CBCT scans provide a 3 D visualization of an Oral & Maxillofacial region which provides a deep and insight information of the structures.

The scan can be done in many situations and help in making a definitive treatment plan.

At Voxel CBCT, the scans are done for various types of conditions and pathologies and we provide the clinically oriented report with a better diagnosis and proper treatment plan to best of our knowledge.

Implant Planning

A field that has been benefited the most since the advent of CBCT is the field of dental implantology. Implants now can be placed with much higher predictability due to pre surgical evaluation of the implant site (both qualitative and quantitative)

  • Quantitative & Qualitative analysis of bone – Sectional images with Measurements.
  • Correlation with the adjacent anatomical structures.
  • Exact dimensions and quality of all the cortices relevant in the implant planning.
  • Clinically driven Implant Planning
  • Comprehensive Full mouth Implant analysis

Implant Planning is done for

  • Single tooth replacement with an implant
  • Multiple teeth replacement with implants
  • Full mouth rehabilitation:
    • All on 4 implant planning
    • All on 6 implant planning
    • Zygomatic Implant planning

Endodontic Evaluation

High-resolution endodontic CBCT scans help determine certain underlying conditions that may go unnoticed in plain/2D radiographs.

This way, the prognosis can be established with the help of CBCT, before taking up a root canal procedure.

The Endo scan will help the visualization of the following, which will help the clinician to confirm the diagnosis with and proceed with the apt & best-suited treatment plan for the patient.

  • Canal localization
  • Canal configuration
  • Fractures
  • Microcracks
  • Perforations
  • Internal and external root resorption
  • Periapical lesions
  • Endo Perio lesions

Impacted Molars

The classic Winter’s classification and the WAR lines from almost a century ago are still in use in the diagnosis and treatment planning of impacted mandibular third molars. Earlier practiced on IOPA radiographs acquired using paralleling technique, orthopantomograms soon became the radiograph of choice in screening, planning and surgical tracing of impacted mandibular third molars. After the advent of CBCT, it became a popular modality for the visualization of Root anatomy, Nerve localization and relation of root with adjacent structure.

There is a new classification system that is based on the CBCT that would enable the operator to orient oneself in three dimensions to evaluate the position of the canal in relation to the tooth and the degree of involvement of the canal with the root apices.1 It is also tricky to visualize a complex root anatomy on an orthopantomogram due to overlap. CBCT helps in visualizing the number, curvature and fusion in roots with complex anatomy.

The following details can be seen in all three dimensions:

  • Tooth position (also, the location of crown for placement of orthodontic device).
  • Root morphology.
  • Relation of the Inferior Alveolar Nerve canal.
  • Cortical plate thickness.
  • Relationship with the adjacent tooth structure.

(1. Gu L, Zhu C, Chen K, Liu X, Tang Z. Anatomic study of the position of the mandibular canal and corresponding mandibular third molar on cone-beam computed tomography images. Surg Radiol Anat 2018;40(6):609–14.)

Impacted Canines & Premolars

Impacted canines and premolars can be treated either by extraction or assisted eruption depending on the indications. CBCT would again help the operator orient oneself in three dimensions to understand whether the tooth is present buccally or palatally/ lingually to predict the probable path of eruption and to determine the cause(s) of impedance in eruption.

One can also ascertain the access (buccal or palatal/lingual) and the amount of bone required to be removed if surgical exposure and orthodontic bonding of the tooth is planned.

One can also assess the involvement of nearby anatomic structures of importance (e.g. maxillary antrum and the foramina, nerve canal) to avoid possible post-surgical complications.

Impacted canines can be visualized for the various purposes

  • Location of unerupted/ impacted teeth
  • Effect of unerupted teeth on the adjacent tissues.
  • Path of the eruption.
  • Tooth position & available bone over the crown ( the location of crown for placement of orthodontic device).

Cysts, Tumours & Maxilofacial Pathology

Intraosseous Cysts of the maxillofacial region are not uncommon and can be screened using a diagnostic orthopantomogram. CBCT is a boon in diagnosis and treatment planning for such lesions.

The information that a cone beam radiograph can provide regarding cysts:

  1. Superior-inferior (Craniocaudal), mediolateral and anteroposterior extension of the lesion
  2. Volume estimation of the cyst is possible to plan for bone graft post enucleation (depending on the volume, one can select whether to choose an allogenic or autogenous bone graft and further select the secondary surgical site, e.g. anterior iliac crest, mandibular symphysis etc.)
  3. Facial or palatal (lingual) location of the cyst – it helps determine the surgical access
  4. The thickness of the remaining cortical plates or the inferior border of the mandible which shall help in the requirement of a palatal or lingual prosthesis and to develop a contingency plan for a possible pathological fracture.
  5. Sometimes the teeth that are marginally involved in a cyst and would require attention are easily missed in two-dimensional radiographs.

