Mitos y Verdades Del CBCT in Orthodontics

7/25/2019 Mitos y Verdades Del CBCT in Orthodontics

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Short Communication

Myths and facts of cone beam computed tomography in orthodontics

Ahmad Abdelkarim a,*

a Care Planning and Restorative Sciences, University of Mississippi, School of Dentistry, Jackson, Mississippi

a r t i c l e i n f o

Article history:

Received 9 December 2011

Received in revised form

16 March 2012Accepted 9 April 2012

Available online 11 May 2012

Keywords:

Advanced imaging

Cone beam CT (CBCT) in orthodontics

Myths and facts of CBCT in orthodontics

Orthodontic cone beam CT

a b s t r a c t

Cone beam computed tomography (CBCT) is a revolutionary imaging modality. It has changed numerous

aspects of dentistry and has added great value to its diagnostic phase as well as that of orthodontics.

Three-dimensional imaging CBCT has the potential to improve the diagnosis and treatment planning of

cases. However, there has been some confusion about CBCT and its implementation in orthodontics. Thiscould be due to overmarketing or limited understanding of the imaging technique itself. The purpose of

this article is to present 10 myths about CBCT in orthodontics and replace them with facts about this

imaging technique.

Published by Elsevier Inc.

1. Introduction

Cone beam computed tomography (CBCT) is a revolutionary

imaging modality that has changed numerous aspects of dentistryand has added great value to its diagnostic phase as well as that

of orthodontics. CBCT three-dimensional (3D) imaging has the

potential to improve the diagnosis and treatment planning.

With the desire to enhance treatment by incorporating the

highest technological advancements, CBCT has attracted signicant

attention. The potential applications in orthodontics have been

recognized and appreciated.

One of the most common selection criteria of CBCT in ortho-

dontics is evaluation of impacted teeth [1e4]. It allows visualization

in three dimensions, and the relation to adjacent teeth. For ex-

ample, visualization of an external resorption of a maxillary lateral

incisor due to impaction of a maxillary canine can be precisely

evaluated [5]. Additionally, CBCT can reveal the presence or absence

of the canine, size of the follicle, inclination of the long axis of the

tooth, relative buccal and palatal positions, amount of the bone

covering the tooth, local anatomic considerations, and overall stage

of dental development[6]. Supernumerary teeth can be evaluated

as well [7]. Additionally, CBCT examination is recommended in

patients with dentofacial deformities, including severe facial

asymmetry or facial disharmony[8], cleft palate[9], patients with

obstructive sleep apnea, and when a patient has an airway study

[10e15]. The clear advantage of CBCT in these cases is evaluation of

3D structures through a 3D imaging modality. Additionally, the

nasopharyngeal and oropharyngeal airway can be assessed involume size and shape. Moreover, if temporary anchorage devices

are planned, CBCT can assist in initial site assessment [16e24], or

temporary anchorage device site status evaluation[25e27].

Therefore, CBCT applications in orthodontics are plentiful.

However, it is easy to be seduced by the sheer beauty of CBCT image

reconstructions. Following the ethical principle of nonmalecence,

practitioners in health care are supposed to minimize harm to

patients. A cornerstone of radiation protection is to keep radiation

As Low As Reasonably Achievable,the ALARA principle.

There has been some confusion about CBCT and its imple-

mentation in orthodontics. This could be due to overmarketing or

limited understanding of the imaging technique itself. The purpose

of this article is to present 10 myths about CBCT in orthodontics and

replace them with facts about this imaging technique.

The 10 myths of CBCT in orthodontics are (1) CBCT exposes

orthodontic patients to low radiation; (2) if daily background

radiation is 8 mSv, any CBCT acquisition would be justied because it

has the effect of only few days of background radiation; (3) we must

have totally new 3D CBCT cephalometric analyses that replace two-

dimensional (2D) standardized analyses; (4) CBCT can replace

impressions for orthodontics and be as accurate; (5) volume

rendering is sufcient to display external root resorption; (6) CBCT

changes the nal outcome of orthodontic treatment; (7) Boards of

Orthodontics will eventually adopt CBCT for all orthodontic records

and superimpositions; (8) CBCT is sufcient and the best imaging

* Corresponding author: Care Planning and Restorative Sciences, University of

Mississippi, 2500 N. State Street, Jackson, MS 39216.

E-mail address: [email protected].

Contents lists available atSciVerse ScienceDirect

Journal of the World Federation of Orthodontists

j o u r n a l h o m e p a g e : w w w . j w f o . o r g

2212-4438/$ e see front matter Published by Elsevier Inc.

doi:10.1016/j.ejwf.2012.04.002

Journal of the World Federation of Orthodontists 1 (2012) e3ee8
mailto:[email protected]://www.sciencedirect.com/science/journal/22124438http://www.jwfo.org/http://dx.doi.org/10.1016/j.ejwf.2012.04.002http://dx.doi.org/10.1016/j.ejwf.2012.04.002http://dx.doi.org/10.1016/j.ejwf.2012.04.002http://dx.doi.org/10.1016/j.ejwf.2012.04.002http://dx.doi.org/10.1016/j.ejwf.2012.04.002http://dx.doi.org/10.1016/j.ejwf.2012.04.002http://www.jwfo.org/http://www.sciencedirect.com/science/journal/22124438mailto:[email protected]


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modality to examine the temporomandibular joints (TMJ); (9) if

CBCT is ordered, the orthodontist is at liability risk for any

pathology in the scan; and (10) CBCT is an orthodontic practice

builder.

