CBCT and RTG

Many clinical conditions in dental practice are impossible to diagnose without correctly performed X-ray images, and only proper imaging diagnostics allow for their detection, which subsequently implies specific therapeutic procedures.
Techniques utilizing X-rays are particularly applicable in dental practice, ranging from 2D images, such as periapical RTG, bitewing RTG, and orthopantomographic RTG (so-called panorama), to much more accurate and increasingly implemented daily practice – 3D imaging. 3D imaging using computed tomography techniques is currently one of the main standards of precision dentistry. Cross-sections available through the use of the CBCT (Cone Beam Computed Tomography) technique, i.e., the cone beam technique, enable precise analysis of the diagnosed area while allowing for a lower radiation dose compared to a classic head CT, and mainly for this reason they are widely used in all fields of dentistry today.

• performed using a radiation detector placed inside the patient's oral cavity adjacent to the part of the dental arch to be imaged
• can be performed using Cieszynski's isometry technique (bisecting angle) or the paralleling technique
• allow for imaging of a small field; most commonly used for the diagnostics of a single tooth.

• allows for simultaneous visualization of the crowns of the upper and lower teeth along with the marginal periodontium
• particularly valuable for the diagnosis of interproximal caries, secondary caries under fillings, and the assessment of the subgingival margins of fillings
• RTG films have special “wings” (bite tabs) used to hold the film between the upper and lower teeth.

• uses a radiation detector placed in the oral cavity in the occlusal plane
• have very specific indications for their performance, such as:

In the case of maxilla diagnostics:

1. Assessment of the position of impacted teeth (buccal/palatal position), supernumerary teeth, supplemental teeth, and odontomas.
2. Determining the extent of lesions, e.g., cysts, tumors.
2. Diagnostics of cleft palate.
3. Assessment of the periapical area.
4. Diagnostics of tooth and alveolar process fractures.
5. Detection and assessment of the position of tooth roots displaced into the maxillary sinus lumen.
6. Auxiliary assessment of tooth root positions.

In the case of mandible diagnostics:

1. Assessment and location of salivary stones in the salivary gland ducts.
2. Assessment of the position of impacted teeth (buccal/lingual position); especially third molars.
3. Determining the extent of lesions, e.g., cysts, tumors.
4. Assessment of the periapical area.
5. Diagnostics of tooth and alveolar process fractures.

• it is a radiograph obtained through the reciprocal movement of the cassette and the X-ray tube around the examined object along an elliptical path
• it is a layered radiograph in which the teeth, maxillary alveolar process, and the alveolar part of the mandible are visualized simultaneously, as well as the craniofacial bones including the maxillary sinuses and temporomandibular joints
• is not a suitable tool for diagnosing the anterior section of the dental arches, i.e., from the canine to the canine, due to image blurring
• allows for the detection of many changes such as bone rarefaction and condensation, which, however, usually require detailed diagnostics within 3D imaging.

• this is a tomography performed using a cone-shaped X-ray beam emitted by an X-ray tube rotating around the patient's head
• short exposure time (10-40 seconds) allows for a reduction in the ionizing radiation dose (compared to classic head CT) and reduces the number of artifacts
• is widely used in all fields of dentistry, including endodontics, dental surgery with implantology, and even daily restorative dentistry.

Applications in endodontics:

• Localization of hidden, additional, and atypically located or coursing root canals.
• Determining the actual number of root canals and their course.
• Detection of early inflammatory processes in periapical tissues, invisible in 2D imaging.
• Diagnosis of root fractures and their course (significant for qualifying for endodontic treatment).
• Determining the extent of lesions and – by comparing images over time – precise assessment of the healing progress (or lack thereof).
• Diagnostics of complications and a more precise assessment of prognosis.

Applications in dental surgery and implantology:

• Precise determination of the position of tooth roots and impacted teeth (as well as additional, supernumerary teeth, etc.) and their position relative to neighboring teeth and strategic anatomical structures, such as the mandibular nerve canal, maxillary sinus, etc.
• Assessment of bone quantity and qualitative suitability for implantation
• Assessment of post-treatment healing progress (or lack thereof)
• Assessment of the extent of inflammatory and neoplastic changes
• Assessment of complications and a more precise evaluation of prognosis

Applications in conservative dentistry:

• Assessment of the extent of the carious process.
• Detection of early inflammatory processes in periapical tissues, invisible in 2D imaging

Note !!! RTG does not detect inflammatory changes occurring in the dental pulp, but only their causes, such as very deep carious lesions or the consequences of a spreading inflammatory process.