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Alex Woodham, managing director and lead radiographer at CT Dent, talks to Dentistry magazine about how CBCT has evolved to be so important in dentistry.

How has cone beam computed tomography (CBCT) improved over the years?
Since CBCT first started being used in the late 1990s for dental and maxillofacial imaging, it has changed considerably. The scanners have developed to now include a variety of fields of view and resolutions to meet many clinical scenarios. The evolution of viewing software now also allows clinicians to diagnose and plan treatment with greater accuracy and precision.

Why is CBCT so important in modern dentistry?
CBCT plays a vital role in patient diagnosis and follow-up management, in all areas of dentistry and beyond. Being able to see the patient’s anatomy in three-orthogonal-planes is important for the planning of implant placement, but also for: assessing lesions; localising unerupted, impacted or supernumerary teeth; seeing the relationship of lower-third molars with the inferior dental canal and assessing the paranasal sinuses, airway and bony structures of the temporomandibular joint (TMJ). Something that may look suspicious on a periapical or orthopantomogram (OPG) can be assessed further with CBCT.

What are dentists’ main reservations with CBCT and why?
Although the prices of CBCT scanners have gone down, it can still be an expensive technology to invest in, not only for set-up and ongoing maintenance but also in terms of training. Having a fundamental knowledge of the theory that underpins CBCT and image interpretation skills are important in order to get the best from it. Not all CBCT scanners share the same level of image quality and limitations, such as beam hardening, scatter or poor patient positioning, which can lead to reduced image quality and loss of faith in the technology.

How can CBCT be used in conjunction with effective treatment planning?
In conjunction with digital impressions and surface laser imaging, CBCT scans can be imported into third-party software to accurately plan for implant placement and more complex surgical procedures. The nature of how CBCT scans are constructed also means that geometrical accuracy is at the greatest level, so it is easy to transfer what you see on screen to the patient.

What does the future hold for CBCT?
With the growth of artificial intelligence, there is the potential for CBCT scans to be auto-reported, the inferior dental canal automatically traced and even automated implant planning. Even smaller fields of view will mean more focused imaging and continued enhancements with motion correction will benefit many patients who cannot tolerate CBCT.

Anything else you’d like to add?
In 15 years of working in dental and maxillofacial radiology, I have seen how CBCT has evolved in the world of dentistry. It has been positive both for dentists and patients alike.

Published first by Dentistry magazine