Cone beam computed tomography in implant dentistry: recommendations for clinical use.
Cone beam computed tomography in implant dentistry: recommendations for clinical use.
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DOI：
10.1186/s12903-018-0523-5
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发表时间：
2018-05-15
期刊：
影响因子：
2.9
通讯作者：
Bornstein MM
中科院分区：
文献类型：
--
作者：
Jacobs R;Salmon B;Codari M;Hassan B;Bornstein MM
在种植牙科中，三维（3D）成像可以通过牙科锥形束计算机断层扫描（CBCT）实现，以相对较低的辐射剂量和成本提供颌骨和牙齿的体积数据。后者可以解释为什么自二十年前第一个牙科CBCT系统出现以来，市场一直在稳步增长。目前有超过85种不同的CBCT设备可用，这种指数增长在科学证据和现有CBCT机器之间造成了差距。事实上，对一台CBCT机器的研究不能自动应用于其他系统。在叙述性综述的支持下，提供了口腔种植牙科中合理和优化CBCT成像的建议。剂量和诊断图像质量的巨大范围需要在临床使用之前进一步优化和论证。然而，种植牙的适应症可能超出诊断范围。事实上，固有的3D数据集可以进一步允许手术规划并通过3D打印或导航转移到手术。尽管如此，不同的牙科CBCT机器和协议的有效辐射剂量可能会有很大的变化，等效剂量范围在2到200张全景X线照片之间，即使是针对类似的适应症。同样，这种变化也被注意到用于诊断图像质量，这揭示了CBCT技术和曝光协议之间的巨大差异。对于解剖模型制作，所谓的分割精度可能高达200 μm，但考虑到机器性能的广泛变化，可能会出现更大的不准确性。这也适用于线性测量，200 μm的精度是可行的，而有时可能达到五倍的不准确度。诊断图像质量也可能受到患者因素（例如运动和金属伪影）的严重影响。除了放射诊断的可能性，CBCT还可以提供巨大的治疗潜力，与手术指南和进一步的假肢康复有关。这些额外的机会肯定会澄清使用CBCT进行手术前植入计划及其转移到手术和假体解决方案的部分成功。因此，牙科CBCT可用于术前诊断、术前计划和口腔种植体康复的围手术期转移，同时努力优化基于CBCT的机器依赖性、患者特异性和适应症导向变量。
In implant dentistry, three-dimensional (3D) imaging can be realised by dental cone beam computed tomography (CBCT), offering volumetric data on jaw bones and teeth with relatively low radiation doses and costs. The latter may explain why the market has been steadily growing since the first dental CBCT system appeared two decades ago. More than 85 different CBCT devices are currently available and this exponential growth has created a gap between scientific evidence and existing CBCT machines. Indeed, research for one CBCT machine cannot be automatically applied to other systems. Supported by a narrative review, recommendations for justified and optimized CBCT imaging in oral implant dentistry are provided. The huge range in dose and diagnostic image quality requires further optimization and justification prior to clinical use. Yet, indications in implant dentistry may go beyond diagnostics. In fact, the inherent 3D datasets may further allow surgical planning and transfer to surgery via 3D printing or navigation. Nonetheless, effective radiation doses of distinct dental CBCT machines and protocols may largely vary with equivalent doses ranging between 2 to 200 panoramic radiographs, even for similar indications. Likewise, such variation is also noticed for diagnostic image quality, which reveals a massive variability amongst CBCT technologies and exposure protocols. For anatomical model making, the so-called segmentation accuracy may reach up to 200 μm, but considering wide variations in machine performance, larger inaccuracies may apply. This also holds true for linear measures, with accuracies of 200 μm being feasible, while sometimes fivefold inaccuracy levels may be reached. Diagnostic image quality may also be dramatically hampered by patient factors, such as motion and metal artefacts. Apart from radiodiagnostic possibilities, CBCT may offer a huge therapeutic potential, related to surgical guides and further prosthetic rehabilitation. Those additional opportunities may surely clarify part of the success of using CBCT for presurgical implant planning and its transfer to surgery and prosthetic solutions. Hence, dental CBCT could be justified for presurgical diagnosis, preoperative planning and peroperative transfer for oral implant rehabilitation, whilst striving for optimisation of CBCT based machine-dependent, patient-specific and indication-oriented variables.
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