc. Some common types of artifacts that may appear in CBCT images include:
- Motion artifacts: These artifacts appear as blurring or smudging in the image. Such artifacts occur if the patient is not stable during the scan.
- Patient positioning artifacts: These artifacts appear as distorted or incomplete images in areas that were not scanned well. Such artifacts are caused by incorrect positioning (posture) of the patient in the CT scanner.
- Hardware artifacts: These artifacts appear as stains or shadows caused by malfunctioning equipment. Such artifacts are caused by problems with the CBCT scanner itself.
- Reconstruction artifacts: These artifacts appear as “stair stepping”, and/or blurring. Such artifacts occur during the image reconstruction process, which converts raw data from basic images into visual images.
All these artifacts should be identified and carefully distinguished from the actual objects and body structures being examined. Inexperienced interpreters may ignore such artifact signals, which may lead to wrong conclusions and impair the accuracy of the diagnosis and the treatment plan. Therefore, adequate training with known artifact examples is highly recommended before attempting to interpret CBCT scans. In addition, it is recommended to use radiologist reports to be on the safe side.
At DentQ, we provide radiology reports, as well as AI radiology reports, to help clinicians to better understand the CBCT scan results, and to alert them on detected abnormalities. See below for further details.
CBCT scan price
CBCT is a commonly used dental imaging modality and is rapidly growing in popularity. It is readily available in many healthcare facilities and imaging centers, as well as in some dental clinics.
The cost of the scan varies from place to place. Local prices vary from facility to facility pending on pricing policy, added value services, competition, regional taxes, demographics, agreements with insurance companies and supply and demand in a specific area. In addition, the larger area that is being scanned, the higher the cost of the scan usually is: sectional, quadrant and one jaw CBCT scans typically cost lest then a full-mouth two jaws scan.
According to an internal survey we did at DentQ, typical price range for CBCT scan of one jaw and of two jaws, in 2022 in various countries, is described in the following table:
|Country||1 Jaw||2 Jaws||1 Jaw||2 Jaws||1 Jaw||2 Jaws||Remarks|
|USA||$ 200||$ 300||$ 400||$ 550||$ 600||$ 800||CBCT scans cost less when insurance covers it|
|Brazil||$ 30||$ 55||$ 50||$ 75||$ 70||$ 110||50% reduced CBCT scan prices via insurance|
|UK||£ 90||£ 160||£ 133||£ 235||£ 190||£ 310||Referral to CBCT twice more common than to OPG|
|Germany||€ 99||€ 99||€ 200||€ 200||€ 300||€ 300||External Referral are to CBCT, never to OPG|
|Spain||€ 65||€ 80||€ 95||€ 119||€ 120||€ 150||50% of external scans are CBCT (2D), 50% OPG (2D)|
|France||€ 69||€ 128||€ 100||€ 170||€ 150||€ 230||CBCT scans cost less when insurance covers it|
|Italy||€ 70||€ 100||€ 125||€ 200||€ 150||€ 250||Higher prices in north Italy, lower in the south|
|Portugal||€ 50||€ 90||€ 80||€ 150||€ 120||€ 220||Relatively low prices for Western Europe|
|Greece||€ 70||€ 100||€ 90||€ 115||€ 100||€ 135||CBCT almost always done externally (not at clinics)|
|Romania||RON 200||RON 330||RON 310||RON 570||RON 420||RON 750||Prices higher in Bucharest, much lower elsewhere|
|HK||HK$ 900||HK$ 1,500||HK$ 1,200||HK$ 2,300||HK$ 2,400||HK$ 4,500||Many clinics do it in-house|
|Dubai||€ 87||€ 174||€ 134||€ 256||€ 268||€ 312||CBCT scans cost less when insurance covers it|
|Israel||NIS 450||NIS 900||NIS 550||NIS 1,100||NIS 650||NIS 1,300||Expect lower prices when insurance covers it|
One thing to take into consideration is that some imaging service providers offer discounts on bundled packages, for example on combo deals for CBCT scan and Intraoral scan.
At DentQ and CTdent dental imaging branches around the world, we enjoy our size advantage to reduce costs. As a result, our strategy is to offer more for less: premium service and quality at reasonable (average and below) costs. Therefore, you can expect our official pricing to be around medium prices. In addition, we have agreements with dentists that allow them to give a discount to their patients, and we also distribute coupons and have special offers from time to time.
Is CBCT scan covered by insurance?
CBCT is a dental imaging technique that is used routinely for various reasons, ranging from surgical needs to orthodontic treatment planning. Dental and health insurance plans, in various countries and by various insurers, may or may not cover the cost of a CBCT based on the specific insurance plan an individual has, and the justification for the CBCT scan. For example, in most countries, basic medical insurance plans do not cover CBCT scans justified as an assistance for planning an implant surgery, but may, however, cover CBCT scans aimed at planning complex and rare maxillofacial surgeries.
Since insurance providers often cover CBCT only for very specific justifications, it is advisable, before taking a CBCT exam, to check with the insurance provider and see if they cover the cost of a CBCT. And when the CBCT scan is not covered by the insurance, some doctors use the OPG reconstruction (resulting from CBCT scans), to let their patients get at least a partial refund from the insurer, for the OPG (panoramic) scan, which is “inherited” within the CBCT scan processing results…
What is the difference between CBCT and OPG scans?