2. Myth 1

CBCT exposes orthodontic patients to low radiation.

2.1. Fact

The effective dose of an imaging modality is a commonly used

term in radiation biology and presents a numeric value in micro-Sieverts (mSv). It provides a mechanism for assessing the radiation

risk from partial body irradiations in terms of data derived from

whole body irradiations. It is calculated as the weighted average of

the mean absorbed dose to the various body organs and tissues,

where the weighting factor is the radiation risk for a given organ

(from a whole-body irradiation) as a fraction of the total radiation

detriment[28].

The effective dose of CBCT is quite exible and the range is much

wider than other imaging techniques used in dentistry. Table 1

describes that the effective dose of panoramic radiography is esti-

mated to be 2.7 to 23 mSv [29e34]. Cephalometric radiography

effective dose is approximately 1.7 e 3.4 mSv[35].

On the other hand, effective dose range of CBCT is very large and

can be anywhere from 20 to 1000 mSv, depending on the machine,eld of view, and selected technique factors[29,31,34,36e40]. Only

one CBCT machine with large eld of view exceeded 1000 mSv[36].

Each CBCT device uses different settings, which results in a wide

range of the effective dose. The latest ndings report that this wide

effective dose range of different CBCT devices is strongly related to

eld size [41]. Increasing the eld of view would increase the

effective dose [31]. Alternatively, reducing the volume size is

perhaps the best way to reduce radiation exposure for the patient.

For example, an impacted tooth does not require imaging of the

whole head. A smaller volume of 40 40 mm, for example, may be

appropriate. This has the potential benet of increased resolution of

theimages because most CBCT machines that provide different scan

volume options usually use larger voxel size on large eld of view

scans and smaller voxels in smaller eld of views.Fortunately, CBCT effective dose is comparatively smaller than

traditional medical CT imaging technique[42e48]. In other words,

CBCT effective dose is higher than conventional panoramic and

cephalometric radiography, but less than conventional CT.

No approach regarding CBCT radiation risk assessment in chil-

dren in particular has been examined yet. However, a CT study

found that the smaller mass of children caused the corresponding

effective doses to be higher than those in adults undergoing similar

CT examinations[49].

Generally, thyroid shielding with a leaded thyroid shield

or collar is strongly recommended for children and pregnant

women d these patients are particularly sensitive to radiation[50].

This reduces the risk because lead shielding reduces the effective

dose[38].

3. Myth 2

If daily background radiation is 8 mSv, any CBCT acquisition

would be justied because it has the effect of only few days of

background radiation.

3.1. Fact

There are certainly other sources of radiation from naturalsources and human activities besides diagnostic imaging. Natural

background radiation, terrestrial radiation, and long ights at high

altitudes constantly expose humans to radiation. The annual global

per capita effective dose due to natural background radiation

sources alone is estimated to be about 2400 mSv at sea level, and

may be of wide range between 1000 and 3000 mSv. Consequently,

the natural background radiation is estimated to be about 8 mSv

per day.

It is correct that a certain CBCT effective dose of 50 mSv is

equivalent in magnitude to 6 or 7 days of background radiation;

however, the effect is entirely different because the acute nature of

CBCT exposure of few a seconds is unlike the very low, continuous,

and chronic exposure of background radiation.

Radiation hormesis concept suggests that very low doses ofcontinuous and chronic ionizing radiation that are equivalent to

natural background levels are, in fact, benecial. This is because

they stimulate the activation of repair mechanisms that protect

against the disease process[51,52].

Therefore, it is better to adhere to the radiation protection

concept of ALARA[53], than comparing CBCT to background radi-

ation, a source that cannot be controlled anyway. Ideally, CBCT

should be acquired in orthodontics when a 3D evaluation is

required. Otherwise, conventional 2D imaging might be sufcient.

For example, ordering a full head CBCT scan just to build cephalo-

metric and panoramic radiographs is not justied, because these

two radiographs could have been ordered without exposing the

patient to the additional radiation. As previously mentioned, a full

head CBCT effective dose, in some machines and settings, can bemuch higher the combined dosage of digital panoramic and ceph-

alometric radiographs.

Consequently, ordering the higher radiation CBCT just to build

panoramic and cephalometric radiographs is not consistent with

the ALARA principle, and could notbe justied if compared with the

myth of few days of background radiation. Additionally, it is

judicious to take advantage of the 3D capability of CBCT after

adopting this technology.

According to Buttke and Proft [54], only 15% of orthodontic

patients are adults. Therefore, because most orthodontic patients

are children, it is important to emphasize that the ALARA principle

applies even more critically in the majority of orthodontic patients

who are more sensitive to radiation and who have long years to live

whereby radiation risks may manifest in their lives [55,56].

