Cone beam CT scan: Importance of CBCT in treatment plan

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Sir, a patient was referred to the oral and maxillofacial surgery clinic at the HCF Dental Centre, Sydney by a GDP for assessment and removal of tooth 37 due to it having radiolucency.

The patient was medically fit and well. He had attended for a routine restorative procedure where the dentist found tooth 37 to have recurrent decay. On routine radiographic examination, radiolucency was noticed in the orthopantomogram involving 37 and the mesioangular impacted 38.

The GDP made his diagnosis based on a decayed tooth with a radiolucency around the roots as dental cyst associated with 37. He discussed the option of root therapy involving 37, which the patient declined and preferred extraction. The GDP did not do a vitality test for 37, which might have helped him review the conclusion. Based on the clinical and radiographic finding, the patient was referred to the oral and maxillofacial clinic for removal of 37 and the associated cystic lesion (Fig. 1).

Figure 1

Orthopantomograph showing decayed 37 with large radiolucency around roots and impacted 38

On clinical examination, 37 was decayed, partly filled, asymptomatic, with no buccolingual expansion. A cone beam CT scan was done then and there as it was available, which revealed a well demarcated radiolucency involving the impacted 38 consistent with a diagnosis of dentigerous cyst, tooth 37 was completely sound and the radiolucency was extending buccal to the roots of 37 (Figs 2 and 3).

Figure 2

CBCT showing distinct radiolucency around impacted 38 with buccal extension around 37

Figure 3

CBCT showing distinct radiolucency around impacted 38 with buccal extension around 37

This case elaborates the importance of cone beam CT as an important tool in achieving a proper diagnosis and treatment plan. Nowadays the CBCT technology is available in most of the chairside clinics and in a clinical situation like this it can be clearly seen how it can be used to make a proper diagnosis and execute appropriate treatment planning.