CBCT (Cone Beam Computed Tomography) , and OPG (Orthopantomogram) are two different types of dental imaging techniques that are each used to produce images of the teeth, jaws, and surrounding structures.
An OPG is a 2D imaging procedure that captures a wide, two-dimensional image of the entire mouth in a single scan. It can be used to detect issues with the position of the teeth, their growth, and development, the jaw, or the temporomandibular joint (TMJ). It is also helpful in planning and assessing orthodontic treatment.
CBCT, on the other hand, is a 3D imaging technique that uses a cone-shaped x-ray beam to capture a series of cross-sectional images of a specific area of the mouth. The images obtained are extracted from a three-dimensional DICOM file and are more accurate. CBCT can be used to view individual teeth or the roots of the teeth. It is highly recommended for implant planning, as it enables to assess of the quality, quantity, and density of the bone in the jaw, for making guides for dental implants, and it helps identify the precise root canal location (in 3D) – often crucial for performing a successful implant procedure.
As for the cost – although both procedures take almost the same time for the scanning itself (2-3 minutes) – CBCT requires a more experienced radiographer and extra processing work. In addition, a CBCT scan often requires a report by a radiologist and may need a more expensive machine to perform the scan. Therefore, the cost of a CBCT scan for 1 jaw is usually 3-fold, and the cost of a CBCT scan for 2 jaws usually costs 5-fold, when compared to the cost of an OPG scan (which scans the entire mouth).
As for safety – both panoramic and CBCT scans are pretty safe when justified, but OPG requires less radiation dose since it only scans one plane (2D) whereas CBCT scans multiple layers (3D). To counterbalance this, sometimes the findings of OPG make it necessary to do an additional scan, this time a 3D CBCT scan, to provide the needed information to the dentist. For example, when the scan is used for orthodontic treatment, the findings of the OPG scan may not suffice, when (in 20% of the cases) an impacted tooth is involved. In such cases, the radiation dozes include that of the initial OPG scan plus that of the following CBCT scan, which means that taking only a CBCT scan alone, to begin with, was a safer (and faster) option. Cephalometric scans present a similar dilemma – the default is a 2D scan for the CEPH exam (OPG), but 3D scans may be needed as they provide more accurate information, as well as a clear image of both sides of the head.
To sum up, OPG scans are two-dimensional, less expensive, and not so accurate, whereas CBCT scans are three-dimensional, more expensive, and way more accurate. A dentist can select the type of scan based on the specific purpose and the availability of the imaging modality. OPG is more readily available in-clinic compared to CBCT, while CBCT is more recommended for Implant planning.
What is the difference between CBCT and a Dental scan?
CBCT (cone-beam computed tomography) scan is a specific type of dental scan that uses a cone-shaped beam of x-rays to produce a detailed three-dimensional image of 3D structures in a single scan, including teeth, jaws, TMJ, sinuses, and surrounding structures.
A dental scan is a general term that can refer to any type of dental imaging technique used to produce images of the teeth, jaws, TMJ, sinuses, and surrounding structures. CBCT scans, as well as other types of x-ray or imaging techniques such as OPG (Orthopantomogram), MRI (magnetic resonance imaging), or CT (computed tomography) scans, are examples of various dental scans.
One difference between the other dental scans and CBCT scans is the area that can be covered. CBCT can scan a wide, three-dimensional image of the entire mouth in a single scan, whereas other types of dental scans, such as IOPA, and bitewings, have only a limited area covered (in example – it often covers only 1-3 teeth).
As mentioned in the previous section, CBCT scans, on the other hand, represent a different type of dental scan, used to provide more detailed or specialized images (when compared with OPG images), and of various areas of the mouth (including 1-3 teeth, quadrant, one jaw, and up to two jaws, for example).
Thus, CBCT scan is just one type of scan included in the large variety of dental scan solutions, and the specific type of dental scan that is to be used entirely depends on the type of information that is needed, and the specific treatment involved.
What is the difference between a CT scan and a CBCT scan?
In reality, CBCT is a form of CT scan that has gained enormous popularity in the past few decades. The difference between them is the type of x-ray beam used: in CT scan a cylindrical beam is used to capture the image of hard and soft tissues, whereas in CBCT a cone-shaped beam is used.
The scan duration is much longer, and the radiation exposure are up to 5 times higher in CT scans when compared to CBCT scan. On the other hand, the area which can be covered by a CT scan (whole body) is much bigger than the area scanned with CBCT machine (head and neck region). In addition, for soft tissues CT provides a sharper and more detailed image.
Is CBCT an MRI?
No, CBCT (Cone Beam Computed Tomography) and MRI (Magnetic Resonance Imaging) are two different imaging modalities. CBCT (Cone Beam Computed Tomography) is a type of dental imaging modality that uses cone-shaped beams of x-rays to create detailed 3D images, whereas MRI (Magnetic Resonance Imaging) is a medical imaging modality that uses magnetic fields and radio waves to create detailed images.