4. Myth 3

We must have totally new 3D CBCT cephalometric analyses that

replace 2D standardized analyses.

4.1. Fact

Panoramic and cephalometric radiographs are standard ortho-

dontic records. Introducing new CBCT cephalometric analyses

require some new landmarks, planes, and angles [57]. CBCT also

requires different analyses that may be difcult to memorize and

apply.

Table 1

Effective doses of basic radiographic imaging versus CBCT and medical head CT

Imaging modality E stimated rang e of effecti ve dose (mSv)

Digital panoramic radiography 2.7e23

Digital cephalometric radiography 1.7e3.4

CBCT 20e1025

Head CT 2000

A. Abdelkarim / Journal of the World Federation of Orthodontists 1 (2012) e3ee8e4


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Realistically, few orthodontists perform tracing and full analyses

on all their patients. In fact, the availability of 2D analyses of

conventional lateral cephalometric radiograph may not make a

signicant difference to the treatment decisions[58].

Tracing the sagittal and frontal cephalometrics and analyzing

CBCT acquisitions are unquestionably recommended. However,

performing CBCT cephalometric analyses in three dimensions

(including new numeric and angle values that are not present in

conventional analyses such as Downs, Steiner, Ricketts, McNamara,

and Tweed) may not be necessary.

The 3D CBCT should benet clinicians in many different ways,

other than complicated 3D cephalometric analyses. This modality

offers three orthogonal images of oral and maxillofacial structures

(axial, sagittal, and coronal views), and any other at and curved

slices of variable thickness. Therefore, 3D superimpositions, asses-

sment of treatment outcome, and growth change evaluation in

three dimensions can be performed [59e63]. Surgical outcomes can

be evaluated, and this can be of great value for the orthodontist and

the patient[64,65]. Lastly, soft tissue change can be visualized and

evaluated in the short- and long-term in cases of orthognathic

surgery[66,67].

Therefore, sophisticated 3D analyses may improve the diag-

nostic records in some cases, but they are questionable to bevaluable as a new standard.

5. Myth 4

CBCT can replace impressions for orthodontics and be as

accurate.

5.1. Fact

Even though CBCT digital models are sometimes accurate for

making linear measurements for overjet, overbite, and crowding

measurements [68], they are unlikely to be accurate for clear tray

and orthodontic wire fabrications as conventional impressions.It takes only one amalgam restoration to create beam hard-

ening artifact [69], which creates distortion. Beam hardening

occurs around dense objects such as metal brackets and bands[70].

Other CBCT image artifacts include cupping, dark bands, noise, and

scatter. Although CBCT acquisition during orthodontic treatment is

possible, the images would be distorted due to the beam hardening

and scatter around orthodontic appliances.

Another signicant limitation for these tasks is possible patient

movement, creating motion artifact during the relatively long

scans, especially in young orthodontic patients. All these limitations

of CBCT technique should be considered as they may reduce image

quality. In reality, image quality itself is not similar among different

CBCT machines. This was found in testing different CBCT machines

in detection of simulated canine impaction-induced external rootresorption in maxillary lateral incisors, a common application of

CBCT in orthodontics [71]. Those who are not familiar with CBCT

images may not be able to differentiate between different

machines, in regards to image quality.

These artifacts are not noted in digital or conventional impres-

sions. One may argue, however, that CBCT will continue to improve

to where it will be as accurate and precise as impressions. But the

numerous CBCT machines already installed will not be replaced

with newer ones to replace these impressions.

6. Myth 5

Volume rendering is sufcient to display external root

resorption.

6.1. Fact

Like any other volumetric imaging, CBCT interpretation requires

the use of computer software to provide multiplanar reformatted

images and supplementary 3D visual representations such as

volume rendering. The volume rendering, usually provided by the

software automatically, is similar to architectural exemplary

illustrations that provide the exterior layout but not the interior

details.

Three-dimensional volume rendering images can only be

utilized as an adjunctive aid where it can help the orthodontist, as

well as a great visual aid for the patient or parent to understand

the treatment plan. However, these attractive illustrations are

computer-generated and are created upon software algorithms that

may not be reliable. Selecting the volume rendering may obscure

normal anatomy or create artifacts that are not present.

Unfortunately, numerous presentations of CBCT images include

the volume rendering only. This rendering may produce false-

negatives or false-positives and is not sufcient to identify presence

or absence of mild external root resorption that may be present on

a maxillary lateral incisor, for example, due to impaction of

a maxillary canine.

Evaluation of multiple slices of the scan is necessary. Perhapssome clinicians opt to present the volume rendering because

evaluating the axial, coronal, and sagittal views of the scan is more

technically demanding. Nevertheless, examination of the scan

through these views is generally required because this has higher

sensitivity and specicity.

7. Myth 6

CBCT changes the nal outcome of orthodontic treatment.

7.1. Fact

CBCT increases accuracy of orthodontic diagnosis. Increasing

diagnostic accuracy eliminates false-positive and false-negative

results. Also, the treatment plan becomes more appropriate for

specic cases. This may change the nal outcome in some cases, but

not always. Until now, there have not been randomized clinical

trials that examine whether there is a favorable difference between

orthodontic patients who were imaged by CBCT and those who

were not. The effects of information derived from these images in

altering diagnosis and treatment decisions have not been estab-

lished in several types of cases[72].

