Journal of Oral and Maxillofacial Radiology / May-August 2015 / Vol 3 | Issue 254

Current status of knowledge, attitude, and perspective of dental practitioners toward cone beam computed tomography: A surveyAmita Aditya, Shailesh Lele1, Priyam Aditya2

Department of Oral Medicine and Radiology, Sinhgad Dental College and Hospital, Pune, Maharashtra, India, 1College of Dentistry, King Faisal University, Saudi Arabia, 2Consultant Prosthodontist, Aditya’s Dental Privilege, Pune, Maharashtra, India,

INTRODUCTION

The introduction of cone-beam computed tomography (CBCT) represents a radical change for dental and maxillofacial radiology. The three-dimensional information appears to offer the potential of improved diagnosis for a wide range of clinical applications.[1]

When compared to conventional CT scanners, CBCT units cost less and require less space, have rapid scan time, limit

the beam to the head and neck, reduce radiation doses and have interactive display modes that offer maxillofacial imaging and multiplanar reformation, making them more suitable for use in dental practices.[2,3] On the other hand, the information obtained from CBCT imaging also requires a substantial level of expertise for interpretation. This implies that the untrained clinician is likely to have a substantial error rate in the interpretation of CBCT images resulting in a high percentage of missed or false positive diagnoses.[4] The European Academy of Dental and Maxillofacial Radiology has issued guidelines for the use of this technology in European countries.[5] However, in many other countries, such guideline is lacking.

In India, CBCT has started gaining popularity as preferred imaging modality by the dental practitioners in recent times. However, CBCT is included neither in the Undergraduate nor the Postgraduate dental curriculum in detail. There is

A B S T R A C T

Context of the Study: In India, cone-beam computed tomography (CBCT) has lately gained popularity as preferred imaging modality by the dental practitioners in recent times. However, CBCT is included neither in the undergraduate nor the Postgraduate dental curriculum. There is also a lack of any standardized training modules on CBCT. Many CBCT imaging centers are being established in various cities of India lately; however optimal use of this technique cannot be assured without assessing the attitude and present status of knowledge of the dental practitioners in this fi eld. This shall warranty some remedial steps; in case a gap in knowledge is identifi ed. Hence, this study was designed to analyze the current status of the knowledge, attitude and perspective of the dental practitioners in Pune, Maharashtra toward the use of CBCT. Materials and Methods: A survey was conducted among dental specialists, using a structured questionnaire. This was complemented with the opinion of the experts in the fi eld of Oral Radiology. Results: The study results indicate that there is a defi nite gap in knowledge of CBCT applications among the dental specialists. The dental specialists themselves feel that there is a lack of awareness as well as training in this fi eld, and strongly perceive a need for the same. Even the experts in the fi eld of oral radiology strongly agree educational strategies must be developed for training in CBCT. Introduction of training in CBCT at undergraduate as well as Postgraduate level, and developing well-structured training modules shall ensure that dental specialists use this technique in an effi cient way to improve the accuracy and reliability of Oral and Maxillo-facial diagnosis, treatment planning and outcomes.

Key words: Cone beam computed tomography, oral radiology, questionnaire

Address for correspondence: Dr. Amita Aditya, Department of Oral Medicine and Radiology, Sinhgad Dental College and Hospital, S. no. 44/1, Vadgaon (Bk) Off Sinhgad Road, Pune - 411 041, Maharashtra, India. E-mail: dr.amita30@rediffmail.com

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DOI: 10.4103/2321-3841.157524

Original Article

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Aditya, et al.: Knowledge, attitude and perspective towards CBCT

Journal of Oral and Maxillofacial Radiology / May-August 2015 / Vol 3 | Issue 2 55

also a lack of any standardized training modules on CBCT in India. Though some workshops are organized sporadically, but there is no standard curriculum or protocol for the same. Although there seems to be a mushrooming of CBCT centers in large cities of India like Pune, the current status of awareness and knowledge regarding CBCT amongst the dental practitioners is not known precisely.

Hence, this study was designed to analyze the current status of the knowledge, attitude and perspective of the dental practitioners in Pune, Maharashtra toward the use of CBCT.

MATERIALS AND METHODS

DesignA survey was conducted among dental specialists, using a structured questionnaire. This was complemented with the opinion of the experts in the fi eld of Oral Radiology.

ParticipantsThe participants included dental specialists and postgraduate students from different branches of Dentistry. Opinion of fi ve experts in the fi eld of oral radiology was also taken over the E-mail regarding this issue.

A questionnaire was designed after an informal discussion with the peers and experts in the fi eld of Oral and Maxillo-facial Radiology. This questionnaire was reviewed by the subject experts, and based on their feedback; suitable modifi cations were done in the design of the questionnaire. The questionnaire was initially validated in a pilot project among fi ve participants, and certain modifi cations were done based on their feedback.

