Clinical Applications of Cone Beam Computed Tomography

Clinical Applications of Cone Beam Computed Tomography Abstract The present article evaluates various clinical applications of Cone Beam Computed Tomography (CBCT). Among scientific articles, a research was conducted by PubMed on dental application of CBCT, containing many articles in general, among which most of them were clinically about dentistry and its related analyses. Different functionalities of CBCT, including oral and maxillofacial surgery, root treatment, implantology, orthodontics, temporomandibular joint dysfunction, periodontics, and forensic dentistry have been indicated in a study. This review article illustrates that different CBCT indicators have been used concerning the need for certain discipline of dentistry and the kind of conducted procedure. Introduction Two-dimensional imaging techniques in dentistry have been employed since the first intraoral radiography was created in 1896. Since then, dental imaging techniques have evolved by the advent of tomography and panoramic imaging. While tomography makes it possible to divide the desired levels from an X-ray range, panoramic imaging provides a comprehensive observable image of maxillofacial structures(1). Recent developments of digital diagnostic imaging has been dealing with lower radiation doses and faster processing times, without affecting the diagnostic quality of intraoral and panoramic images. Two-dimensional images, however, have their own natural limitations (including enlargement, distortion, and folding images), which cause the structures to appear erroneously(1). Cone Beam Computed Tomography (CBCT) is capable of producing 3D images, which leads to effective diagnosis, treatment, and further advances. By introducing dent alveolar imaging in 1998, CBCT could produce lower-cost and lower absorbed dose 3D data in comparison to conventional CT(2). CBCT imaging technique is based on a cone-beam X-ray, gathered on a two-dimensional recognizer, with the privilege of achieving more radiation. In contrast to the conventional CT, a parallel change from the recognizer system is not required during the spinning, which brings about a more efficient use of tube power(3). Being compared with the resultant slideshow images of the conventional CT, the cone shaped radiation spins around a certain object once (in this case was the patients head and neck) and is capable of producing hundreds of 2D images from a certain anatomical volume(4). Then, using different kinds of algorithms that are made by the Feldkamp in 1994, the images are reconstructed in a 3D observable data set(5). Compared to a common 2D radiography, CBCT has various advantages, including no folded images, measuring ratio of 1:1, no geometric distortion, and 3D demonstration. It is worth mentioning that, by using a relatively low ionic radiation, CBCT provides a 3D representation from hard tissues along with little information from soft tissues(6). Common CT systems have similar advantages (in addition to providing information on soft tissues), however, they create the image call with higher levels of ionic radiation and longer scanning time. In total, larger CT units will cause them to be a weak alternative for the Dental offices(7). Applications in oral and maxillofacialsurgery The resultant 3D CBCT images have been used to investigate the right place and the maxillofacial pathology area, as well as assessing the final impact or the additional tooth and its link with vital structures(8-23). These images have been utilized to look into the bone graft space, before and after the surgery and osteonecrosis of the jaw changes (such as those who were exposed to bisphosphonates), as well as the pathology and/or paranasal sinus defect(24-28). Moreover, CBCT technology was applied to assess patients with obstructive sleep apnea to adopt an appropriate surgery method (if required)(29). Since CBCT units were available extensively, dentists have made use of this technique increasingly to investigate maxillofacial injuries. In addition to preventing form folded images, which appear in panoramic images, CBCT made it possible to precisely measure the surface intervals, as well(30, 31). This distinct advantage caused CBCT to become an established method for the evaluation and management of mid-face lesions and orbital fractures, assessment of fracture, observation of maxillofacial bones engaged in surgery, and routing during operation along the processes that are related to gunshot(32-37). CBCT is widely used in orthognathic (orthodontic surgery) and orthmorphic surgeries, in a way that the details of intraocclusalrelationships and the display of tooth surface are vital for adding a 3D skull model. Using advanced software, CBCT made it possible to slightly observe the soft tissues and enable the dentists to control posttreatment beauty, as well as assessing the outline of lips and bone area of the palate in patients with palatal split(38-43). Applications in root treatment While several studies have shown that high contrast CBCT images could be used to distinguish between apical granuloma and apical cysts with measuring dental trauma, yet CBCT imaging is an applicable tool for the diagnosis of periapical injuries(44-46). Other scholars use CBCT as a useful tool to classify the origin of damages, including root or non-root origin, which indicates another period of the treatment(47). The reliability of theses labels (root or non-root) are doubtful. Consequently, they are the foundation of demand on (more) non-invasive techniques for the diagnosis of damages that are usually detected through non-invasive processes. Several clinical sample reports have concentrated on using high resolution CBCT images to diagnose the vertical fractures of the root(45, 46, 48, 49). CBCT is considered a salient technique for periapical radiographs in diagnosing root vertical fractures, measurement of dentin fracture depth, and detecting the root vertical fracture(50, 51). CBCT imaging has made the early diagnosis of inflammatory root resorption possible, which is slightly detectable by 2D radiography(52, 53). As well as detecting the root and cervical root resorption (internal and external), CBCT is also capable of recognizing the extent and progress of the injury(54-58). CBCT could be used to identify the number and morphogenesis of roots and their related canals (both main and supplementary), and also determine the functional length, type, and angle size(54-56). CBCT performs a more accurate evaluation of root canal resorption than 2D imaging(48). It also applies in identifying the extent of pulp in talon cusp and the position of damaged tools(59, 60). Due to its simplicity and precision, CBCT is utilized in canal preparation with different tool techniques, as well(61, 62). CBCT is a pre-operation tool for figuring