This certainly does not mean that there is no benet of CBCT for

specic cases such as impacted and supernumerary teeth, tempo-

rary anchorage device site assessment, pharyngeal airway assess-

ment, craniofacial deformities, cleft palate, identication of rootresorption, and orthognathic surgery planning[72].

Moreover, retrospective evaluation of existing CBCT data may, in

many cases, provide additional understanding of numerous aspects

of orthodontics. At this point, it is still arguable whether CBCT in

orthodontics always provides more diagnostic information than

panoramic and cephalometric radiographs, changing the nal

outcome, in order to justify its routine use in all orthodontic

patients. In fact, additional information or lack thereof cannot be

discovered unless comprehensive CBCT evaluation is performed. It

also should be remembered that incorporating CBCT routinely in

regular orthodontic practice increases the collective dose to

orthodontic patients as a whole, thereby increasing the probability

of deleterious effects of radiation in a group that is relatively

sensitive to radiation.

A. Abdelkarim / Journal of the World Federation of Orthodontists 1 (2012) e3ee8 e5


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8. Myth 7

Boards of Orthodontics will eventually adopt CBCT for all

orthodontic records and superimpositions.

8.1. Fact

As of today, these boards have not recommended CBCT for all

cases. It is, however, likely that 3D imaging will be required when it

provides useful information that meets the treatment needs.

For example, in 2000, a position paper by the American

Academy of Oral and Maxillofacial Radiology (AAOMR) recom-

mended that some form of cross-sectional imaging be used for most

patients receiving implants [73]. Today, CBCT is the preferred

imaging modality for implantology. Fortunately, most elderly

patients receiving implants are less sensitive to radiation than most

orthodontic patients who are typically young. In another position

paper by the AAOMR and the American Association of Endodon-

tists, CBCT was recommended for selected, but not all, cases in

endodontics[74]. It was recommended that CBCT must not be used

routinely for endodontic diagnosis or for screening purposes in the

absence of clinical signs and symptoms[74].

In orthodontics, the frequency of CBCT use is likely to be equal toendodontics, unlike implant imaging, where CBCT is used more

frequently. Selection of CBCT in orthodontics is clearly case specic,

and wise clinical judgment should be used. In other words, CBCT is

justied in selected, but not all cases in orthodontics[75].

9. Myth 8

CBCT is sufcient and is the best imaging modality to examine

the temporomandibular joints (TMJ).

9.1. Fact

CBCT is excellent for imaging of the bony component of the

temporomandibular joints, especially if compared with panoramicradiography. Therefore, it is a valuable diagnostic tool for TMJ

evaluation[76e78].

However, TMJ complex is composed of bony and soft tissue

structures. Unfortunately, CBCT does not map out the muscle

structures, and the articular disk cannot be visualized [79]. The

inability to visualize the articular disk and internal derangements

through CBCT imaging is a signicant disadvantage for TMJ imaging.

Although degenerative bone changes (which can be depicted by

CBCT) may be correlated with disk displacement without reduction

[80], there is actually a poor correlation between condylar changes

observed on CBCT images and pain, and with other clinical signs

and symptoms of TMJ of osteoarthritic origin [81].

Magnetic resonance imaging (MRI) is the imaging technique of

choice if an evaluation of the articular disk is required [82,83].Although CBCT can provide valuable information about TMJ bony

changes, it is not the best imaging modality for TMJ evaluation. At

least, it is not sufcient to create a comprehensive radiographic

evaluation of the TMJ.

10. Myth 9

If CBCT is ordered, the orthodontist is at liability risk for any

pathology in the scan.

10.1. Fact

Lately, there has been considerable concern among dental

practitioners regarding the liability of reporting any pathology or

incidentalnding present in the CBCT scan. Dentists are not typi-

cally trained on CBCT interpretation in dental schools, so a full

evaluation of CBCT scans can be a difcult task. Even though the

radiographic anatomy of CBCT is the basic structure of the skull,

differentiation between a patient with a normal anatomy and an

abnormality can be challenging. Until now, there have been mixed

opinions on this issue.

No denitive guidelines have been formed at this time. Turpin

[84] and Jerrold [85] advise that orthodontists, if ordering CBCT

imaging, are liable for the interpretation of the CBCT volume. But it

should be remembered that potential risks for the orthodontist

include unidentied pathology in traditional radiographs and

possibly photographs.

If examined by an oral and maxillofacial radiologist, liability

risks can be avoided. Afterwards, other risks in orthodontics may be

avoid as well, because CBCT contributes to accurate diagnosis and,

therefore, improved treatment plan[86].

Some argue that a legal document can eliminate the risk. The

patient can sign an informed consent that no interpretation of the

volume would be performed, and only the prescribed diagnostic

task would be evaluated. There is less discussion regarding the

moral consideration of fully evaluating the CBCT for the patients

bene

t.Another way to reduce the risk is to use a smaller eld of view.

This actually has another benet of reduced effective dose.