CBCT is often used in the dental and maxillofacial diagnosis and treatment planning, and in some other medical specialties such as ENT or sleep medicine. However, the usage of CBCT is mostly limited to the head and neck region. MRI can be used to visualize soft tissues in any part of the body. The usage is very wide, it can be used to scan the whole body, including the tongue, TMJ, and a few other anatomical structures in the head and neck region also.
What is the difference between MRI and CBCT?
MRI is a medical imaging modality that uses a magnetic field and radio waves to produce detailed images of the body’s tissues and organs. It is particularly useful for producing images of the soft tissue, and therefore it is immensely used for brain and spinal cord imaging. MRI can give a very clear image for brain tumors, stroke, and spinal cord injuries. It can also be used for the imaging of muscles, tendons, and ligaments.
CBCT (Cone Beam Computed Tomography) is a type of dental imaging modality that produces 3D images of the body. CBCT uses a cone-shaped beam of X-rays to produce images. It is majorly used for the diagnosis and treatment planning of conditions related to the dental and maxillofacial region, and it is particularly useful got producing images of hard tissues, such as teeth and bones.
Which scan is the best
The various scans used in the medical field are OPG, CT, CBCT, MRI, USG, and PET/SPECT. Each scan used has its advantages and disadvantages. It depends on the clinician or the radiologist to decide which scan can be the best-suited one in terms of the requirement.
Is CBCT scan safe or dangerous?
CBCT is one of the most advanced imaging modalities. The advantage of CBCT is the significantly lower radiation caused to the patient which makes it an excellent alternative to conventional CT scans. A conventional CT scan exposes patients to roughly 400-1000 µSv (micro-sieverts) whereas the exposure in CBCT is only about 50-200 µSv, which is roughly 80% lower than a regular CT scan. The reason for this is the cone-shaped beam used in CBCT, which has less scattered radiation.
The exposure can be further reduced with the use of a lead apron. In addition, dental radiation has always been considered safer than other forms of medical radiation because it is directed to areas of the body that just aren’t radiosensitive. And if we shield the areas of concern—like the thyroid—and make sure that the lenses of the eyes are kept out of the x-ray fields, then we are helping the patient to feel safe and protected.
It is also important to take into account that the human body is used to getting bombarded with x-ray radiation from cosmic rays from space and radon gas in the air constantly, from the moment we are conceived to the moment we die. Hence, our bodies are used to repairing the damage caused by low amounts of radiation.
The bottom line is that CBCT is a safer imaging modality when compared to conventional CT, but it still has its radiation factors that should be considered.
Can CBCT scan cause cancer?
The amount of radiation used in CBCT is not 100% safe for mankind. Some studies showed radiation from CBCT may induce a high risk of thyroid, oral, and pharyngeal cancers in both adults and children. The risk is higher in female and young patients to develop cancer, when compared to male and adult patients.
Some other factors such as the position of the X-ray beam and the FOV may also be associated with the risk of cancer. Some studies support that usage of CBCT for orthodontic treatment may put the patient at a high risk of developing cancer because orthodontic treatment is usually provided to younger adults, and since the CBCT scans for the orthodontic treatment are comparative and therefore are repeated for several time.
The justification for a CBCT scan, as well of the timing for performing it, must take into account the above mentioned risk factors (age, gender, position of x-rays, etc.), and the previous exposures to x-ray by the patient. Therefore, a referral (with a clear justification) from a doctor is always required when taking a CBCT scan.
Does CBCT have a lot of radiation?
CBCT (cone-beam computed tomography) is a type of medical imaging that uses X-rays to create detailed 3D images. Therefore, CBCT does involve some radiation exposure. However, the amount of radiation used in CBCT is significantly lower than that used in traditional CT (computed tomography) scans, and the risk of negative side effects from the CBCT radiation exposure is very small.
The radiation dose from a CBCT scan is generally considered to be low. Still, it is important to note that the amount of radiation exposure from CBCT should be considered before the scan, and it should be assured that the benefits of the test outweigh the potential risks.
How often does CBCT scan
In general, CBCT scans are considered to be relatively low-risk procedures, as they use a lower dose of radiation than traditional CT scans. However, the frequency with which a CBCT scan can be performed must be justified and allowed only when the potential benefits outweigh the potential risks. CBCT scans use ionizing x-ray radiation, which is why it is important to carefully consider the need for a repeated CBCT scan before undergoing the procedure.
The permitted frequency of CBCT scans depends on several factors, including the purpose of the scans and the patient’s medical history, including the doses and timing of exposure to x-ray radiation in previous imaging procedures. In some cases, a CBCT scan may be recommended regularly, especially in pedodontics (oral care to children), to track the growth and development of the teeth and jaws in a child.
What are the disadvantages of CBCT?
CBCT scan is an imaging modality that gives a high-quality image in less time with less radiation exposure compared to conventional CT, but still, it has its own disadvantages.
The amount of radiation exposure in CBCT is typically 80% less than the one used in traditional CT, but it is higher than the radiation amount for other types of medical imaging, such as MRI or ultrasound. Therefore, patients who may be at increased risk of developing radiation-induced cancer or those who need to undergo frequent imaging procedures, should be cautious.
