PAGD Keystone Explorer Winter 2020

18 www.pagd.org Q dentistry issues It is no secret that the use of Cone Beam Computed Tomography (CBCT) has proven valuable in the specialized fields of Oral Surgery and Endodontics. From diagnosing root fractures to planning precise implant placement and restorations, the CBCT has become an amazing tool in our dental armamentarium. While a specialist may choose a smaller field of view (FOV) for single tooth diagnostics and implant placement, and this type of machine may be a more initially affordable investment, incorporating a larger FOV CBCT into the general dental practice may provide a diagnostic advantage to the general dentist. improved diagnostic and screening abilities of a large FOV CBCT may help bridge the gap with other healthcare professions such as primary care physicians, ENT’s, pediatricians, and chiropractors. This is especially true in the quickly advancing field of Airway Centered Dentistry, which typically requires a team treatment approach. Airway Centered Dentistry refers to dental teams that are trained to recognize and provide treatment and therapy options for patients with sleep disordered breathing. In 2017, the ADA recommended that all dentists screen for obstructive sleep apnea (OSA). Including a sleep and breathing questionnaire into existing medical history and use of the Epworth Sleepiness Scale (ESS) are common ways to incorporate OSA screening. While a CBCT is not necessary to complete the screening process, a large FOV CBCT can help to visualize areas of possible obstruction and many softwares allow the user to measure airway volume. While the CBCT cannot predict airway collapsibility, it is a powerful screening and educational tool for the patient as well as the patient’s medical and dental treatment team. Clinicians must use judgement when determining which patients may benefit from use of such a tool. A clinician may choose to obtain a large FOV CBCT if a patient has a high score on ESS or other concerns on a sleep and breathing questionnaire. A large FOV CBCT may also be helpful when determining if a patient would benefit from such therapies as oral appliance therapy (OAT) with mandibular advancement devices (MAD). While the radiation exposure is much less than traditional medical CT imaging, it is higher than the dental standard of a panoramic radiograph. These factors should be considered carefully when choosing to use a large FOV CBCT. Typical field of view for endodontics and single implant restorations is variable and based on provider preference but may be limited in most cases to keep radiation exposure at a minimum. A FOV of 15 cm x 15 cm or larger can capture many structures vital to understanding and Large FOV CBCT: Bridge the Gap By Jessica Zugai, DMD Image above is an example 23 cm x 23 cm CBCT of a 38 yo male with medical history of moderate sleep apnea, hypertension, and diabetes mellitus type 2. Entire airway is visible from nose to just above the trachea. Narrowest portion is noted posterior to tongue, making oral appliance therapy with a mandibular advancement device a possible therapy option for this patient. This image allows for clear and effective communication with the patient’s sleep physician and entire medical team.