11. Myth 10

CBCT is an orthodontic practice builder.

11.1. Fact

This is probably the most ironic and debatable myth. One may

claim that CBCT provides superior images that facilitate treatment

plan presentation. As previously said, some believe that CBCT has

the potential of replacing conventional impressions and intraoraland extraoral photos, and subsequently, one CBCT scan can be

sufcient for initial orthodontic records. Furthermore, some believe

that patients are attracted to this technology.

However, this expensive technology that involves ionizing

radiation is unlikely to replace conventional impressions and be as

accurate and sufcient to create comprehensive diagnoses and

build wires and clear trays. Additionally, progress and nal photos

and radiographs cannot be compared with a single 3D radiographic

scan. For consistency, an initial CBCT scan would require an addi-

tional nal scan for comparison. In this case, the radiation dose is

doubled, assuming no acquisition retakes are performed.

Many parents are aware of ionizing radiation risks and are

unlikely to be interested in higher radiation for their children if

given the choice of whether or not to use CBCT.Three-dimensional evaluations through CBCT should continue

to evolve in orthodontics. Unfortunately, this technology is not

ubiquitous yet. At this point, it is still signicantly more expensive

than other technologies in standard orthodontic practice. As

a result, CBCT may not be an orthodontic practice builder for

everybody.

12. Conclusions

CBCT is a valuable imaging modality in orthodontics. Its appli-

cations in this eld have been widely recognized. It is time to

reevaluate the validity of some erroneous ideas that are based on

blind faith and overmarketing, instead of scientic evidence and

common sense.



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The riskebenet ratio of CBCT is usually favorable. Due to

numerous overlapping carcinogenic factors in human life, it is

impossible to assess the long-term stochastic effects of radio-

graphic examinations. For that reason, the concept of ALARA, sug-

gesting that radiation should be kept As Low As Reasonably

Achievable, should be adhered to, rather than justifying CBCT

acquisitions by comparing their dose exposure to background

radiation. Replacing impressions with CBCT, ordering it for every

patient, and claiming that it would build the orthodontic practice

are tactics that should be debunked.

Once acquired, orthodontists are encouraged to evaluate the

scan thoroughly, primarily for the patients benet. Because

acquisition of CBCT is case specic, each patient may benet

differently, but some patients may not benet from the procedure.

In addition, CBCT usage will ultimately result in more validated

research being performed and will become an advantage of our

profession with secondary tangential benets to those undergoing

orthodontic therapy.

References

[1] Botticelli S, Verna C, Cattaneo PM, Heidmann J, Melsen B. Two- versus three-

dimensional imaging in subjects with unerupted maxillary canines. Eur JOrthod 2011;33:344e9.

[2] Haney E, Gansky SA, Lee JS, et al. Comparative analysis of traditional radio-graphs and cone-beam computed tomography volumetric images in thediagnosis and treatment planning of maxillary impacted canines. Am J OrthodDentofacial Orthop 2010;137:590e7.

[3] Liu DG, Zhang WL, Zhang ZY, Wu YT, Ma XC. Localization of impactedmaxillary canines and observation of adjacent incisor resorption with cone-beam computed tomography. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 2008;105:91e8.

[4] Maverna R, Gracco A. Different diagnostic tools for the localization of impactedmaxillary canines: clinical considerations. Prog Orthod 2007;8:28e44.

[5] Alqerban A, Jacobs R, Lambrechts P, Loozen G, Willems G. Root resorption ofthe maxillary lateral incisor caused by impacted canine: a literature review.Clin Oral Investig 2009;13:247e55.

[6] Walker L, Enciso R, Mah J. Three-dimensional localization of maxillary canineswith cone-beam computed tomography. Am J Orthod Dentofacial Orthop2005;128:418e23.

[7] Liu DG, Zhang WL, Zhang ZY, Wu YT, Ma XC. Three-dimensional evaluations ofsupernumerary teeth using cone-beam computed tomography for 487 cases.Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:403e11.

[8] White S, Pae E. Patient image selection criteria for cone beam computedtomography imaging. Semin Orthod 2009;15:19e28.

[9] Korbmacher H, Kahl-Nieke B, Schllchen M, Heiland M. Value of two cone-beam computed tomography systems from an orthodontic point of view.J Orofac Orthop 2007;68:278e89.

[10] El AS, El H, Palomo JM, Baur DA. A 3-dimensional airway analysis of anobstructive sleep apnea surgical correction with cone beam computedtomography. J Oral Maxillofac Surg 2011;69:2424e36.

[11] Schendel S, Powell N, Jacobson R. Maxillary, mandibular, and chin advance-ment: treatment planning based on airway anatomy in obstructive sleepapnea. J Oral Maxillofac Surg 2011;69:663e76.

[12] Schendel SA, Hatcher D. Automated 3-dimensional airway analysis fromcone-beam computed tomography data. J Oral Maxillofac Surg 2010;68:696e701.

