Edicio Clinica Felix Boada, Calle Bolivar, Nº 59, Baruta – Caracas – Venezuela
RID
REPORTE
Imagenológico Dentomaxilofacial
Sociedad Venezolana deSociedad Venezolana de
Radiología e ImagenologíaRadiología e Imagenología
DentomaxilofacialDentomaxilofacial
SVRID
08-11-2012
ISSN: 2791-1888. Número 2 Volúmen 1 Julio - Diciembre 2022
LA IMPORTANCIA DE LA TOMOGRAFÍA
COMPUTADA DE HAZ CÓNICO EN LA ESTRATEGIA
CLÍNICA ELUCIDANTE: REPORTE DE UN CASO
THE IMPORTANCE OF CONE BEAM COMPUTED
TOMOGRAPHY IN ELUCIDATING CLINICAL
STRATEGY: A CASE REPORT
REPORTE DE CASO
Husmann Santos Torres
1
, André Luca Araújo de Sousa
2
, João Pedro Perez Gomes
3
, Sérgio
Lúcio P. de Castro Lopes
4
, Paulo Henrique Braz da Silva
5
, Antonione Santos Bezerra Pinto
6*
,
André Luiz Ferreira Costa
7
1
Graduated in dentistry, Faculty of Dentis
try, Piauí State University, UESPI. Parnaiba, Brazil.
husmannguthemberg.phb@gmail.com ORCID: 0000-0002-0960-1916
2
Graduating in Dentistry, Faculty of Dentistry, Piauí State University, UESPI. Parnaiba, Brazil. a.lucaaraujo10@
gmail.com ORCID: 0000-0003-4876-9188
3
Master in Sciences, Department of Stomatology, Division of General Pathology, School of Dentistry, University
of São Paulo. São Paulo, Brazil. jotapepeg@hotmail.com ORCID: 0000-0003-2321-133X
4
PhD in Dentomaxillofacial Radiology, Postgraduate Program in Oral Biopathology - Institute of Science and
Technology - Paulista State University Júlio de Mesquita Filho – ICT UNESP, São José dos Campos. São Paulo,
Brazil. sergiolucio@gmail.com ORCID: 0000-0002-7229-7558
5
PhD in Oral and Maxillofacial Pathology, Department of Stomatology, University of São Paulo. São Paulo, Brazil
pbraz@usp.br ORCID: 0000-0002-1842-9521
6
PhD in Morphofunctional Sciences, Institute of Higher Education of Vale do Parnaíba, IESVAP. antonione.
pinto@iesvap.edu.br ORCID: 0000-0002-6577-2816
7
PhD in Medical Pathophysiology, Postgraduate Program in Dentistry, Cruzeiro do Sul University, São Paulo.
São
Paulo, Brazil. alfcosta@gmail.com ORCID: https://orcid.org/0000-0003-4856-5417
Editor Académico: Dr. Alejandro Hidalgo.
Recibido: 26/08/2022
Aceptado: 04/09/2022
Publicado: 09/10/2022
How to cite: Torres HS, de S
ousa ALA, Gomes JPP, Lopes SLPC,
da Silva PHB, Bezerra Pinto AS, et al. The importance of cone beam
computed tomography in elucidating clinical strategy: a case
report. Rep Imagenol Dentomaxilofacial 2022;1(2): 41-6.
41
DOI: 10.60094/RID.20220101-18
Rep Imagenol Dentomaxilofacial 2022 julio-diciembre; 1(2): 41-46
e-ISSN: 2791 -1888
Disponible en:: https://publicaciones.svrid.org.ve/index.php/rid
INTRODUCTION
Cone beam computed tomography (CBCT) has changed the way oral radiology is practiced,
improving
diagnostic quality, accuracy of surgical procedures and its capacity to provide
volumetric data of anatomical structures and pathological entities are fundamental for prognostic
enhancement, especially considering the volume can be interpreted as a biological marker. In this
manuscript, we describe a case report in which the CBCT has provided a great number of details,
enabling to determine the most accurate treatment plan.
Key words: Cone beam computed tomography, mandibular injuries, temporomandibular
joint, tooth root, oral surgery (MeSH)
ABSTRACT
REPORTE DE CASO
Cone beam computed tomography (CBCT)
is an advanced imaging modality that offers 3D
exploration of the anatomical structures and a more
accurate diagnosis compared to radiographies,
with high clinical application in dentistry eld
1,2
.
The use of CBCT brings an important advantage
in comparison to regular computed tomography
(CT) scan, with regard to radiation exposure. CBCT
exposure dose is 10 times lower than regular
CT
2
. Moreover, CBCT presents lower costs, easier
image acquisition, fewer space requirements
and interactive display modes. Despite CBCT is
not recommendable for accurately represent the
internal structures of soft-tissues and soft-tissues
lesions, it is very applicable in dento-maxillofacial
surgeries, oral implantology, image-guided
endodontics and periodontics procedures
3
.
