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THE ASSESSEMENT OF PERIODONTAL LESIONS

USING CBCT
Article January 2015

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Revista Romn de Anatomie funcional i clinic, macro- i microscopic i de Antropologie

Vol. XIV Nr. 3 2015

CLINICAL ANATOMY

THE ASSESSEMENT OF PERIODONTAL

LESIONS USING CBCT
Alexandra Dumitrescu1, Ana Gabriela Benghiac1, I. Salamastrakis1, M.S.C. Haba2,
I.V. Simion2, Danisia Haba3
Gr.T. Popa University of Medicine and Pharmacy, Iai
1. PhD Student
2. Student
3. Oral and Maxillofacial Department
THE ASSESSEMENT OF PERIODONTAL LESIONS USING CBCT (Abstract): This article
aims at highlighting the role of CBCT in the assessment of the periodontal disease, a chronic
condition which is more common in current practice lately, and with multiple implications in the
oral cavity. We analyzed the presence of periodontal lesions using CBCT, in three planes, at a
total of three patients. The patients presented at the radiology center to take craniofacial CBCTs.
CBCT increases the certainty of diagnosis and treatment of periodontal diseases compared to
conventional methods, classical or digital dental radiography. So, as long as we can get appropriate diagnosis, the therapeutic plan will be handled better, implicitly entailing an excellent prognosis of treatment. Key words: CBCT, PERIODONTAL DISEASE, ALVEOLAR RESORPTION

INTRODUCTION
Periodontal disease is a chronic inflammatory disease caused by the invasion of anaerobic
bacteria and spirochaetes in the periodontal
space, including the gingival tissue, the periodontal ligament, the alveolar bone and can lead
to tooth loss and impaired oral functions. Periodontal disease diagnosis is mostly based on
signs and clinical symptoms, however when it
comes to bone resorption, radiography remains
the most conclusive investigation (1,2). Panoramic radiographs are often used to diagnose
alveolar resorption in periodontal disease, achieving a 2D image of several 3D structures and
presenting a number of disadvantages, among
which: underestimation of bone loss, difficult
identification of certain anatomical points and
overlap of adjacent anatomical structures, projection geometry, thus creating an image with
a non-high degree of accuracy; therefore, in
order to eliminate these shortcomings, CBCT
shall be used (1,3). Three-dimensional imaging
created by CBCT allows a better diagnosis,
treatment planning and monitoring, as well as

a better analysis of results, compared to conventional two-dimensional images. Due to this

new revolutionary imaging technology, we can
now create and interact with virtual models of
tooth and jaw structures of patients, fact which
allows us to offer an improved treatment compared to the previous options (4).
Cone Beam Computed Tomography (CBCT)
is one of the latest technologies in the field of
imaging which allows the three-dimensional
view of scanned areas. Using an X-ray cone
beam, the CBCT scanner needs a single rotation around the patient to take hundreds of
pictures of the area of interest, which are then
reconstructed using an imaging software in order to obtain a 3D virtual model of the patient.
The entire procedure is very short (5,6,7,8).
Several studies proved that CBCT presents
some advantages compared to other radiological investigation methods, and compared to CT,
the CBCT image shows a superior quality, reproducibility and validity and a much lower
exposure to radiation. These studies have concluded that CBCT is useful in the maxillofacial
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Alexandra Dumitrescu et al.

Fig. 1. CBCT. Panoramic reconstruction plays severe periodontal lesions. Surrounding bone is sclerotic
and teeth appear as floating in air, the contour is deleted, irregular and lamina dura is missing.

Fig. 2. CBCT.Paraxial reconstruction- deep alveolar bone loss on the mandibular molar;
the molar appears as floating in air.

Fig. 3. CBCT. 3D Reconstruction osteodistruction of the alveolar bone,

teeth are like floating in the air.

area, especially for the evaluation of bone tissue; instead, images are not the desired ones
when it comes to injuries of the soft tissue (9).
In terms of irradiation dose, studies have found
that the radiation dose for CBCT is much lower
compared to a conventional CT, but increased
when compared to a panoramic x-ray (1,9).
CBCT gives the possibility of choosing the field
of view, depending on the area of interest, and
thus the area exposed to radiation is a single
one, the others areas being safe, and finally this
function is considered to be very important for
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the patient because radiation dose will be low

(7,9).
CBCT can be used in the field of periodontology in: diagnosis of craters, furcation and
bone defects, in the assessment of the periodontal bone level and in the assessment of
continuity of lamina dura (1,6,10,11). Former
studies have shown that CT may render a clear
and precise image in case of periodontal bone
height and bone defects, but this can sometimes be unjustified by the high degree of irradiation (9).