This questionnaire was personally handed over to 50 potential participants, which included teaching faculty at Sinhgad Dental College and Hospital; Pune, private practitioners and Postgraduate students. A brief discussion regarding the questionnaire and any clarifi cation regarding any question was also done during the meeting.

The questionnaire was a self-administrated one and included the demographic details of the participant; including their qualifi cation, designation, specialty, whether they had a private practice and the duration of their experience.

The questions in the questionnaire were focused on participant’s awareness, attitude and his perspective towards the use of CBCT in dentistry. There were certain questions, which were focused at fi nding out the gap in their current knowledge whereas some others were aimed at gauzing their perceived needs about training in CBCT.

A reminder was given to the participants after 1-month for the completion of the questionnaire.

The data collected was sorted, tabulated, and analyzed in the view of the objectives of the study, using descriptive analysis.

RESULTS AND DISCUSSION

A total of 50 dental specialists were invited to participate in the educational project, of which 45 gave their consent to participate. Out of the 45 participants, 11 had BDS degree and 34 were Postgraduates (MDS). 31 participants were faculty at dental college as well as had their private practice whereas four had only clinical practice. Ten postgraduate students also participated in the study. Among the specialists, there were 5 Oral physicians and maxillo-facial radiologists, 6 Endodontists, 4 Orthodontists, 6 Oral surgeons, 1 Pedodontist, 9 Periodontists and 13 Prosthodontists. Hence, there were representatives from almost every clinical branch of Dentistry. There was a wide variation in the work experience of the faculty and practitioners, ranging from 4 months to 21 years.

There was an initial discussion with the participants in which majority of them opined that though they are aware of applications of CBCT in dentistry; their factual knowledge in this fi eld was limited. In fact, 5 of the potential participants approached for the project denied their participation citing the reason of unawareness.

Initial few questions in the questionnaire focused on current practice amongst the dental specialists and perceived usefulness of CBCT by them.

Thirty-two of the participants (71%) said that they advised CBCT in <25% of the cases. Six participants (13%) advised CBCT in 25-49% of their cases. There were 7 specialists who said that they never advise CBCT for any of their cases, and, in fact, two of them were Oral Radiologists. This may indicate a low awareness regarding applications of CBCT among the practitioners. This may also implicate that CBCT is still not very frequently used by dental specialists which could be secondary to low availability of the technique, high cost or inability of case selection for CBCT imaging by the dentists.

Very few studies have been reported in the literature regarding the knowledge and attitude of the present day dental fraternity toward advanced oral radiographic imaging.[6,7] Reddy et al. carried out a study to evaluate knowledge and attitude of dental fraternity toward CBCT

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Aditya, et al.: Knowledge, attitude and perspective towards CBCT

Journal of Oral and Maxillofacial Radiology / May-August 2015 / Vol 3 | Issue 256

in South India.[8] They found that there was low awareness amongst the Dentists regarding applications of CBCT. They pointed out the lack of availability of few CBCT centers in institutions in India as well as noninclusion of CBCT training during dental education could be the possible causes of this low awareness. They recommended that owing to the vast usage of CBCT in various fi elds of dentistry, there is a need for well-guided and well-planned teaching programs for the present day dental fraternity.

Another study done in Turkey by Kamburoglu et al. indicated that there was a very low awareness about CBCT amongst the dental students. They also suggested that efforts should be made to improve students’ knowledge base regarding CBCT and that the dental school curriculum should devote more curriculum time to this promising new technology.[6]

Literature shows that CBCT has a wide application in the fi eld of dentistry.[9-11] However, the majority of our participants either advised CBCT in less than one-fourth of their cases or did not advise CBCT at all. This may represent a conundrum amongst the dental specialists regarding applications of CBCT. In our study, Prosthodontists seemed to be using CBCT for treatment planning more commonly than specialists of other branches. This may indicate that the potential of CBCT in other branches still remains unexplored.

As many as 33 (73%) participants agreed that CBCT was very useful for implant planning and assessment of the proximity of the surgical site and/or pathology to the vital structures. Twenty-one (47%) participants opined that CBCT is useful, and 19 (42%) opined that it is very useful for additional imaging for pathology to supplement two-dimensional imaging. The majority of participants (80%) also felt that CBCT is useful in orthodontic, periodontal, endodontic and temporomandibular Joint assessment. There was no response regarding the usefulness of CBCT in ENT assessment by 12 participants, and in airway study by 14 participants. This shows that dental specialists do have a fair idea about the usefulness of CBCT in different fi elds of dentistry; however, they are not sure about its usefulness in relatively unconventional applications like airway study. There were certain confl icting responses like 19 participants felt that CBCT is useful or very useful in assessing soft tissue pathologies and 28 thought that it is useful in the assessment of mixed dentition in children and adolescents. This defi nitely indicates a gap in knowledge regarding CBCT as the above two are not considered to be its indications. The appropriate and effi cient use of CBCT is not possible if the dental practitioners are unable to select specifi c cases for CBCT examination.

