Title	Cone-Beam Computed Tomography Provides Clearer Identification Of The Mandibular Canal Than Digital Panoramic Imaging In Pre-Surgical Dental Implant Assessment
Clinical Question	In a healthy adult patient, can cone-beam computed tomography (CBCT) more accurately identification the mandibular canal than standard digital panoramic radiography for pre-surgical implant assessment?
Clinical Bottom Line	Researchers found that CBCT reformatted panoramic images proved more accurate than digital panoramic images for the identification of the mandibular canal. However, since CBCT images cause greater radiation exposure to the patient (4 to 20 times) than digital radiographs, the use of CBCT over digital radiographs should be based on necessary diagnostic benefit. (See Comments on the CAT below)
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 18848113 Angelopoulos/2008 68 radiographs from each of 3 different modalities for pre-implant assessment (CBCT, digital panoramic, and digital panoramic based on storage phosphor system). Randomized Controlled Trial Key results Reformatted CBCT images rated higher than either digital panoramic method (p < 0.001) for all locations of mandibular canal (posterior, middle, and anterior).
Evidence Search	"Cone-Beam Computed Tomography"[Mesh] AND "Implant Assessment"[All Fields]
Comments on The Evidence	The magnitude of effect was not stated; therefore, it is difficult to determine if the improved performance of CBCT is clinically relevant. Inter-rater and intra-rater assessments were not done and therefore it is difficult to know the variability of raters’ findings. The research method restricted viewers from image enhancement, while other cited studies allowed reviewers to use this function of image analysis. These three limitations reduce the quality of the evidence.
Applicability	Any practitioner planning to place an implant in their patient should consider using cone-beam computed tomography prior to treatment, taking into account the higher radiation exposure associated with CBCT and the limitations of this investigation.
Specialty	(Oral Medicine/Pathology/Radiology) (Oral Surgery) (Periodontics)
Keywords	Implant, Digital Radiography, Cone Beam Computer Topography, CBCT, Digital Imaging, Mandibular Canal Imaging
ID#	510
Date of submission	01/13/2010
E-mail	kartaltepe@uthscsa.edu
Author	Christen Kartaltepe
Co-author(s)	Elliot M. Ayoub
Co-author(s) e-mail
Faculty mentor	Stephen Matteson, DDS
Faculty mentor e-mail	matteson@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) by Alvin D. Nguyen (Houston, TX) on 04/12/2012 I wanted to perform a follow up search on the topic of CBCT being accurate for pre-surgical implant assessment. A more recent publication: PubMed: 21903512 confirms the fact that CBCT is indeed very precise and accurate at detecting such structures for pre-surgical implant assessment. by Matteson, Stephen R. (San Antonio, TX) on 09/20/2010 Confirmation and clarification of the concept described in this CAT was published by Naitoh et. al. in 2010 (PMID 20123365). CBCT was shown to depict accessory mental foramina and lateral lingual bony canals.