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3D Cone Beam Instructions

3D Cone Beam Instructions

The more information a patient can research and the more details (including a comprehensive Medical Dental History and oral examination) allow potential dental patients to see the depth of what a quality 3D Cone Beam can reveal.  This is one of the key areas that has become a challenge when patients do not have access to a comprehensive and high-resolution scan, a professional with the skills to identify what the Scan reveals, a comprehensive medical, and dental chronological history, and a thorough examination to assist the dentist, doctor and patient with details to make informed decisions.

Thank you for your interest in obtaining CBCT 3D Cone Beam Scan.  If you are submitting a scan to our office for evaluation, please read and follow all instructions to clarify the goals of the imaging procedure and to obtain the optimal diagnostic image.  The following information includes the imaging protocols that we make available to the patient and to any imaging services to facilitate the highest quality and best possible dental services.

3D Scan Posture Protocol:

  1. Scan needs to be taken at the highest resolution with a 0.2 or 0.3 mm voxel size.
  2. Scan size should be at least 13 x 16 cm, 15 x 15 cm, or larger.  If the high-resolution image is for ridge augmentation reconstruction, please use the highest resolution possible for exact details for 3D construction.  Place cotton rolls in the vestibule to retract cheeks and tongue to aid in ridge imaging.
  3. Remove all hairpins, jewelry – necklaces, earrings, intraoral partials, dentures, and appliances
  4. Patient should be in a normal posture for the scan with eyes looking forward.  Keep the eyes and chin level. Do not stretch the chin up, slouch down, lean forward, or backward or allow the head to tilt; side to side or up and down.
  5. Mandibular jaw position - The patient should be biting on the normal habitual bite on the back teeth (posterior) centric occlusion.  If no back teeth are present; rest jaw in a relaxed position with lips together (humming position).  “Scout scan” positioning or alignment of the scan should capture the soft tissue profile and cervical vertebrae with Temporomandibular Joint.
  6. Tongue position – place the tip of the tongue on the anterior portion of the upper jaw mimicking the “N” sound and hold the tongue to the roof of the mouth behind the front teeth.
  7. Stabilize the head position either sitting or standing and ask the patient to not rest their chin on the chin rest, just lightly touch it or do not touch it at all so that there is not any distortion of the soft tissue profile.
  8. Explain to the patient that if there is any movement during the scanning process, there will not be a clear image and another scan will need to be taken.  Check to be sure the image is the clearest image possible and all details are clear.  If it is not clear, retake the scan before dismissing the patient. If the patient has a condition that produces tremors, it may be difficult to obtain a clear scan and every effort must be made by the patient and assistant to minimize movement.
  9. Have the patient gently swallow prior to the scan, blink, and have eyes open, and don’t breath heavy breathe– very light.  Again the object is to be still without movement.
  10. If a patient is sending a scan to be evaluated by Dr. Evans or Dr. Johnson, all of the Dicom images need to be placed on a disc or flash drive so that it can be loaded into Anatomage Invivo 5.4 or 6 software. (If the scan is from Sirona Galileos software, please request that it is sent to us unencrypted).

Please contact our office if you have any questions or need assistance.  Thank you,

Dr. Stephen R. Evans DDS

 

Digital 3D CBCT Cone Beam Radiographic Review Form and Example of Findings

The Digital 3D CBCT Cone Beam Radiograph Reveals the Following

Airway

Maxillary sinus congestion WNL on the left side, or 5% on the right side

Tooth roots 1,12,16 at the sinus floor and tooth roots 2, 4, 13, 14, 15 in the sinus due to sinus pneumatization

Pneumatization of sinus on right side 5mm inferior area #3

Sinus-Tooth roots, MRC, Size N/A, Foreign bodies: Right #3 Radiopacities Right #3

Posterior airway; Constricted, MCA 118.3 mm2, Total Volume 17.1  cm2, Level of obstruction N,L

Nasal turbinates’ inferior and middle turbinates are inflamed and congested posteriorly with minimal space between turbinate and maxillary bone.

Septum—slight deviation to the Left. Ostia Patent Right and Left

Anatomy for Nerve Spaces

Pulp chamber WNL, diminished, #4 & #19, Endodontic TX None  Periapical Changes None

The inferior alveolar nerve canal is clear though interrupted on right

The inferior alveolar nerve canal was interrupted in area 32 Superior portion of the Inferior alveolar nerve canal was interrupted, none on left and 6mm on right.

Bone Patterns and Densities

Hu average measurements area; # 3 500-700; area # 7 below 300; area # 10 below 300; area # 18 below 400

Radiolucency—ghost marrow; None, irregularities; None and multilocular None

Radiopacities –medium in area #3

Changes in trabecular pattern in areas #3, 18 and 32

Decreased alveolar bone height # 3 with possible sinus communication 5mm pneumatization and 3 mm alveolar ridge atrophy.

Decreased bone densities in area #32 have a minimal trabecular pattern with an HU average below 100 area # 32. Generalized decrease in bone density under mandibular molars.

Bone Density—WNL, increased in areas #3 & #18

Increased bone density on genial tubercle lingual of the anterior mandible

Stylohyoid ligament-reveals medium ossification on both the right and left sides

Ligament calcification stylomandibular ligament, WNL,

Orthopedic / Orthodontic, TMJ

Dental Classification; Class ½ 2 Deep bite 3mm, overjet 1mm due to congenitally missing laterals

Missing teeth # 3, 7, 10, 18 and 32

Condylar position ( P. S. abnormal) Temporomandibular joint; Right condylar is superior displaced with decreased joint space, Left condyle has condylar bending with slight posterior superior position displacement with decreased joint space (SMV 15.1  degrees right, 12.4 degrees left).

Skeletal growth pattern— Mesocephalic

Jaw Symmetry—relative equal proportion Right, Elongated Right Cant inferior Maxillary midline shift 2mm to the right Mandibular midline shift 2mm to the left

Cervical vertebrae rotations or impingements—show some rotations between C1, C2, and C3

Hyoid Bone at the level of cervical vertebrae # 3 & 4

During Initial Consultations prior to any services, Dr. Evans discussed and reviewed symptoms, relevant previous surgeries, and significant and potentially relevant dental and medical history. Notes: Dr. Evans compared radiographic findings with pertinent chronological history.