Nearly half of the dental specialists (22) responded that it’s the personnel at CBCT center who does interpretation for them, whereas a very few (3) relied on the interpretation done by Oral and maxillo-facial radiologist. Seven of the participants said that they either do the interpretation themselves or rely on the personnel at CBCT center. A few dental specialists (10) seem to be interpreting the images themselves.

Only a few (11) dental specialists actually were aware of the CBCT machine used at their referral center and only 4 were aware of the software used for viewing the images. 23 confessed that they were satisfi ed only to some extent with the report provided by their referral center. Four of the dental specialists were not satisfi ed with the report provided by the referral centers. One of the participants pointed out a very interesting fact that many of the features of the CBCT software are locked by the CBCT centers, because of which he is not able to use the image volume to his desired extent. Six of the participants commented that they would like to do the interpretation themselves according to their clinical needs, but were unable to do so because of lack of expertise in the fi eld. This scenario defi nitely indicates a need of giving some basic training in CBCT to the dental professionals so that they can use this technology effi ciently for their diagnostic and clinical needs.

Some of the questions in the questionnaire were specifi cally designed to evaluate the present status of knowledge and expertise regarding CBCT imaging among the dental specialists. Nine participants felt that the ability of a CBCT machine to generate DICOM images is very important, 13 felt it was important, 2 felt it was least important whereas 21 had no idea about this issue. Only 8 of the participants were able to able to obtain orthogonal views in CBCT images whereas others had no idea what orthogonal views mean. On the other hand, 30 were able to mark important structures like inferior alveolar nerve on the CBCT image. Only 20 used multiplanar reconstruction to examine the images. Fourteen dental specialists said they were able to identify the normal anatomical structure in the sectional CBCT images with an accuracy of more than 80%, where another 14 said they were able to do so 50-80% of times. Five said they were able to do so 25-49% of times whereas twelve of them said they could identify it <25% of time. Not even a single participant was able to tell the optimum spatial resolution of CBCT correctly. Many of the participants did not respond to these questions at all and stated that they have no idea regarding these features. The response regarding the relative importance of CBCT machine characteristics was also very low and more than half of the participants had no idea about these features. Nine participants felt that the main cause of poor CBCT

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Aditya, et al.: Knowledge, attitude and perspective towards CBCT

Journal of Oral and Maxillofacial Radiology / May-August 2015 / Vol 3 | Issue 2 57

image quality was poor patient positioning, whereas 5 felt it was secondary to patient motion. One of the participants felt that poor image quality could be secondary to low-quality CBCT machine used by the CBCT centers.

The responses to the above questions emphasized the absence of complete and accurate information regarding CBCT, as it is a recent advancement in the fi eld of oral radiology. The optimum use of any technology is possible only when there is an understanding of the technical nuisances related to it. CBCT seems to have a tremendous potential as an imaging modality in the fi eld of dentistry.[11] However, if there is a lack of awareness among the dental practitioners, its potential can never be explored to the fullest. This low awareness could be attributed to lack of formal training in CBCT as evident by the fact that only 6 (13%) of our participants had undergone any such training. Even 75% of the Oral and maxillo-facial radiologists did not have any training in CBCT. All of the participants felt that there is a lack of the standardized training program in CBCT in India. There was only one participant who said that there is no need for such special training, but more information regarding CBCT shall be included in the existing dental curriculum.

The above fi ndings indicate that there is a general need felt by the dental specialists to have a structured, detail and formal training in CBCT.

Five experts in the fi eld of Oral Radiology who also have signifi cant expertise in CBCT imaging were approached to participate in the project and present their valuable feed-back. All of them either owned or worked in a CBCT center, and three of them also had a formal training in CBCT. Similar to the opinion of the dental specialists, the experts’ opinion also emphasized the need of training the dentists in CBCT, and including it in detail in the undergraduate and postgraduate curriculum. They also expressed the need of developing a well-structured training module for the same.

CONCLUSION

Cone beam computed tomography is a relatively advanced imaging technique with a profound potential in the fi eld of

dentistry. This fact is now being realized and accepted by the dental specialists. The study results indicate that there is a defi nite gap in knowledge of CBCT applications amongst the dental specialists. The dental specialists themselves feel that there is a lack of awareness as well as training in this fi eld, and strongly perceive a need for training in this fi eld. Introduction of training in CBCT at undergraduate as well as Postgraduate level shall ensure that dental specialists use this technique in an effi cient way to improve the accuracy and reliability of oral and maxillo-facial diagnosis, treatment planning and outcomes.

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Cite this article as: Aditya A, Lele S, Aditya P. Current status of knowledge, attitude, and perspective of dental practitioners toward cone beam computed tomography: A survey. J Oral Maxillofac Radiol 2015;3:54-7.

Source of Support: Nil. Confl ict of Interest: None declared.

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