CBCT scan is also more expensive than other types of medical imaging modalities, such as OPG (Panoramic) scan. Some patients who may not have insurance coverage or who cannot afford to pay for the CBCT scan are at loss.
In addition, CBCT may not be suitable for soft tissue imaging, nor for patients who are unable to hold still during the 10-30 seconds scan, due to movement or anxiety.
CBCT scan when pregnant
During pregnancy, if possible, X-rays should be avoided! This is especially true and important in the first trimester of the pregnancy, when all the elective treatments that require x-ray exams probably should be postponed.
It is important to inform your clinician as well as the radiographer who performs the scan if you are pregnant or suspect that you may be pregnant, before the scan, because a cone beam CT (CBCT) scan uses ionizing radiation, which can be harmful to a developing fetus. Therefore, it is generally not recommended to undergo a CBCT scan while pregnant.
In some cases, when there is an urgent procedure that cannot be delayed until delivery, and if it is mandatory to take an CBCT x-ray for such treatment, then it can be taken in the second trimester, which is it is considered to be a safer period during pregnancy. In such cases pregnant patients must seek prior advice and approval from a radiologist, and further care can be taken by making the patient wear a lead apron during the scan.
Who does CBCT scans
Cone beam computed tomography (CBCT) scans are typically performed by dentists, radiographers (Roentgen technicians), dental nurses, dental assistants or oral and maxillofacial radiologists. These should all be specialized medical professionals who are trained to position the patient and operate the CBCT scanner.
The regulation in this regard varies from country to country, so it is important to confirm that whoever is working with the CBCT machine is allowed to do so by the authorities. For example – in some countries dental nurses are not allowed to perform dental scans, and in other countries even dentists are not allowed to do it before completing a radiography course, or other types of specialized training and education.
In this respect, it is also important to confirm that whoever is doing the interpretation of the OPG scan results, is qualified by the medical authorities to do so. In some countries, for example, only radiologists are allowed to provide radiology reports to patients, whereas dentists are allowed to use the scans only for their own treatment plan, but not to create, print and provide radiology reports to their patients (unless they took a mandatory dental radiology course or did a dental imaging specialty beforehand).
Where is CBCT done?
A CBCT scan is one of the routinely used dental imaging techniques that produces a wide image of the upper and lower jaws, which can be used for diagnosis in the initial phases. A CBCT is usually done in a dental clinic or a diagnostic imaging center. However, the use of CBCT for educational purposes in dental schools makes it mandatory to have an CBCT machine in dental colleges and in hospital setups.
In different countries, in-house CBCT machines may be very common at dental clinics (e.g. – more than 50% of the clinics in Spain and Germany), whereas in other countries CBCT scans are almost always done externally (e.g. – Greece), at hospitals, at medical imaging centers and at dedicated dental imaging centers (like DentQ and CTdent).
In addition, in some countries it is very common that dentists send patients to do a scan with a colleague – a nearby dental clinic that holds a CBCT device (for example – in HK). This is not always recommended for the dentist, since some of his patients may decide to stay with the clinic they were sent to and do the needed treatment there. Sending patients to independent dental imaging centers (such as DentQ and CTdent imaging branches in many countries) makes more sense for the dentist in this respect, as he will lose less patients to his competitors.
What are DICOM files?
DICOM (Digital Imaging and Communications in Medicine) is a standard for storing and transmitting medical images and related data. It is widely used in hospitals, clinics, and other healthcare settings for storing and sharing medical images.
DICOM files are digital files that use the DICOM format to store medical images and related information. They typically have a .dcm file extension and contain both the image data and metadata such as patient information, image acquisition details, and other relevant information.
DICOM files can be viewed using specialized medical image viewing software, which is typically used by healthcare professionals to diagnose and treat patients. These software applications allow users to view and manipulate the images, as well as extract and analyze the metadata contained within the DICOM files.
Who should decide where the CBCT scan is done?
In most cases, the decision on where a CBCT (cone-beam computed tomography) scan is done is made by the healthcare provider who is ordering the scan. This could be a dentist, oral surgeon, or another medical professional who is responsible for diagnosing and treating the patient’s condition. The provider will typically consider a variety of factors when deciding where to have the CBCT scan performed, including the availability of the necessary equipment, the expertise and experience of the staff at the facility, and the cost and convenience for the patient. It is important for the patient to follow the recommendations of their healthcare provider and to discuss any concerns or questions they may have about the CBCT scan with the provider.
Patients need a referral in order to justify a CBCT scan, as it involved exposure to x-ray radiation. So they are not supposed to come “of-the-street” on their own initiative to do a CBCT exam. In addition, even when they do have a referral, the resulting CBCT scan is not for them to use and interpret, as it requires professional training and education. Hence, patients cannot differentiate between high and low quality of dental imaging service, including CBCT, and therefore should not be the ones to choose where to do it. Dental imaging, including CBCT scans, serve as “an extended pair of eyes” for the dentist, so he is the one that should a dental imaging centers he trusts, just like he is the one that chooses the dentist-chair, the implant brand, or the bone-graft type for their treatment.
The bottom line is that CBCT service providers (and providers of all other dental scans) should be chosen by medical professionals, based on their professional experience, and not by the patients. Patients’ voice is very important in many respects, but we strongly believe that this is not one of them.
