PAGD Keystone Explorer Spring 2021

Keystone Explorer | Spring 2021 9 dentistry issues Q » Sinonasal and airway applications (all) » TMJ hard tissue diagnosis » Surface imaging integration, model superimposition, virtual surgical planning, and other digital workflow solutions 2D imaging remains the gold standard for caries detection, routine imaging of general periodontal bone support, and routine dental and orthodontic diagnostic tasks for the pediatric population provided that clinical examination does not immediately establish a clear indication to image in three dimensions for one of the above tasks. And, 2D imaging is often a good tool for images that need to be taken in frequent series, such as progress orthodontic panoramic images, implant post-op periapical images, and intraoperative checks, etc.—of course at the discretion of the clinician. Most dentists wonder which type of CT machine to purchase if they are thinking of integrating 3D imaging within their practice or which local dentist or imaging provider to send their patients for a scan. The most important factor in this decision should be related to the field of view required for the diagnostic applications that will be used most often. For example, an endodontist will want to select a unit with the best resolution and smallest fields of view. A dentist who will extract the occasional third molar, place the occasional implant, or do the occasional complex root canal will select similarly. More complex cases with full-mouth implant rehabilitations or sinus lifts will likely require some upward flexibility in the field of view. An oral surgeon, TMJ specialist, or sleep therapy provider will want to capture an upper medium to large field of view depending on their scope of practice. An orthodontist who would like to evaluate pediatric patients for more complex airway or structural diagnosis might seek a CT unit that allows for a faster scan with parameters geared to intentionally reducing the total radiation burden to even less than that of the sum of a traditional panoramic and cephalometric series. Many units commercially available offer a range of collimations, from an arch or a quadrant to a full-head view, and this may be the best solution for a versatile provider. Every dentist should define a workflow appropriate for their practice and patient imaging needs that includes the following considerations: » Perform a clinical examination and review the patient’s history prior to radiographic prescription to better pinpoint the imaging that will most benefit the patient, as opposed to instituting a blanket imaging protocol that “every patient automatically gets.” » Know your patient (age, size, radiation history, etc.). » Review a patient’s chart to check for similar prior examinations, within which may lie answers to current clinical questions, if recent, or guide future imaging protocols in the presence of a finding that needs monitoring, referral, or follow-up (this is an oft- understated aspect of imaging selection). » Adequately train staff on how to select the proper acquisition parameters and field of view for the examinations ordered. » Employ a system for reviewing all conventional radiographs or scrolling through any CBCT volume in its entirety, and if it cannot be done during the patient’s appointment, set aside time later to do so. » Determine how to manage the requirement to interpret the entirety of all radiographic exams to cover the full range of anatomy captured (self- acquired or outsourced). The specific information you need for your patient and why you need it should be determined prior to all CBCT scans taken. It is important to gain the expertise, at minimum, to understand the content of the volume of a CBCT image within the region of interest. Further, it is essential to either have or seek the expertise to interpret all structures outside the region of interest, as most CBCT scans contain an abundance. Dr. Newaz received his DDS degree from the University of Michigan School of Dentistry and continued on to complete residencies in both Oral & Maxillofacial Radiology and Orthodontics from the University of Florida and NYU-Langone Hospitals, respectively. He has been a member of the BeamReaders team since 2016 and is currently engaged in airway-focused practice of both specialties, based out of Florida and New York City. This content is provided by BeamReaders. For more information, visit www.beamreaders.com .