As many of you who are regular readers know, I'm a big believer in CBCT (cone beam computed tomography). The Gendex GXCB-500HD that is in my office routinely provides me with views of things I wouldn't be able to see without 3D technology.
I also provide scans for other offices that require 3D scans for their patients, so when I got a call from an oral surgeon recently, I was glad to be able to provide a scan. It helps ensure the best possible treatment for the patient. This particular situation required a 3D scan because the surgeon had evaluated the panoramic radiograph and felt there was a potential for the impacted third molar to be close to the inferior alveolar neuro-vascular bundle. In order to get a view of what the situation truly held, the scan was needed.
So we took the scan, burned it to a CD, and had it ready for the surgeon's office to stop by and pick it up.
After taking the scan, I had a few minutes at my desk and decided to open the file in Anatomage's Invivo5 software, just to see what I could see. The surgeon had told me the reason for the scan and I was just curious to see the situation and to see if there was any type of potential complication if the tooth was extracted.
After doing a "nerve tracing" and then applying some filters to the reconstructed image, I ended up with the view seen above. For those of you without a dental background, the red line is the main nerve and blood vessels that travel through the lower jaw. You can clearly see the roots of the lower right third molar are fused and that the nerve and blood vessels are passing directly through the opening between the fused roots. If this tooth were to be extracted, these delicate structures would be severed; causing, at a minimum, permanent nerve damage and numbness to the right lip, chin, and all teeth forward of the third molar. There is also the potential of severe bleeding as the blood vessels would also be severed.
These are the kinds of clinical situations we are seeing with 3D on an amazingly regular basis. Cone beam imaging, simply stated, provides an ability to view structures in ways that are impossible to do so without it.
I highly suggest at least having access to one of these machines. Owning CBCT may not be for you, but you should definitely check your area and see if there is an office or a hospital that will provide scans for you on an as needed basis. The best outcomes are generally dependent on the most reliable information.
Thursday, May 12, 2011
Posted by John Flucke at 6:00 AM