3d X-Rays vs. 2D X-Rays: How Cone beam imaging is radically transforming dentistry

New technology is something we strive to incorporate into our everyday patient care at Magic Smile Dental. The technology we add to our practice must fulfill three main requirements: 1) it must improve the quality of care to our patients and 2) it must make for a more comfortable dental visit 3) It must be safe. One gadget we have that fulfills all of these goals is Cone Beam Computed Tomography (CBCT), which gives us the ability to view your teeth, jawbone and important oral anatomy in 3 dimensions rather than 2 dimensions.

A standard dental x-ray is a 2-dimensional representation of the oral cavity, which is a 3-dimensional space.  2-D images are great for evaluating tooth decay, bone loss, and other common dental issues and are still the standard for the routine check-up x-rays we take. 3-d images are used for more diagnosing and planning more complicated dental procedures.

Most commonly, the CBCT will be used prior to dental implant placement. The trouble with 2D traditional x-rays is that you can only see height and width, but not depth. When evaluating important nerves and blood vessels throughout the oral cavity with 2D x-rays, you are making an educated guess as to where these structures are located. With CBCT, there is no guesswork. The structures of the jawbone, the teeth, the nerves and their corresponding heights, widths, and depths can all be seen from multiple angles. This gives the doctor infinitely more knowledge about where to place the implant, what size to use, how dense the jawbone is, and other valuable information.

Even more advanced is the ability to complete “Guided Implant Surgery.” With guided surgery, the information from the CBCT is sent to a lab which fabricates a stent which the doctor places against existing teeth or gum tissues. The stent has holes in it so that the implant can be placed at the exact proper depth, angulation, and position. Even the most talented and experienced surgeon cannot replicate this accuracy. With use of the CBCT images, the doctor can determine the difficulty of the implant case and decide whether the patient may benefit from guided surgery.

What else can the CBCT machine do? It can also take the standard 2D panoramic x-ray of the machine it replaced, in fact with higher quality and resolution. In addition, it can take extraoral bitewing x-rays. This will come as a relief to patients who gag during regular dental x-rays or who have painful bony growths called “tori.”

Lastly, CBCT helps with diagnosis of oral conditions which cannot be seen on 2-D images. For instance, many tooth infections cause destruction of the bone surrounding the end of the root. Often we can see this with a regular dental x-ray; however, in some cases it cannot be identified without a 3D image. This information will decrease the number of inconclusive diagnoses for tooth-related pain. Also, we can send a copy of the 3D scan to an oral radiologist, a specialist in reading complex dental radiography. The radiologist can help identify any abnormal findings and recommend further follow-up if needed.

If you have concerns about the amount of radiation coming from our new piece of equipment, let us address those fears. A 3D image with our CBCT machine in the Ultra Low Dose setting (always used) is 38 μSv. For comparison, a flight from New York to Los Angeles will expose you to about 40 μSv of radiation, which is also the equivalent of 6 standard dental x-rays. If you have any questions regarding our new machine, don’t hesitate to ask our fantastic staff or doctors.

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