[13] Enciso R, Nguyen M, Shigeta Y, Ogawa T, Clark GT. Comparison of cone-beam

CT parameters and sleep questionnaires in sleep apnea patients and controlsubjects. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:285e93.[14] Ogawa T, Enciso R, Memon A, Mah JK, Clark GT. Evaluation of 3D airway

imaging of obstructive sleep apnea with cone-beam computed tomography.Stud Health Technol Inform 2005;111:365e8.

[15] Aboudara CA, Hatcher D, Nielsen IL, et al. A three-dimensional evaluation ofthe upper airway in adolescents. Orthod Craniofac Res 2003;6(Suppl 1):173e5.

[16] Farnsworth D, Rossouw PE, Ceen RF, Buschang PH. Cortical bone thickness atcommon miniscrew implant placement sites. Am J Orthod Dentofacial Orthop2011;139:495e503.

[17] Miyazawa K, Kawaguchi M, Tabuchi M, Goto S. Accurate pre-surgical deter-mination for self-drilling miniscrew implant placement using surgical guidesand cone-beam computed tomography. Eur J Orthod 2010;32:735e40.

[18] Fayed MM, Pazera P, Katsaros C. Optimal sites for orthodontic mini-implantplacement assessed by cone beam computed tomography. Angle Orthod2010;80:939e51.

[19] Heymann GC, Cevidanes L, Cornelis M, De Clerck HJ, Tulloch JF. Three-

dimensional analysis of maxillary protraction with intermaxillary elastics tominiplates. Am J Orthod Dentofacial Orthop 2010;137:274e84.

[20] Baumgaertel S. Quantitative investigation of palatal bone depth and corticalbone thickness for mini-implant placement in adults. Am J Orthod DentofacialOrthop 2009;136:104e8.

[21] Baumgaertel S, Hans MG. Buccal cortical bone thickness for mini-implantplacement. Am J Orthod Dentofacial Orthop 2009;136:230e5.

[22] Gracco A, Lombardo L, Cozzani M, Siciliani G. Quantitative cone-beamcomputed tomography evaluation of palatal bone thickness for orthodonticminiscrew placement. Am J Orthod Dentofacial Orthop 2008;134:361e9.

[23] Kim SH, Kang JM, Choi B, Nelson G. Clinical application of a stereolithographicsurgical guide for simple positioning of orthodontic mini-implants. World JOrthod 2008;9:371e82.

[24] Kim SH, Choi YS, Hwang EH, Chung KR, Kook YA, Nelson G. Surgical posi-tioning of orthodontic mini-implants with guides fabricated on modelsreplicated with cone-beam computed tomography. Am J Orthod DentofacialOrthop 2007;131(4 Suppl):S82e9.

[25] Alves Jr M, Baratieri C, Nojima LI. Assessment of mini-implant displacementusing cone beam computed tomography. Clin Oral Implants Res 2011;22:1151e6.

[26] Hong C, Truong P, Song HN, Wu BM, Moon W. Mechanical stability assessmentof novel orthodontic mini-implant designs: Part 2. Angle Orthod 2011;81:1001e9.

[27] Kau CH, English JD, Muller-Delgardo MG, Hamid H, Ellis RK, Winklemann S.Retrospective cone-beam computed tomography evaluation of temporaryanchorage devices. Am J Orthod Dentofacial Orthop 2010;137:166.e1e5.discussion 166e7.

[28] McCollough CH, Schueler BA. Calculation of effective dose. Med Phys 2000;27:828e37.

[29] Okano T, Harata Y, Sugihara Y, et al. Absorbed and effective doses from conebeam volumetric imaging for implant planning. Dentomaxillofac Radiol 2009;

38:79e

85.[30] Garcia Silva MA, Wolf U, Heinicke F, Grndler K, Visser H, Hirsch E. Effectivedosages for recording Veraviewepocs dental panoramic images: analog lm,digital, and panoramic scout for CBCT. Oral Surg Oral Med Oral Pathol OralRadiol Endod 2008;106:571e7.

[31] Ludlow JB, Davies-Ludlow LE, Brooks SL, Howerton WB. Dosimetry of 3 CBCTdevices for oral and maxillofacial radiology: CB Mercuray, NewTom 3G andi-CAT. Dentomaxillofac Radiol 2006;35:219e26.

[32] Gijbels F, Jacobs R, Bogaerts R, Debaveye D, Verlinden S, Sanderink G.Dosimetry of digital panoramic imaging. Part I: patient exposure. Dento-maxillofac Radiol 2005;34:145e9.

[33] Lecomber AR, Yoneyama Y, Lovelock DJ, Hosoi T, Adams AM. Comparison ofpatient dose from imaging protocols for dental implant planning usingconventional radiography and computed tomography. Dentomaxillofac Radiol2001;30:255e9.

[34] White S, Pharoah M. Oral radiology: principles and interpretation. 6th ed. StLouis: Mosby; 2009. 35.

[35] Gijbels F, Sanderink G, Wyatt J, Van Dam J, Nowak B, Jacobs R. Radiation dosesof indirect and direct digital cephalometric radiography. Br Dent J 2004;197:149e52.

[36] Ludlow JB, Ivanovic M. Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology. Oral Surg Oral Med Oral PatholOral Radiol Endod 2008;106:106e14.