Further reading: Who should decide where to do a dental scan?
Software readers for CBCT scan
Cone Beam CT (CBCT) scanners, generate 3D images of an object by taking a series of 2D X-ray images from different angles. The resulting images are used for medical diagnosis, industrial inspection, and other purposes.
Software programs, also known as “viewers,” are used to view and analyze the images produced by CT scanners. Some software programs are specifically designed to work with CBCT scanners and may offer specialized features and tools for viewing and analyzing images.
Before choosing a reader for CBCT scans, it is important to consider:
- Cost: is it a free software, or does it require to purchase a license (and what does it include)?
- Compatibility: the operating systems that it works with (e.g. – Windows? Mac?) and the system requirements
- Functionality: can you only read with it, or also add measurements, create reports, convert to STL, etc.
As mentioned above, software applications that can be used to view and analyze CBCT scan images include, for example:
- Online tools: There are some websites where DICOM files (Digital Imaging and Communications in Medicine) can be uploaded and viewed – including, for example: PostDicom, Horos (for Mac), RadiAnt and 3DimViewer.
- Offline DICOM viewers: There are many free (or freemium) DICOM viewer applications available, that can open and display CT scan data – including: OsiriX, MicroDicom and Sidexis 4.
- Commercial software: Many commercial software programs exist that can open and display CT scan data, as well as plan surgical procedures with, including for example: 3D Slicer, Amira, Avizo, Mimics, and ImFusion.
At DentQ and CTdent dental imaging centers, we provide dentists with a variety of free 3D viewers (iRys, Romexis for Mac and i-Cat) to download at our website in our support page, and we also provide them together with the patients’ results, in a digital format (e.g. – Disk-on-key of CD-ROM) upon request. Note that in order to successfully view a 3D data file (e.g. – a DICOM file), it is important to keep the file in the same directory where you keep the viewer application on your computer.
Can CBCT be used for Implants?
Yes, cone beam computed tomography (CBCT) can be used for dental implants. CBCT is a type of dental imaging modality that produces a detailed 3-dimensional image of the teeth and surrounding structures. It is often used in dentistry for dental implant planning. In fact, this is the most common justification for a CBCT scans.
During a CBCT scan, for image acquisition, a patient is made to sit or stand in front of a machine that rotates around the patient at 180-360 degrees. During the scan, a series of X-ray images from different angles are captured. These images are then combined to create a detailed 3D model of the teeth and surrounding structures with the help of algorithms. The resulting images are cross-sectional images with high resolution which can provide detailed information about the teeth, jaws, and surrounding structures.
Before the implant is placed, detailed and precise planning is required, and for this CBCT servers as an invaluable tool. With the help of CBCT, dentists and oral surgeons can assess the health of the surrounding bone in terms of quantity and quality and can identify any potential risk which can be associated with implant surgery. They can also learn from the CBCT scan what type of implant can fit in, how deep to insert it, is bone graft needed and howe much of it. The CBCT scan can also alert the implantologist about medical conditions that can impact the implant surgery, as well as enable the planning of more complex reconstructions with multiple implants and improve precision for usings implant guides.
Overall, CBCT can be a very useful tool for planning and placing dental implants, as it provides detailed and accurate information about the bone and surrounding structures such as nerves, canals, adjacent teeth, etc.
Is a CBCT scan necessary for dental implants?
To follow up on previous implant surgery, if the implant is asymptomatic then a 2D image such as a periapical image is the most indicated imaging modality. However, if the implant is symptomatic and the periapical radiograph shows bone loss, then a CBCT scan may be advised, to gain a detailed and more accurate image. The image obtained from the CBCT scan can be used to measure and localize bone defects.
In CBCT the multiplanar 3D images are used to determine the exact height, width, and alveolar ridge anatomy of the alveolar bone. By reorienting the MPR images at different angles the relationship of the edentulous sites with adjacent anatomical structures can be viewed. These important vital structures such as the mandibular canal, mental foramen, and the maxillary sinus and nasal fossa can be accurately checked for their proximity to the implant site.
After the CBCT acquisition is complete, the data volume may be exported in a DICOM file format that is compatible with the software, to create virtual 3D models for implant planning or to fabricate surgical guides. These 3D models can be used for patient education, pre-surgical evaluation, and precise treatment planning, and are also the building blocks for digital dentistry operations.
All-in-all, CBCT scan are very useful before, during and following dental implant procedures, and are indeed recommended and necessary in many of these cases.
CBCT scan for root canal
During a CBCT scan for root canal therapy, a small amount of radiation is used to create detailed images of the teeth and surrounding structures. The images are then used to guide the dentist in performing the root canal procedure. The scan can help the dentist identify the location and shape of the root canals, as well as the presence of any abnormalities or infections.
For using CBCT in root canal treatment, it is recommended that the CBCT unit should allow acquiring a small FOV with a small voxel size; which will result a radiographic image with high resolution, thus allowing the accurate evaluation of dental pathoses and relationships with adjacent anatomical structures.
