Cone beam computed tomography … Kumar M et al Journal of International Oral Health 2015; 7(2):64-68

Received: 15th November 2014  Accepted: 07th February 2015  Conflicts of Interest: None Review Article
Source of Support: Nil

Cone Beam Computed Tomography - Know its Secrets

Mohan Kumar1, Muhammad Shanavas2, Ashwin Sidappa3, Madhu Kiran4

Contributors: Technical basis

1
Professor & Head, Department of Prosthodontics, Mahe The CBCT technique consists of the use of a round or
Institute of Dental Sciences, Mahe, Pondicherry, India; 2Senior rectangular cone shaped X- ray beam with a single 360° scan
Lecturer, Department of Oral Medicine & Radiology, Mahe where the X-ray source and a reciprocating array of detector
Institute of Dental Sciences, Mahe, Pondicherry, India; 3Reader,
simultaneously move around the patient’s head, which is
Department of Oral Pathology, Mahe Institute of Dental Sciences,
Mahe, Pondicherry, India; 4Reader, Department of Conservative stabilized with a head holder. Single projection images, known
& Endodontics, Mahe Institute of Dental Sciences, Mahe, as “basis” images, are acquired at certain degree intervals,
Pondicherry, India. which are similar to lateral cephalometric radiographic images,
Correspondence: each slightly offset from one another. The series of such basis
Dr. Shanavas M. Department of Oral Medicine & Radiology, Mahe projection images is referred to as the projection data, on which
Institute of Dental Sciences, Mahe, Pondicherry, India. Phone: software programs incorporating sophisticated algorithms
+91-8157807166. Email: [email protected] are applied to generate a 3D volumetric data set, which can
How to cite the article: be used to provide primary reconstruction images in all three
Kumar M, Shanavas M, Sidappa A, Kiran M. Cone beam computed
orthogonal planes (axial, sagittal, and coronal).
tomography - Know its secrets. J Int Oral Health 2015;7(2):64-68.
Abstract:
CBCT versus spiral CT
Cone-beam computed tomography (CBCT) is an advanced
imaging modality that has high clinical applications in the field of The fundamental difference between CBCT and spiral CT is
dentistry. CBCT proved to be a successful investigative modality that CBCT utilizes a cone shaped beam and an area detector
that has been used for dental and maxillofacial imaging. Radiation and that captures a full volume of image in a single rotation
exposure dose from CBCT is 10 times less than from conventional where patient movement is not required. On the other hand,
CT scans during maxillofacial exposure. Furthermore, CBCT is spiral CT makes use of a narrowly collimated, fan-shaped
highly accurate and can provide a three-dimensional volumetric X-ray beam and a linear group of detectors. Here, the patient
data in axial, sagittal and coronal planes. This article describes the has to be moved continuously along the gantry while the X-ray
basic technique, difference in CBCT from CT and main clinical beam rotates around the patient. In most of the dental offices
applications of CBCT.
conventional CT has not been widely utilized due to the high
Key Words: Cone-beam computed tomography, diagnostic radiation dosage, the cost of the procedure, proximity to a
imaging, spiral computed tomography, X-ray CT center and a dentist’s unfamiliarity with interpreting CT
results. The use of CBCT can negate these concerns and allow
Introduction for improved diagnosis and patient safety.2 On comparison
Cone beam computed tomography (CBCT) is a radiographic with CT, CBCT has high accuracy and sensitivity and can
imaging method that allows accurate, three-dimensional (3D) capture the maxilla and mandible in a single rotation of the
imaging of hard tissue structures. CBCT is the most significant X-ray source.3-5
among the medical diagnostic imaging modalities that have
emerged recently. This imaging modality is capable of Clinical Applications in the Maxillofacial Region
providing sub-millimeter resolution (2 line pair/mm) images CBCT has gained increased acceptance as a 3D imaging
of higher diagnostic quality, with shorter scanning times modality offering an alternative to CT especially in the
(~60 s). Radiation exposure dose from CBCT is 10 times maxillofacial area.6
less than from conventional CT scans during maxillofacial
exposure (68 μSv compared with 600 μSv of conventional Applications in oral and maxillofacial surgery
CT)1 and also it has got great dimensional accuracy (only Most important application of CBCT in oral and maxillofacial
about 2% magnification). Increasing availability of this surgery is to investigate the exact 3D location of jaw
technology is now providing the dental clinician an imaging pathologies like benign or malignant tumors, inflammatory
modality, which is capable of providing a 3D representation bone lesions,7 to assess impacted teeth, to investigate the
of the maxillofacial structures with minimal distortion and exact location of supernumerary teeth and to assess their
reduced radiation hazards. relation to vital structures,8 to demarcate changes in the