 CBCT in tumours proves to be beneficial as it correctly depicts the extent and orientation of osseous and intraosseous lesions. Quality and degree of bone formation can be understood in detail by cone-beam imaging in different types of osseous and fibro-osseous lesions. It will also help in planning the debulking/resection of the lesion. With accurate measurements, the ensuing deformity can be predicted, and appropriate reconstruction option can be planned. It is also possible to print the bone using 3D printing and prepare a surgical template for different steps of resection and reconstruction.

Temporomandibular Joint Disorders

Although panoramic radiographs are used in initial screening of TMJ disorders and MR imaging is used to ascertain disc position, CBCT assists as a cost-effective measure to understand the degenerative bony changes in the mandibular condyle and fossa. Patients presenting with excessive pain, gritting and crepitus of the joint should undergo CBCT, which will depict the cortical bone morphology of the articulating surfaces. Also, CBCT, in different cut sections, would be able to show advanced degenerative changes like the presence of subcortical cysts.

 The CBCT scan is indicated in:

  • Pain in TMJ.
  • Clicking of TMJ.
  • Fractures of TMJ
  • TMJ arthritis/arthrosis.
  • Systemic arthritis manifested in the TMJ.
  • Ellis cyst.

Degenerative bony changes such as erosion, lipping, osteophytes.

Orthognathic Surgery

Two-dimensional skull radiographs are essential for various cephalometric analyses and orthodontic diagnosis. But once an ortho-surgical treatment plan is ascertained, CBCT can be an important diagnostic tool in refining the surgical planning.

  1. CBCT can help determine the exact discrepancies of mandibular ramus height, body length, lower border asymmetry etc.
  2. Sagittal split ramus osteotomy is the workhorse of mandibular orthognathic surgery. One of the dreaded complications of this procedure is the propagation of a bad split. CBCT imaging of the mandible helps visualization of the lingula and its relations from the anterior border of ramus and the last standing molar. 3D printing can be used to make a surgical template for different cuts to enhance precision or, the mandible can be printed, and mock surgeries can be carried out. It is also possible to put indicative fiducial markers on the surgical instruments to keep a track of measurements during osteotomy. Measurement of cortical thickness and location (as seen on coronal sections) of the crista colli mandibulae would give an insight on the possible propagation of bad splits and assist in selection and planning of alternative osteotomies. Similarly, the overall quality and thickness of the mandible, including its lower border, can be studied before surgery.
  3. Maxillary cortical thickness, sinus and pyriform anatomy and location of infraorbital foramina are important steps that can be carried out before maxillary surgery using CBCT. As mentioned before, a 3D printed surgical template can be used in placing the osteotomy lines.
  4. CBCT of zygomatic bone would help determine the most suitable region on the buttress for placement of skeletal anchorage systems.

Maxillofacial Trauma

Patients in whom, head and cervical spine injuries have been ruled out clinically and who can maintain an upright standing position are good candidates to undergo CBCT imaging. CBCT is an excellent tool in understanding the fracture pattern, extent, communition and displacement of mandibular fractures, including that of the condyle. Targeted imaging of other regions like the midface, bony orbit, naso-orbito-ethmoid complex, nasal bones, zygomatic bones and arches and frontal bone can be done based on the clinical features to visualize traumatic defects in respective regions.

Pre prosthetic Surgery

Cone beam imaging is a preferred mode of diagnostic imaging in all types of surgical-prosthodontic planning. CBCT is capable of showing:

  • Bone quality of the edentulous areas
  • Exact dimensions and contour of the residual ridge
  • Residual mandibular/maxillary height
  • The proximity of important anatomic structures, e.g. pyriform aperture, mental foramina, etc.
  • Implant planning (*discussed further in the implantology section)
  • CBCT of targeted regions like the bony orbit or temporal bone can be obtained for planning and placement of craniofacial implants for prosthesis.
Orthodontic Evaluation

As CBCT scans carry an added advantage of the 3D reconstruction as well as the detailed alignment of the anatomical structures, it becomes easy for the treating clinician to assess the possible outcome. And if required, alter it accordingly.

Impacted canines can be visualized for the various purposes

  • Location of unerupted/ impacted teeth
  • Effect of unerupted teeth on the adjacent tissues.
  • Path of the eruption.
  • Skeletal deformities.
Periodontal Disease evaluation

2D scans have a limited scope in predicting the prognosis in periodontal diseases. The assessment of bony defects – extent and dimension of the bone loss and quality of the remnant bone, gives a clearer idea of the condition. More focused treatment can be planned to achieve the best results.

The CBCT scan is indicated in:

  • 1 walled, 2 walled, 3 walled defects
  • Fenestrations
  • Dehiscence

Periodontal cysts and abscesses

Diagnosis of Sinus Pathologies

Paranasal sinuses are readily appreciated in the CBCT of the head and neck region. The scans are evaluated by our team, which has expertise in the diseases of paranasal sinuses such as:

 The CBCT scan is indicated in:

  • Sinusitis (Acute, Chronic, Fungal)
  • Inflammatory polyps, mucoceles, and mucous retention cysts
  • Fibro-osseous lesions
  • Neoplasms and Non-Inflammatory soft tissue pathology