[37] Ludlow JB, Davies-Ludlow LE, Brooks SL. Dosimetry of two extraoral directdigital imaging devices: NewTom cone beam CT and Orthophos Plus DSpanoramic unit. Dentomaxillofacial Radiol 2003;32:229e34.

[38] Roberts JA, Drage NA, Davies J, Thomas DW. Effective dose from cone beam CTexaminations in dentistry. Br J Radiol 2009;82:35e40.

[39] Tsiklakis K, Donta C, Gavala S, Karayianni K, Kamenopoulou V, Hourdakis CJ.Dose reduction in maxillofacial imaging using low dose Cone Beam CT. Eur JRadiol 2005;56:413e7.

[40] Danforth RA, Dus I, Mah J. 3-D volume imaging for dentistry: a new dimen-sion. J Calif Dent Assoc 2003;31:817e23.

[41] Pauwels R, Beinsberger J, Collaert B, et al. SEDENTEXCT Project Consortium.Effective dose range for dental cone beam computed tomography scanners.Eur J Radiol 2012;81:267e71.

[42] Brooks S. CBCT dosimetry: orthodontic considerations. Semin Orthod 2009;15:14e8.

[43] Silva MA, Wolf U, Heinicke F, Bumann A, Visser H, Hirsch E. Cone-beamcomputed tomography for routine orthodontic treatment planning:a radiation dose evaluation. Am J Orthod Dentofacial Orthop 2008;133:640.e1e5.

[44] Bianchi S, Anglesio S, Castellano S, Rizzi L, Ragona R. Absorbed doses and riskin implant planning: comparison between spiral CT and cone-beam CT.Dentomaxillofac Radiol 2003;30:S28.

[45] Danforth RA, Peck J, Hall P. Cone beam volume tomography: an imagingoption for diagnosis of complex mandibular third molar anatomical rela-tionships. J Calif Dent Assoc 2003;31:847e52.

[46] Sukovic P. Cone beam computed tomography in craniofacial imaging. OrthodCraniofac Res 2003;6(suppl 1):31e6. 179e82.

[47] Mah JK, Danforth RA, Bumann A, Hatcher D. Radiation absorbed in maxillo-facial imaging with a new dental computed tomography device. Oral Surg OralMed Oral Pathol Oral Radiol Endod 2003;96:508e13.

[48] Mozzo P, Procacci C, Tacconi A, Martini PT, Andreis IA. A new volumetric CTmachine for dental imaging based on the cone-beam technique: preliminaryresults. Eur Radiol 1998;8:1558e64.

A. Abdelkarim / Journal of the World Federation of Orthodontists 1 (2012) e3ee8 e7


6/6

[49] Huda W, Atherton JV, Ware DE, Cumming WA. An approach for the estimationof effective radiation dose at CT in pediatric patients. Radiology 1997;203:417e22.

[50] American Dental Association Council on Scientic Affairs. The use of dentalradiographs: update and recommendations. J Am Dent Assoc 2006;137:1304e12.

[51] Gori T, Mnzel T. Biological effects of low-dose radiation: of harm andhormesis. Eur Heart J 2012;33:292e5.

[52] Kaiser J. Hormesis. Sipping from a poisoned chalice. Science 2003;302:376e9.[53] Farman AG, Scarfe WC. Development of imaging selection criteria and

procedures should precede cephalometric assessment with cone-beam

computed tomography. Am J Orthod Dentofacial Orthop 2006;130:257e

65.[54] Buttke T, Proft W. Referring adult patients for orthodontic treatment. J AmDent Assoc 1999;130:73e9.

[55] Farman AG. ALARA still applies. Oral Surg Oral Med Oral Pathol Oral RadiolEndo 2005;100:395e7.

[56] Lin EC. Radiation risk from medical imaging. Mayo Clin Proc 2010;85:1142e6.[57] Cho HJ. A three-dimensional cephalometric analysis. J Clin Orthod 2009;43:

235e52.[58] Devereux L, Moles D, Cunningham SJ, McKnight M. How important are lateral

cephalometric radiographs in orthodontic treatment planning? Am J OrthodDentofacial Orthop 2011;139:e175e81.

[59] Nguyen T, Cevidanes L, Cornelis MA, Heymann G, de Paula LK, De Clerck H.Three-dimensional assessment of maxillary changes associated with boneanchored maxillary protraction. Am J Orthod Dentofacial Orthop 2011;140:790e8.

[60] Cevidanes LH, Oliveira AE, Grauer D, Styner M, Proft WR. Clinical applicationof 3D imaging for assessment of treatment outcomes. Semin Orthod 2011;17:72e80.

[61] Cevidanes LH, Alhadidi A, Paniagua B, et al. Three-dimensional quanti

cationof mandibular asymmetry through cone-beam computerized tomography.Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:757e70.

[62] Cevidanes L, Heymann G, Cornelis M, DeClerck H, Tulloch J. Superimposition of3-dimensional cone-beam computed tomography models of growing patients.Am J Orthod Dentofacial Orthop 2009;136:94e9.

[63] Cevidanes LH, Styner MA, Proft WR. Image analysis and superimposition of3-dimensional cone-beam computed tomography models. Am J Orthod Den-tofacial Orthop 2006;129:611e8.