Uses of a limited FOV CBCT in endodontics (the treatment of the dental pulp) can be helpful in two stages:
- Pre-surgical: where a clinician can localize the number of root canals, the length of the individual canal, root apices, and proximity to anatomical structures before an apical surgery. Additionally, a small FOV can help to evaluate the complex pulpal morphology or accessory canals, root fractures, or the presence of resorptive defects.
- Post-treatment: where indications include evaluation of endodontic treatment complications, such as overextended canal obturations, separated instruments, or perforations.
A CBCT may also particularly be beneficial to the clinician for diagnosis in patients with inconclusive intraoral radiographic findings. Some patients have non-specific clinical signs and symptoms associated with untreated or endodontically treated teeth. When the cause is not visible on the intraoral radiograph, then a small size FOV is used.
Which scans detect cancer
Scans such as CT, MRI, CBCT or PET scan can be used to detect cancer, though the level of accuracy varies from one scan to another, and each scan has its limitations in terms of the type of tissues being scanned (hard or soft), area of scan, and the exposure factor.
Can CBCT scan detect cancer?
If cancer is suspected based on other diagnostic tests or clinical symptoms, a CBCT scan may be ordered to help confirm the diagnosis, or to determine the extent of cancer. CBCT scans can provide detailed images of the location and size of a tumor, which can help guide treatment decisions.
A CBCT scan is a wide view of the maxilla and mandibular region with its surrounding structures. The bony structure seen on the CBCT scan can tell us a lot about normal and abnormal conditions. The changes in the bone itself or due to its surrounding structures can be seen on CBCT scans as well. There are various appearances of bone that are typically seen in different types of cancerous lesions, ranging from expansion of bone to resorption of bone. In the CBCT scan, the extent of cancer can be seen with approximate dimensions.
AI, Artificial Intelligence tools (e. g. – DiagnoCat platform, in which DentQ and CTdent exclusively collaborate within many countries) can also detect and alert on unusual findings, including cysts (suspected to indicate cancer). These tools, naturally, work better on 3D scans, such as CBCT.
CBCT scan for TMJ
CBCT scans are often used to diagnose TMJ disorders, assess the results of treatment, or plan surgical procedures. They may be ordered by a dentist, oral surgeon, or another healthcare provider.
The CBCT scan is a non-invasive procedure that is generally quick and painless. It can provide valuable information about the structure and function of the TMJ (osseous component), including any abnormalities or injuries.
A CBCT scan can visualize the TMJs for osseous changes to the mandibular condyle, or glenoid fossa of the temporal bone, which are an osseous component of the joint. However, CBCT will not demonstrate the position or integrity of the disk and the musculature of the TM joints, which are soft tissue component of the joint. CBCT has a limitation for scanning soft tissues.
Therefore, if any soft tissue components of the joint are requested by the clinician, another type of imaging, such as magnetic resonance (MR), is recommended. The use of a CBCT scan for diagnosis and treatment of myofascial pain disorder or disk displacement is not indicated, and thus will not be useful to the clinician.
A CBCT can be used to diagnose any osseous changes to the mandibular condyle or glenoid fossa, which can be the result of trauma/fracture, degenerative changes, or neoplastic processes.
During a CBCT scan for TMJ, a patient will sit or stand in front of a machine and an appropriate scan height is chosen to adequately image the entire joint space. The scanner takes a series of X-ray images from different angles. The images are then combined to create a 3D model of the patient’s head, neck, and jaw with the help of various software, these modes can then be used for patient education and pre- or post-surgical assessment.
Some CBCT machines use an image intensifier as the detector. However, in such cases, the TM joint spaces are often incompletely imaged, or will be visualized at the edge of the spherical scan and prone to distortion.
Does CBCT show infarction?
An infarction means an obstruction of the blood supply to a region, which can occur due to a mass in the blood vessel or a narrowing of the space within the vessel. Considering the area which can be captured on CBCT, the carotid artery at the level of C3 vertebrae can be seen. Therefore, any calcification inside the carotid artery at this level can also be seen on CBCT.
On CBCT, either a nodular radiopaque mass or two radiopaque vertical lines can be seen at the level of the lower margin of the third cervical vertebra (C3). These radiopaque signals represent calcification within the walls of the vessel of the carotid artery, which suggests that CBCT may help to detect calcifications in the cervical region. The level of precision of the CBCT in detecting carotid artery calcification is still under research.
Like other CT scans, CBCT can show infarction, although it may not be as detailed as a traditional CT scan.
Does CBCT show cavities?
CBCT is an advanced imaging modality that uses a cone-shaped beam for producing a high-quality image. The resolution of these images is very high which allows them to show also the minor changes happening in teeth or jaws. Cavities are seen as dark spaces in teeth on CBCT scans. Additionally, orientation of MPR images at different angles can help to locate the exact point of decay/cavities on the teeth.
Can CBCT detect cracked teeth?
Yes, CBCT (cone-beam computed tomography) can detect cracks in teeth. CBCT is a type of 3D X-ray imaging that produces detailed images of the teeth, jaws, and surrounding structures. It is often used to help diagnose and plan treatment for a variety of dental conditions, including cracked teeth.
A cracked tooth may not always be visible on a traditional 2D X-ray, but it can often be detected using CBCT. The detailed 3D images produced by CBCT allow dentists to see the entire tooth and its surrounding structures in greater detail, which can help them identify cracks that may not be visible on a traditional X-ray.