The Assessement of Periodontal Lesions Using CBCT

Fig. 4. CBCT. Panoramic reconstruction- alveolar bone loss on the maxillar and mandibular area;
deep vertical bone resorption around 1.1, widening desmodontal space; deep horizontal resorption at
1.4,1.5; intraosseous lesions at 2.4,2.5; vertical bone resorption on surface of the first mandibular
molar; approximal septal defect in the third cadran on 3.6

Fig. 5. CBCT. Sagital reconstruction- Deep vertical bone resorption around 1.1,
widening desmodontal space marked with vestibular cortical thinning and discontinuity.

Fig. 6. CBCT. Paraxial reconstruction- deep horizontal resorption at 1.4,1.5

METHODOLOGY
The CBCT were obtained from the database
of the MedImagis private dental radiology clinic from Iasi, from three patients who made the
CBCT for investigations in the maxillofacial
area. The CBCT were achieved with Planmeca

3D MID and the evaluation of the periodontal

lesions was made with the softwear Romexis
3.6.0. Image density and contrast were adjusted digitaly for easy viewing. The CBCT
obtained were analized twice. The analises was
performed in a quiet environment with adecvate
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Alexandra Dumitrescu et al.

Fig. 7. CBCT. Paraxial reconstruction-intraosseous lesions with two walls at 2.4,2.5

Fig. 8. CBCT. Paraxial reconstruction- performed using CBCT show a vertical bone resorption
on surface of the first mandibular molar

Fig. 9. CBCT. 3D reconstruction - alveolar bone loss in 1 and 4 cadran

lighting and was evaluated in three spatial

planes: coronal, sagittal axial and 3D reconstruction.
Case 1: A.V, 60 years old, male patient
who admit using CBCT scan using the following acquisition protocol; the exposure date was
3.06.2014, the image size is 458x458x458mm,
kV 90, mA 12, the voxel size 400 and the exposure time 13.817 s.
Case 2: A. I, 36 years old, male patient
who admit CBCT scan using the following protocol acquisitions: the exposure date was
11.10.2014, the image size is 505x505x434mm,
486

90 kV, 10 mA, voxel size 400, and the exposure

time 13.904s, DAP(mGyxcm)- 2490.
Case 3: I. M, 39 years old, female patient,
who admit CBCT scan using the following acquisition protocol: the exposure date was
4.10.2014, the image size is 452x452x447mm,
90 kV, 12 mA, voxel size 400, with an exposure
time 13.907s and DAP(mGyxcm)- 2964.
CONCLUSION
To conclude, CBCT is successfully used in
the investigation of periodontal disease, bringing multiple benefits, and it should also be used

The Assessement of Periodontal Lesions Using CBCT

Fig. 10. CBCT. Panoramic reconstruction-Chronic inflammation of the mucous reveals at right maxillary sinus in the lower 1/3 of dental origin without sinus ostium obstruction. Intrasinusal chronic
inflammatory lesion is possible due to chronic periodontal lesion 1.8. which has a much larger desmodontal spatial-looking pockets wich is thinning the cortical, and with discontinuity of sinus recession;
alveolar bone resorption on the 1.8, 1.6, 1.5 and 1.7 is absent; alveolar bone resorption on the second
cadran and furcation on 2.6,2.7; in the fourth cadran alveolar bone loss on vestibular and lingual face
on the teeth 4.6, 4.7,4.8 with discret desmodontal widening; moderate retraction of periodontal edge
predominantly in the right vestibular 3.7 and 3.8 molar roots.

Fig. 11. CBCT. Paraxial reconstruction- Chronic periodontal lesion at the level
of 1.6 with vestibulo-palatal bone resorption and furcation.

Fig. 12. CBCT. Paraxial reconstruction- presents a significant retraction mainly

palatal of the dental ridge without widening desmodontal space, on 1.5.

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Alexandra Dumitrescu et al.

Fig. 13. CBCT. Paraxial reconstruction- Vestibular and palatal bone resorption
mainly with furcation on the tooth 2.6.

Fig. 14. CBCT. 3D Reconstruction- Vestibular and palatal bone resorption mainly
with furcation on the tooth 2.6, 2.7. Moderate retraction of periodontal edge predominantly
in the right vestibular 3.7 and 3.8 molar roots.

whenever the standard 2D x-ray may not provide the necessary information for dentist to
establish the diagnosis and the optimal treatment plan. CBCT diagnosis can give accurate
information on bone status and bone defects,
and injuries of furcation and craters appear to
be better represented. Yet, since the radiation
dose is higher than other radiological investigations, the choice of CBCT as a radiological
investigation must be justified and must have
an increased benefit for the patient, compared
to risks (6,12,13). Information about the CBCT
is still new to many medical specialties and due

to its importance and usefulness, it has to be

developed with the help of courses and research.
ACKNOWLEDGEMENTS
This paper received financial support by the
project Programme of excellence in doctoral
and postdoctoral multidisciplinary research in
chronic diseases, Grant No. POSDRU/
159/1.5/S/133377, project co-financed by Sectorial Operational Programme of Human Resources Development, financed from the European Social Fund.

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Corresponding author
Fochi (Dumitrescu) Maria Alexandra
e-mail: fo_ale@yahoo.com

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