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Cone beam computed tomography … Kumar M et al Journal of International Oral Health 2015; 7(2):64-68

cortical and trabecular bone in cases of bisphosphonate-

associated necrosis of the jaws, and to evaluate bone grafts.
CBCT is also used to investigate the pathologies related to
paranasal sinuses, and to assess obstructive sleep apnoea.9
Since the images of CBCT are collected as a combination
of several two-dimensional (2D) slices, this technique is
superior in overcoming superimpositions and is helpful in
calculating surface distances. These superior features have
made CBCT the technique to go for the investigations of
mid-facial fracture and in inter-operative visualization of
the facial bones after fracture. Furthermore, as CBCT is
not a magnetic resonance technique, it is the best option
for intra-operative evaluation during procedures involving
gun-shot wounds. CBCT is considered to be a better imaging
modality in assessing metal fragments in the face in cases
of fragments embedded from automobile or industrial
accidents, gunshot and for localizing retained broken dental
needles. It is widely used in planning orthognathic and
orthomorphic surgeries. Regardless of the low soft-tissue
contrast of CBCT images, it is considered to be superior
to spiral CT in depicting soft-tissue calcifications, such as
carotid atherosclerosis, tonsilloliths and sialoliths. Small
Figure 1: Cone beam computed tomography image detecting
calcifications are easier to be identified on a CBCT scan than
the presence of fractured instrument and root perforation on
panoramic or intraoral radiographs, and these calcifications
a molar tooth.
can be important diagnostic clues for some types of cysts
and tumors (e.g. Pindborg tumor, Gorlin cyst).10 CBCT has potential in detecting these lesions in its early stage itself.
invaluable applications in the evaluation of dental age, arch In addition to detecting the presence of resorption in cases
segment positioning, cleft size, morphology of the defect, of external root resorption, CBCT is superior in detecting
the volume of graft material necessary for repair, stability the extent of these lesions also.15 It can be used to measure
of the arch after grafting, the quality of the bone graft over a the number of roots, to determine root morphology, root
period, and the effect on overall facial growth in cleft lip and canals and accessory canals, and to establish their working
palate cases.11 Contrast-enhanced CBCT images have been lengths and angulations. It gives an accurate assessment of
widely used in treatment adaptation for tumor visualization root canal fillings, helps in the detection of pulpal extensions
and may lead to improved treatment outcome in the case of in talon cusps and also helpful in detecting the position of
radiotherapy patients.12 fractured instruments. It is a reliable tool for the pre-surgical
assessment of the propinquity of the tooth to adjacent vital
Application in endodontics structures, the size and extent of the lesion through very
CBCT is an important investigative tool in diagnosing accurate measurements. In emergency cases requiring a
apical lesions supported by a few research studies that tooth assessment after trauma, CBCT applications can aid
have shown that contrast-enhanced CBCT images can be in deriving a proper diagnosis to determine the most suitable
used to differentiate between apical granulomas and apical treatment approach.
cysts by measuring the lesion density.13 It has applications
in cases of differentiating the lesions of endodontic and Applications in implant dentistry
non-endodontic origin. Inconspicuous cases of vertical Greater accuracy of CBCT in measurements at lower
root fractures are best diagnosed with CBCT.14 It is more radiation doses has made it a preferred option in implant
favored to periapical radiographs in the detection of dentistry.16 The incorporation of new software to construct
fractures in mesiodistal or buccolingual directions, in the surgical guides has further reduced the possibility of structural
detection of horizontal root fractures, in the measurement damage. CBCT provides reliable information that has led to
of depth in dentin, for the better visualisation of fractured improvements in case selection and aids in both qualitative
instrument and root perforation (Figure 1). Conventional and quantitative measurement of bone, which has led to a
2D radiographs have limitations in detecting early stages of reduction in implant failure. Virtual implant planning using
inflammatory root resorption, whereas CBCT has proved its CBCT data empowers the clinicians to predict and visualize

