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      Cone Beam Computed Tomography in Oral and Maxillofacial Surgery: An Evidence-Based Review

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          Abstract

          Cone Beam Computed Tomography (CBCT) is a valuable imaging technique in oral and maxillofacial surgery (OMS) that can help direct a surgeon’s approach to a variety of conditions. A 3-dimensional analysis of head and neck anatomy allows practitioners to plan appropriately, operate with confidence, and assess results post-operatively. CBCT imaging has clear indications and limitations. CBCT offers the clinician 3-dimensional and multi-planar views for a more accurate diagnosis and treatment without the financial burden and radiation exposure of conventional computed tomography (CT) scans. Furthermore, CBCT overcomes certain limitations of 2-dimensional imaging, such as distortion, magnification, and superimposition. However, CBCT lacks the detailed depiction of soft tissue conditions for evaluation of pathologic conditions, head and neck infections, and temporomandibular joint (TMJ) disc evaluation. This review evaluates the evidence-based research supporting the application of CBCT in the various fields of oral and maxillofacial surgery, including dentoalveolar surgery, dental implants, TMJ, orthognathic surgery, trauma, and pathology, and will assess the value of CBCT in pre-operative assessment, surgical planning, and post-operative analysis when applicable. Additionally, the significant limitations of CBCT and potential areas for future research will be discussed.

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          Most cited references120

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          Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis.

          As part of the Multisite Research Diagnostic Criteria For Temporomandibular Disorders (RDC/TMD) Validation Project, comprehensive temporomandibular joint diagnostic criteria were developed for image analysis using panoramic radiography, magnetic resonance imaging (MRI), and computerized tomography (CT). Interexaminer reliability was estimated using the kappa (kappa) statistic, and agreement between rater pairs was characterized by overall, positive, and negative percent agreement. Computerized tomography was the reference standard for assessing validity of other imaging modalities for detecting osteoarthritis (OA). For the radiologic diagnosis of OA, reliability of the 3 examiners was poor for panoramic radiography (kappa = 0.16), fair for MRI (kappa = 0.46), and close to the threshold for excellent for CT (kappa = 0.71). Using MRI, reliability was excellent for diagnosing disc displacements (DD) with reduction (kappa = 0.78) and for DD without reduction (kappa = 0.94) and good for effusion (kappa = 0.64). Overall percent agreement for pairwise ratings was >or=82% for all conditions. Positive percent agreement for diagnosing OA was 19% for panoramic radiography, 59% for MRI, and 84% for CT. Using MRI, positive percent agreement for diagnoses of any DD was 95% and of effusion was 81%. Negative percent agreement was >or=88% for all conditions. Compared with CT, panoramic radiography and MRI had poor and marginal sensitivity, respectively, but excellent specificity in detecting OA. Comprehensive image analysis criteria for the RDC/TMD Validation Project were developed, which can reliably be used for assessing OA using CT and for disc position and effusion using MRI.
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            Limited cone-beam CT and intraoral radiography for the diagnosis of periapical pathology.

            To compare intraoral periapical radiography with 3D images for the diagnosis of periapical pathology. Maxillary molars and premolars and mandibular molars with endodontic problems and examined with periapical radiographs and a 3D technique (3D Accuitomo) were retrospectively selected and evaluated by 3 oral radiologists. Numbers of roots and root canals, presence and location of periapical lesions, and their relation to neighboring structures were studied. Among 46 teeth, both techniques demonstrated lesions in 32 teeth, and an additional 10 teeth were found in the Accuitomo images. As regards individual roots, 53 lesions were found in both techniques, and 33 more roots were found to have lesions in Accuitomo images. Artefacts were sometimes a problem in Accuitomo images. In 32 of the 46 cases, all observers agreed that additional clinically relevant information was obtained with Accuitomo images. A high-resolution 3D technique can be of value for diagnosis of periapical problems.
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              The radiological prediction of inferior alveolar nerve injury during third molar surgery.

              The surgical removal of an impacted mandibular third molar may result in damage to the inferior alveolar nerve and may cause disabling anaesthesia of the lip; anaesthesia of the lower gingivae and anterior teeth may also result. Assessing the likelihood of injury depends to a great extent on preoperative radiographic examination. Seven radiological diagnostic signs have been mentioned in the literature; the reliability of these signs as predictors of likely nerve injury have been evaluated through retrospective and prospective surveys. Three signs were found to be significantly related to nerve injury and a further two were probably important clinically.
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                Author and article information

                Journal
                Dent J (Basel)
                Dent J (Basel)
                dentistry
                Dentistry Journal
                MDPI
                2304-6767
                02 May 2019
                June 2019
                : 7
                : 2
                : 52
                Affiliations
                [1 ]Department of Oral and Maxillofacial Surgery, Texas A&M University College of Dentistry, Dallas, TX 75246, USA
                [2 ]Baylor Scott and White Health, Baylor University Medical Center—Dallas, Dallas, TX 75246, USA
                [3 ]Attending Physician, Baylor Scott and White Health, Baylor University Medical Center—Dallas, Dallas, TX 75246, USA
                Author notes
                [* ]Correspondence: rweiss@ 123456tamhsc.edu (R.W.II); readfuller@ 123456tamhsc.edu (A.R.-F.)
                Author information
                https://orcid.org/0000-0001-8443-0873
                Article
                dentistry-07-00052
                10.3390/dj7020052
                6631689
                31052495
                36e0c57f-65e5-4b40-8ca4-1b0ba1b75973
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 01 March 2019
                : 11 April 2019
                Categories
                Review

                cone beam computed tomography (cbct),evidence-based,oral and maxillofacial surgery

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