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Questionable Overuse of CBCT

From: Terry Pannkuk
To: ROOTS
Sent: Thursday, September 01, 2011 2:29 AM
Subject: [roots] Questionable Overuse of CBCT

This is an implant I placed today and according to current CBCT use guidelines for dentistry might
be considered inappropriate.   I took a CBCT for planning the implant before placement and took one
afterwards to check the positioning and match it up.  In my opinion the narrow arch made it difficult
to demonstrate the proper positioning with just a PA, but the CBCT showed that it was ideally where
I planned it.

Ethical Questions:

1. Did I need to take the CBCT after placing it?  (probably not and if it had been place slightly
   off line it wouldn’t have been a significant issue causing me to necessarily remove the implant)

2. Is the radiation from the Kodak CBCT significant and was taking this post treatment CBCT an
   unnecessary risk imposed upon the patient?

I think these considerations are important, but I was interested in my positioning as I am with my
recalls where I routinely take CBCT’s if the patient will let me.

Interesting discussion point and I’m sure there are different viewpoints.  - Terry



Ethical Questions:
1. Did I need to take the CBCT after placing it?  (probably not and if it had been place slightly
   off line it wouldn’t have been a significant issue causing me to necessarily remove the implant)

like i said before, i think it is about the journey in the planning and not what factors you have a
solid need to have vs want to have.

you cant monkey see monkey do these things. each case is unique and needs to be handled that way.
you get the information that is pertinent for that individual situation. what you might want may
not be what i would want and vice versa.

as for the after cbct in this case, if you feel like it might teach you something, then it is
necessary. part of doing business is making a profit. part of learning is someone has got to
"suffer"/lay themselves out there for the cause such that the next event is more well founded
and solid than this event...

2. Is the radiation from the Kodak CBCT significant and was taking this post treatment CBCT an
unnecessary risk imposed upon the patient?

now this depends on who you talk to...it sucks but if you felt like you and the patient has
something to learn/avoid a failure then it was worth it..... - Craig barrington

Dear Terry, I prefer to use a model in plaster with a wax crown,  surgical guide  and mark this
guide with gutta percha. with this info I would use the scanner ....Dr.Glen George Williams do Carmo

Terry, If the CBCT guidelines were done by same boneheads reviewing JOE and all the junk articles
on CBCT, then the proper course of action would be to ignore the guidelines.

Somehow in dental school, it was OK to shoot:

1) Multiple angled preops
2) First instrument
3) Last instrument
4) Conefit
5) Downpack
6) Backfill
7) Final...often multiple angles.

This was all done with D speed film, half-wave rectified generators and only Al filtrations.
Of course, we never missed, so there were no re-takes.
This was somehow acceptable.

What I'd like to do is do an inspection of endodontic offices and see how many are still using film,
and have the same guidelines applied to them.

Take your recalls as you see fit. - John A Khademi

I have a Kodak 9000 3D too, and usually I perform pre-op and post op CBCT ex
am after any kind of surgery (implantology or endodontic surgery), because of th
e very low irradiation of the patient and the problems of diagnosis due to the l
imits of 2D radiology . In the upper frontal area, patients receive almost the s
ame amount of irradiation with a conventional Xray as with a CBCT performed with
 9000 3D; anyway the amount of irradiation for exams in other areas is very low,
 too

My praxis is limited to endodontics and surgery, so often I have to solve very c
omplexendodontic problems. I use daily my CBCT to diagnose these problems, accor
ding to the Joint position of AAE- AAOMR it is said (in the summary) that " Limi
ted FOV CBCT systems ...may provide a dose saving over multiple traditional imag
es in complex cases".  -  Leleambu

I do understand why somebody would take a pre-op CbCT. I do not understand why
you would take a post-op CbCT. If you would take a new one at the follow-up visit
that would be logical again. -  Rafael Michiels