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Cone beam computed tomography … Kumar M et al Journal of International Oral Health 2015; 7(2):64-68

the end result before initiating treatment.17 The assessment TMJ, thereby reducing the requirement for the use of magnetic
of success of bone grafts and other post-treatment evaluations resonance imaging in these cases. These advantages made
are also possible. CBCT, a valuable imaging device of choice in cases of trauma,
pain and dysfunction, and fibro osseous ankylosis, as well as
Applications in orthodontics in the detection of condylar cortical erosion and cysts.21 The
The applications of CBCT in cephalometric analysis with the advanced 3D imaging features facilitates the safe application
introduction of a new software in orthodontic assessment has of the image-guided puncture technique, which is a treatment
made CBCT, the tool of choice for assessing facial growth, option for the TMJ disk adhesion.
age, airway function and disturbances in tooth eruption.
CBCT is a reliable tool in assessing the proximity of the Applications in periodontics
tooth to vital structures that may interfere with orthodontic CBCT has invaluable applications in the branch of periodontics.
treatment. CBCT acts as a useful visual guiding technique High measurement accuracy with minimal margins of error
for safe insertion of these anchors as well as to evaluate the allows the use of CBCT in obtaining a detailed morphologic
bone density before, during and after treatment, especially description of the bone, with measurement accuracy equal
in cases that require the placement of tiny screw implants to that of direct measurement with a periodontal probe. The
as temporary anchors. This imaging modality incorporates accurate assessment of furcation involvement and detection
multiple different views of an object in one scan (e.g., frontal, of buccal and lingual defects are possible where the value of
right lateral, left lateral, 45°, and sub-mental views), which conventional 2D radiography is limited. CBCT has made a
is an additional advantage. CBCT has the added advantage remarkable contribution in an accurate assessment of intra-
of self-correction of its images for magnification producing bony defects, dehiscence, fenestration defects and periodontal
orthogonal images with a 1:1 ratio thus making it a more cysts. CBCT has also proved its supremacy in evaluating the
accurate option of investigation for the clinician.18 Recent outcome of regenerative periodontal therapy. It has made
studies have shown that the orthodontists had significant an important application that allows for the analysis of the
differences in perception of localization and root damage, buccal and lingual surfaces and an improved visualization of
and a substantially higher confidence in diagnosis and the depth, height and morphology of the defects (Figures 3
treatment planning with CBCT images than with routine and 4).22
radiographs such as panoramic, occlusal or periapical
views.19,20 Applications in forensic dentistry
Dental age estimation is considered an important factor in the
Applications in temporomandibular joint (TMJ) imaging field of forensic science. Non-invasive method of dental age
CBCT is highly effective tool to define the true position of assessment can be performed using CBCT in which an estimate
the condyle in the fossa, thereby revealing the possibility of of the subject’s age can be derived from the subject’s pulp/
dislocation of the disk in the joint and the extent of translation tooth ratio. CBCT images of the face through routine scanning
of the condyle in the fossa (Figure 2). Due to its accuracy, protocols are reliable for measuring soft tissue thickness in
CBCT facilitates easy measurement of the roof of the glenoid the oro facial region, and these images provide an adequate
fossa and provides the ability to visualize soft tissue around the representation of the facial soft tissues.23

Figure 2: Axial, sagittal, coronal and three-dimensional reconstructed cone beam computed tomography images of a normal
temporomandibular joint depicting the condyle-fossa relationship in open and closed mouth position.

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3. Winter AA, Pollack AS, Frommer HH, Koenig L. Cone

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