It is also very important to note that while CBCT can help detect cracks in teeth, its radiation exposure may exclude the use of CBCT for this purpose. In some cases, a traditional X-ray or other diagnostic tools may be sufficient (and safer) for detecting cracks in teeth.
CBCT scan for airways
Large FOV CBCT studies, such as those which are done to assess the craniofacial skeleton for orthodontics and orthognathic surgery, can show airway space. The entire airway is composed of the nasal cavity, nasopharynx, velopharynx, oropharynx, and hypopharynx.
The airway which is seen on the scan depends on the position of the soft tissue of the neck, the position of the tongue during acquisition, and the patient’s position while the scan is performed.
In most of the CBCT machines, the patient is in a seating position that does not replicate the sleeping position. CBCT can provide only a static image of the airway space, and it does not provide any direct information on airflow or airway resistance. It can, however, be helpful in the detection of anatomical or pathological changes. The airway model can be developed with CBCT, which can be used for calculating the dimensions or volume of airway space at different levels.
Thus, CBCT can help diagnose obstructive sleep apnea (OSA), although the final diagnosis is typically made through a medical sleep study (polysomnography).
CBCT can also be used to diagnose hyperplasia of the nasal turbinates, which is the most common form of nasal obstruction, and can be caused either by infection or by chronic inflammation. Other causes of nasal obstruction are nasal septum deviation, nasal polyps, benign tumors (such as osteoma), and malignant tumors (such as squamous cell carcinoma).
Neoplasms in the nasopharynx and oropharynx can cause narrowing and/or asymmetry of the airway space. The most common pathological conditions that can affect the airway in children are enlarged pharyngeal and palatine tonsils.
An airway CBCT analysis may be performed before orthognathic surgery. Volumetric measurements can be taken for the patient before and after the surgical treatment along with the position of the jaws.
CBCT scan for a sinus
CBCT scan can be used to view sinuses. The four paranasal sinuses of the head are ethmoid, sphenoid, frontal, and maxillary. They appear as radiolucent (black) areas in normal scans. However, the change in the gray levels (varying opacities) within a sinus on a CBCT image may suggest some type of pathology.
The inner walls of the paranasal sinuses are covered with a thin layer of mucosa, which is not seen radiographically. On a CBCT scan, it can be viewed with great detail. Pathology arising from the sinus, or outside the sinus, causes discontinuity in the floor of the maxillary sinus. And even the minute ones can be viewed.
Indications for sinus scan can include mucosal thickening due to allergies, foreign bodies, or even odontogenic processes in proximity to the floor of the maxillary sinus, or localized reactional mucosal thickening, which might be mucositis. The resolution of CBCT images is so high and accurate that even the calcification of the Schneiderian membrane can be viewed.
A dome-shaped lesion arising from the floor of the sinus, without mucosal thickening of the rest of the sinus, is characteristic of a retention pseudocyst. This common pathologic finding is generally asymptomatic and does not require treatment unless it grows to the point where it blocks the ostium.
Pre-surgical CBCT scan for sinus lift procedures and foreign body removal are also useful.
Does CBCT show bone density?
A CBCT scan is available in the form of DICOM files which are viewed in different software. Every software has a different set of features, and some software can calculate bone density while some cannot. But the files which are generated from the CBCT scan are indeed capable of showing bone density if used in the correct software.
CBCT scan near me
CBCT scan is a routinely used dental imaging modality and it is available in many dental clinics, medical radiology, and dental radiology centers, as well as some hospitals (especially those with dentistry schools, oral medicine departments, or extended radiology departments). To find the nearest CBCT scan, one can use the google search engine.
However, patients need a referral for an CBCT scan, since x-ray radiation is involved, and medical justification signed by a doctor is required. In addition, not all imaging centers are alike, and the service provided may differ in quality and scope. Therefore, it is advisable to visit your dentist and consult with him about where to do the CBCT exam. In addition, it is advisable to arrive with a referral signed by a dentist, or to make sure there will be a doctor that can provide such a referral at the imaging center you plan to visit.
As for DentQ and CTdent dental imaging branches near you, you can find them here.
Radiology Report for CBCT
A CBCT produces images and sections of the entire lower and upper jaws, with sinuses and surrounding structures.
A description of these images in the correct format is important, which can be done by a dental professional who is specially trained for doing so, such as a dentist or a dental radiologist.
A CBCT report summarizes all the findings present on the image and provides any necessary recommendations for treatment if needed.
A radiology report for CBCT would typically include the following:
- Patient’s name, age, and sex
- Identification number
- The date of the CBCT scan
- Interpretation of the images by a dental radiologist
- It may also include any recommendations if required for further testing.
- Date of the report
- Reporting radiologist’s name and signature
The report may be provided to the patient, as well as to the referring healthcare provider who ordered the CBCT exam. It is an important part of the patient’s medical record and can be used to inform treatment decisions and follow-up care.
Radiology reports for CBCT are mandatory in some countries (e.g. – Italy), and then the CBCT scan cannot be provided to the patient without it. Since Dental Radiologists are usually rare, it is important to verify that you receive such reports from a qualified and experienced dental radiologist.