[64] Tucker S, Cevidanes LH, Styner M, et al. Comparison of actual surgicaloutcomes and 3-dimensional surgical simulations. J Oral Maxillofac Surg2010;68:2412e21.

[65] Cevidanes LH, Bailey LJ, Tucker Jr GR, et al. Superimposition of 3D cone-beamCT models of orthognathic surgery patients. Dentomaxillofac Radiol 2005;34:369e75.

[66] Cevidanes LH, Motta A, Proft WR, Ackerman JL, Styner M. Cranial basesuperimposition for 3-dimensional evaluation of soft-tissue changes. Am JOrthod Dentofacial Orthop 2010;137(4 Suppl):S120e9.

[67] da Motta AT, de Assis Ribeiro Carvalho F, Oliveira AE, Cevidanes LH, de OliveiraAlmeida MA. Superimposition of 3D cone-beam CT models in orthognathicsurgery. Dental Press J Orthod 2010;15:39e41.

[68] Kau CH, Littleeld J, Rainy N, Nguyen JT, Creed B. Evaluation of CBCT digitalmodels and traditional models using the Little s Index. Angle Orthod 2010;80:435e9.

[69] Hsieh J, Molthen RC, Dawson CA, Johnson RH. An iterative approach to thebeam hardening correction in cone beam CT. Med Phys 2000;27:23e9.

[70] Endo M, Tsunoo T, Nakamori N, Yoshida K. Effect of scattered radiation onimage noise in cone beam CT. Med Phys 2001;28:469e74.

[71] Alqerban A, Jacobs R, Fieuws S, Nackaerts O, Willems G. SEDENTEXCT ProjectConsortium. Comparison of 6 cone-beam computed tomography systems forimage quality and detection of simulated canine impaction-induced externalroot resorption in maxillary lateral incisors. Am J Orthod Dentofacial Orthop2011;140:e129e39.

[72] Kapila S, Conley RS, Harrell Jr WE. The current status of cone beam computedtomography imaging in orthodontics. Dentomaxillofac Radiol 2011;40:24e34.

[73] Tyndall DA, Brooks SL. Selection criteria for dental implant site imaging:a position paper of the American Academy of Oral and Maxillofacial radiology.Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:630e7.

[74] American Association of Endodontists; American Academy of Oral andMaxillofacial Radiology. Use of cone-beam computed tomography inendodontics Joint Position Statement of the American Association ofEndodontists and the American Academy of Oral and Maxillofacial Radiology.Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:234e7.

[75] Merrett SJ, Drage NA, Durning P. Cone beam computed tomography: a usefultool in orthodontic diagnosis and treatment planning. J Orthod 2009;36:202e10.

[76] Hilgers ML, Scarfe WC, Scheetz JP, Farman AG. Accuracy of linear temporo-mandibular joint measurements with one beam computed tomography anddigital cephalometric radiography. Am J Orthod Dentofacial Orthop 2005;128:803e11.

[77] Honda K, Arai Y, Kashima M, et al. Evaluation of the usefulness of the limitedcone-beam CT (3DX) in the assessment of the thickness of the roof of theglenoid fossa of the temporomandibular joint. Dentomaxillofac Radiol 2004;

33:391e

5.[78] Tsiklakis K, Syriopoulos K, Stamatakis HC. Radiographic examination of thetemporomandibular joint using cone beam computed tomography. Dento-maxillofac Radiol 2004;33:196e201.

[79] Kau CH, Richmond S, Palomo JM, Hans MG. Three-dimensional cone beamcomputerized tomography in orthodontics. J Orthod 2005;32:282e93.

[80] Sylvester DC, Exss E, Marholz C, Millas R, Moncada G. Association betweendisk position and degenerative bone changes of the temporomandibularjoints: an imaging study in subjects with TMD. Cranio 2011;29:117e26.

[81] Palconet G, Ludlow J, Tyndall D, Lim PF. Correlating cone beam CT results withtemporomandibular joint pain of osteoarthritic origin. Dentomaxillofac Radiol2012;41:126e30.

[82] Bertram S, Rudisch A, Innerhofer K, Pumpel E, Grubwieser G, Emshoff R.Magnetic resonance imaging to diagnose temporomandibular joint internalderangement and osteoarthrosis. J Am Dent Assoc 2001;66:75e7.

[83] Chirani RA, Jacq JJ, Meriot P, Roux C. Temporomandibular joint: a method-ology of magnetic resonance imaging 3D reconstruction. Oral Surg Oral MedOral Pathol Oral Radiol Endod 2004;97:756e61.

[84] Turpin DL. Befriend your oral and maxillofacial radiologist. Am J OrthodDentofacial Orthop 2007;131:697.

[85] Jerrold L. Litigation, legislation, and ethics: liability regarding computerizedaxial tomography scans. Am J Orthod Dentofacial Orthop 2007;132:122e4.

[86] Curley A, Hatcher DC. Cone beam CT e anatomic assessment and legal issues:the new standards of care. J Calif Dent Assoc 2009;37:653e62.


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