In this manuscript, we show how CBCT can
be used for a variety of purposes. We provide the
imaging analysis of a patient who suffered a car
accident and through volumetric assessment it
became feasible to provide the best treatment
alternative. This case report elucidates how
CBCT application provide benets to all
dento-maxillofacial regions, improving diagnostic
accuracy and a safer treatment planning. It is
important to emphasize new studies aiming
to establish safer CBCT protocols have been
conducted in order to provide accuracy along with
lower doses of radiation
4
.
LA IMPORT
ANCIA DE LA
TOMOGRAFÍA COMPUTADA DE
HAZ EN LA ESTRATEGIA CLÍNICA ELUCIDANTE
Santos Torres, et al.
42
RESUMEN
La tomografía computarizada de haz cónico (CBCT) ha cambiado la forma en que se practica la
radiología oral, mejorando la calidad diagnóstica, la precisión de los procedimientos quirúrgicos y su
capacidad para proporcionar datos volumétricos de estructuras anatómicas y entidades patológicas
son fundamentales para la mejora pronóstica, especialmente considerando que el volumen puede
ser interpretado. como marcador biológico. En este manuscrito describimos un caso clínico en el
que el CBCT ha aportado una gran cantidad de detalles, lo que permite determinar el plan de
tratamiento más preciso.
Palabras clave: Tomografía computadorizada de haz cónico, traumatismo mandibular, articulación
temporomandibular, raíz del diente, cirurgía bucal (DeCS)
Rep Imagenol Dentomaxilofacial 2022 julio-diciembre; 1( 2): 41-46
e-ISSN: 2791-188827
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left temporomandibular joint (TMJ): The condyle
and its relation to proximal and distal segments
on fracture line, displaced from the glenoid fossa
(Figure 2). The fracture line is also clearer in CBCT.
The CBCT examination showed more
LA IMPORT
ANCIA DE LA TOMOGRAFÍA COMPUTADA DE
HAZ EN LA ESTRATEGIA CLÍNICA ELUCIDANTE
Santos Torres, et al.
CASE PRESENTATION
A 42-year-old female patient with aesthetic and
functional impairment sought care at a dental
clinic after having suffered an automobile accident.
Her complaints regarded pain in the left side of
the face. The panoramic radiograph (PR) showed
an image suggestive of a fracture in the region of
the left side mandibular ramus. However due to
the excessive overlap of anatomical structures and
eventual distortions in this region, which is typical
of radiographies limitations
5
, many questions
could not be answered, reason why a CBCT was
performed to complement information data.
The limitations regarding PR can be seen in
Figure 1. This case demonstrates that, in more
generalized cases with multiple lesions, the level
of accuracy of PR is insufcient for an accurate
diagnosis, being highly recommend the request
of additional exams, including CBCT and MRI for
brain evaluation.
CBCT made it possible to better elucidate
details in bone structures and teeth in comparison
to PR image. CBCT enabled visualize a continuity
condition of bone, compatible with fracture in the
conclusively that the cortical structures of the
bone were altered on the left side with the position
of the anterior condyle in the glenoid fossa and it
was possible to have a better view of the anatomy
details for further treatment planning.
Figure 1. Limitations regarding panoramic radiography: possible evidence of mandibular ramus fractures, molar root fracture, possible
intrusion of tooth 38 into mandibular canal, and a hypodense foreign body in right maxillary sinus.
43
Rep Imageno l Dentomaxilofacial 2022 julio-diciembre; 1(2): 41-46
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Figure 3. Tomographic sections A - Showing the presence of root remnant located in the epicenter region of the right maxillary
sinus associated with reactional sinusitis. B- Presence of root fracture located in the distal root associated with an inammatory
furcal lesion. C - Protrusion of the roots of tooth 28 into the left maxillary sinus. D - Tooth 38 showing a close relationship between
its roots and the mandibular canal, not respecting the cortical limits of the roof of the mandibular canal.
Figure 2. Cone beam computed tomography showing the fracture line on the left mandibular condyle.
44
LA IMPORTANCIA DE LA TOMOGRAFÍA COMPUTADA DE
HAZ EN LA ESTRATEGIA CLÍNICA ELUCIDANTE
Santos Torres, et al.
R
ep Imagenol Dentomaxilofacial 2022 julio-diciembre; 1( 2): 41-46
e-ISSN: 2791-188827
Disponible en:: https://publicaciones.svrid.org.ve/index.php/rid
otolaryngology, CBCT has been recommended as
a viable alternative to CT due to its practicality and
lower dose of radiation applied. CBCT has been
considered a suitable imaging modality for bony
Figure 4. Panoramic radiography after treatment. Reduction of mandibular fracture (mandibular branch close to the left condyle),
endodontic treatment of teeth 17 and 47, extraction of teeth 46.
DISCUSSION
CBCT is a complementary imaging exam able
to greatly improve the diagnostic accuracy using
a lower radiation dose than conventional CT scan
1-3.