At DentQ and CTdent we have an international Maxillofacial radiology center, with highly experienced dental radiologists, assisted by a well-trained processing team of radiographers (x-ray technicians). Every month we provide CBCT radiology reports in many languages (English, Italian, Hebrew and Greek, to name a few) to many thousands of patients and dentists.
AI reports for CBCT
Artificial Intelligence (AI) system can automatically analyze CBCT images and produce a report on its findings. However, the AI’s report and the images’ interpretations are assessed by a dental professional or a dental radiologist, that can add his observations and remarks (we call it an AI+Human report).
An AI radiology report for a CBCT is similar to a CBCT radiology report made by a dental radiologist, which includes information such as the patient’s name and identification number, and the date of the CBCT. The major difference is the image interpretation, which is an AI report done by the AI software. The time taken for generating AI reports is comparatively less than the one provided by the radiologist. It is done within seconds.
In the present scenario, AI is conquering the healthcare system at an immense pace, but it should always be noted that the patient’s well-being is completely dependent on the correct diagnosis and based on which treatment is provided. Therefore, any decision about treatment or diagnosis should always be made by a qualified healthcare professional, because this is a very critical step.
Thus, the AI report has the advantage of saving time for the patient, which is very helpful, but the report should serve only as an assistive tool and should always be reviewed by a dental professional.
At DentQ, we collaborate with Diagnocat, the most advanced AI platform for interpreting and processing dental imaging scans. We also add human interpretation by our radiologists and processing team, and hence provide AI+Human CBCT radiology reports to our clients.
For the dentist, the AI+Human CBCT report can serve as a neutral and unbiased “second opinion” report, thus improving the dialogue with the patient, and evoking patients’ trust and loyalty. In fact, recent research that compared between dental clinics that use AI radiology reports as a routine, and clinics who have not used AI reports at all, revealed that the former enjoy a 2.5-fold growth of the clinic annual income. Accordingly, we strongly encourage dentists to use AI reports as a mean of communication with their patients.
Further reading: AI+Human radiology report (based on CBCT)
Is CBCT Scanner a medical device?
Yes, a CBCT (cone-beam computed tomography) scanner is defined, licensed and regulated as medical device by the FDA, CE and other medical authorities. Accordingly, it has to comply to the local medical device regulations in the country where it is installed. These usually include instructions related to proper licensing, calibration, maintenance, safety conduct, etc.
To be more precise, CBCT machine is a dental imaging device. It provides detailed three-dimensional images of the of the upper and lower jaws along with their surrounding structures, as well as the head, neck, and spine. CBCT scanner is often used in dentistry and oral surgery to create images of the teeth, jaws, and surrounding structures, as well as in radiology to produce images of the head, neck, and spine. The device uses a cone-shaped X-ray beam to produce detailed images of the body, which can be viewed on a computer and used to help diagnose and treat various medical conditions.
CBCT scan without referral
It is generally mandatory to obtain a referral from a healthcare provider before undergoing a CBCT scan. This is because CBCT scans involve exposure to ionizing (x-ray) radiation, and it is important to ensure that the exam is necessary and appropriate for the individual. A healthcare provider, such as a primary care physician or a specialist, can assess the individual’s symptoms and medical history and determine whether a CBCT scan is the most appropriate test to order.
If you are considering a CT scan without a referral, it is important to first consult with a healthcare provider to determine if the test is necessary and appropriate for you. You should also discuss any concerns you may have about the risks and benefits of the scan with your healthcare provider.
In most of the countries where DentQ and CTdent operate, it is advisable to arrive to one of our dental imaging centers with a referral from a doctor. In some of our locations, there is a resident doctor (usually a radiologists) that can prescribe a referral when needed.
It is also advisable to book your visit to one of our imaging centers in advance. This helps to save time, and to be prepared upfront for the desired exam. However, we do accept “off-the-street” patients, without pre-ordered booking, in most of our branches.
Is a referral required for CBCT?
Yes, it is. As explained above, it is required to obtain a referral from a healthcare provider before undergoing a CBCT scan, since a medical justification is required to do a scan that exposes the patient to ionizing (x-ray) radiation. A healthcare provider, such as a primary care physician or a specialist, can assess the individual’s symptoms and medical history and determine whether a CBCT scan is the most appropriate test to order.
How long are CBCT scans kept for the dentist and the patient?
For the traditional 2D radiographs which use radiographic films, the storage is not for life long because after some years the films start to lose the details, but a CBCT scan has no such limitation it can be stored on a computer in the form of DICOM files which can be viewed at any point of time and can be transferred from one place to another via a secure transfer.
Pending on the local regulation, dental scans (including CBCT files) are kept with other patients’ files, between 8 to 10 years. Old scans can help to review changes in the mouth (and face structures) when compared to newer scans. Some software solutions can help in this comparison automatically (for example – for orthodontic cases).
However, for dental treatment, it is usually better to use scans that are not older than 6 months, in order to take into account “fresh” changes and new medical conditions that took place recently.
At DentQ and CTdent, we usually keep patients records and scans for at least 8 years in our secured cloud, and can provide it as a service to the patients and their dentists many years after we scanned the patients.