Not only in the dental practice, but in pediatric
45
sinus, presenting pathological material next to
de maxillary sinus walls, compatible with chronic
reactional maxillary sinusopathy (Figure 3-Coronal
section).
After the analysis of the complementary exams,
the treatment plan could be effectively elaborated,
involving the extraction of tooth 46, endodontic
treatment of tooth 47 and reduction of fracture
in the mandible with an internal xation system.
Subsequently, a new PR was performed showing
good prognosis in the region of tooth 46 and the
calcication in mandibular fracture area (Figure 4).
LA IMPORT
ANCIA DE LA TOMOGRAFÍA COMPUTADA DE
HAZ EN LA ESTRATEGIA CLÍNICA ELUCIDANTE
Santos Torres, et al.
With the CBCT, it was possible to visualize the
impacted tooth 28, projected in a vertical position,
showing roots with extreme proximity to the oor
of the left maxillary sinus (Figure 3 - Axial slice) and
the roots of tooth 38 projected in vertical position
with close proximity to the left mandibular canal
(Figure 3 - Cross sections). Additionally, the tooth
46 presented a solution of continuity (hypodense
line), compatible with a vertical oblique root
fracture in the region of the cervical mesial portion
of the distal root. There is a hypodense image
suggestive of inammatory odontogenic lesion
(Figure 3- Sagittal section). Hyperdense material
(Root fragment) lodged inside the right maxillary
Rep Imageno l Dentomaxilofacial 2022 julio-diciembre;
1(2): 41-46
e-ISSN: 2791 -1888
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REFERENCIAS
1. Venkatesh E, Elluru SV. Cone beam computed
tomography: basics and applications in dentistry.
J Istamb Univ Fac Dent. 2017;51:102-121. DOI:
10.17096/jiufd.00289.
2. Kumar M, Shanavas M, Sidappa A, Kiran M.
Cone beam computed tomography – Know its
secres. J Int Oral Health. 2015;7(2):64-8.
3. Kamburoglu K. Use of dentomaxilofacial
cone beam computed tomography in dentistry.
World J Radiol. 2015;7(6):128-30. DOI: 10.4329/wjr.
v7.i6.128
4. Costa ALF, Barbosa BV, Perez-Gomes JP, Calle
AJM, Santamaria MP, Lopes SLPC. Inuence of
voxel size on the accuracy of linear measurements
of the condyle in images of cone beam computed
tomography: a pilot study. J Clin Exp Dent.
2018;10(9):876-82. DOI: 10.4317/jced.54500
5. Turner KO. Limitations of panoramic
radiography. Oral Surg Oral Med Oral
Pathol. 1968;26(3):312-20. DOI: 10.1016/0030-
4220(68)90401-5
6. Walliczek-Dworschak U, Diogo I, Strack
L, Teymoortash A, Werner JA, Güldner C.
Indications of cone beam CT in head and neck
imaging in children. Acta Otorhinolaryngol Ital.
2017;37(4):270-75. DOI:10.14639/0392-100X-1219
46
st
ructures in adults and children with settings
mainly depending on the region of interest
6
.
The CBCT exam is fast, taking not more than
18 seconds, which makes this procedure a good
alternative for patients, such as claustrophobic
or anxious people, such as children
6
. In the
pr
esent case report, CBCT was fundamental for
an accurate diagnosis of a mandibular f
racture,
which was causing constant pain and was not
suff
icient apparent in PR so an effective treatment
could
be provided.
The effectiveness of the treatment in directly
associated with the diagnostic capacity, and
imaging techniques such as CBCT must be
encouraged to better elucidate the condition
of the bones and its relation to the teeth. A
three-dimensional visualization of the anatomical
structures provide means to assess the relation of
the roots to the mandibular canal, the intrusion
of foreign bodies into the maxillary sinus and
to have good view of the extension of fractures
that, by assessing only the PR, many questions
regarding lesion extension may remain. CBCT
allows for a precise evaluation and classification
of bone fractures, which makes it an
indispensable imaging exam in cases of accident
and extensive damage to face.
Conflict of interests: The authors declare no
conflict of interest.
Corr
esponding author:
Antonione Santos Bezerra Pinto. Institute
of Higher Education of Vale do Parnaíba. Rua
Maria Teresa Dutra, 90, ZIP Code 64202 475.
Parnaíba, Piauí, Brazil. Phone number: +55 86
99415 2880 antonione182@hotmail.com
LA IMPORTANCIA DE LA
TOMOGRAFÍA COMPUTADA DE
HAZ EN LA ESTRATEGIA CLÍNICA ELUCIDANTE
Santos Torres, et al.
Rep Imagenol Dentomaxilofacial 20
22 julio-diciembre; 1( 2): 41-46
e-ISSN: 2791-188827
Disponible en:: https://publicaciones.svrid.org.ve/index.php/rid