out the proximity of tooth to the adjacent vital structures, make the surface anatomy right size and cause extent determination to become possible(63-65). In emergency cases after the injury, in which it is vital to recognize the desired tooth status, CBCT images could help dentistry with a selection of the best treatment methods(66, 67). Applications in dental implants As the need for dental implant, as an alternative to the lost tooth, increased helping the treatment plan and avoiding the damage to vital adjacent surfaces during the operation requires for a technique to get the right cavity and measure the position of implant. Previously, such measurement was generally provided by 2D radiographs (in special cases) that was obtained through conventional CTs. CBCT, however, is an appropriate option for dental implant, which in comparison with 2D images, provides more precision in measurement and lower radiation dose at the same time(68-80). The new software lowers the chance of improper settling of accessories and damaged anatomic structures(81-84). CBCT decreases the implant failure by providing information on bone density and cavity shapes, as well as the height and width of the proposed implanting space for patient(85, 86). CBCT does not calculate the Hounsfield scale accurately; hence, the number of bone density through this technique could not be vertical through a group of CBCT units or patients. However, the effect of CBCT in measuring and evaluating the cavity shapes has brought about the selected improvements. By a prior notice about the complications, which could occur during a proposed treatment, the plan can be designed in a way that resolves them or results in an alternative treatment. CBCT is usually used in post-operation evaluation to assess the bone graft and implant position in the cavity(79). Orthodontics applications Orthodontics, in introducing qualitative software of evaluation such as Dolphin (Dolphin ]maging Management Solutions) and In Vivo Dental (Anatomage), enables the dentists to fully exploit the CBCT images for cephalometric analysis. Moreover, it is an appropriate tool for investigating the amount of facial growth, age, function of respiratory tract, and disrupting the destruction of tooth(87-92). CBCT is a reliable tool to evaluate the amount of damaged tooth proximity to the vital structure, which could interrupt the orthodontic procedure(93, 94). When the mini-implant[1] is required as a temporary holder, CBCT provides the observable guidelines for accurate and safe installation and thus, accidental and fatal injuries could be avoided(95-97). Accordingly, the evaluation of bone density before, during, and after the treatment indicates that whether or not the injury has decreased or remained unchanged(98, 99). CBCT illustrates different aspects of maxillofacial complications in one scan. In addition to 3D structure of skeleton bones, it enables the dentist to access anterior, crowns, and axial images. These images could be turned to allow the dentist to observe patterns and various angles of the image, including those that are not available in 2D radiography(100, 101). CBCT images are capable of auto-correction for enlargements and creating vertical images by measurement ratio of 1:1. Consequently, CBCT is more accurate than panoramic and conventional 2D images(102). Applications in TMJ disorders TMJ (temporomandibular joints) diagnostic images are vital for to accurately detect diseases and joints malfunction. According to Tsiklakis et al., though CT is easily available, it is not prevalent in dentistry due to high required costs and doses. Examining the right linking space and position of condyle in the cavity has been made possible by CBCT, which is a tool for showing probable dislocation in a connecting disk(103). CBCT precision and lack of folded images make the measurement of the roof of the glenoid fossa and observation of soft tissue around TMJ possible, which can provide a practical diagnosis and eliminate the need for MRI(104-106). According to Tsiklakis et al., MRI â€Å"is one of the most useful tests since it provides images from both soft and bone tissues†(103). While MRI is recommended for evaluation of TMJ soft tissues, CBCT has lower radiation dose. However, it is emphasized that CBCT technique, unlike CT and MRI, does not reveal the details of soft tissues. The aforementioned advantages made the CBCT the best imaging tool for incurred injuries, fibrous ankylosis, pain, dysfunction, cortex erosion of Cortical condyle, and cyst(107-109). Applications in periodontics As Vandenberghe et al. believe, 2D radiography is the most prevalent imaging used in the bone morphology, such as a defect in periodontal bones. The limitations of 2D radiography, as a result of probable errors and misconceptions in indentifying reliable reference anatomic points, forced dentists to estimate the amount of lost or existing bone(110). These findings approve the observations achieved by Misch, in which the 2D radiography is for identification of alterations in bone level or the architecture of inefficient bone defect(111). CBCT provides an accurate measurement of intrabony defects, by which doctors are able to assess the amount of rupture, valve defects, and periodontal cyst(112-114). While CBCT and 2D radiography are compatible with revealing interproximal defects, it is only the 3D images, such as CBCT, that are able to illustrate the buccal and lingual defects(115). To obtain the details of morphologic of bone features, CBCT is used with precision as the direct measurement with a periodontal probe(110, 111). Moreover, CBCT could be utilized to express the performance derived from periodontal defects and enable the doctors to assess the results of post-periodontal surgeries(115). Application in forensic dentistry Age estimation is one of the significant aspects of forensic dentistry. In this process, is it vital for doctors to be capable of estimating the age of every person in a legal system (including those who have passed away). This is one of the specific cases in Europe and as Yang et al. declared in 2006, â€Å"every year thousands of under-aged people flee over the all European countries with no formal ID card to find a shelter and protection. On top of this, most of the crimes are committed by people, who seem to be under-aged. In either case, it is necessary to determine the chronological age and fill them in documents, similar to those we have seen in Belgian that are under-aged and want to enjoy ethnic and social benefits.† The text of the present article was published for age estimation in line with the relationship between tooth change and age. The tooth enamel, beyond a natural cover, is extremely safe against such major alterations. However, as the age raise the pulp com plex (dentin, cementum, and pulp) illustrates the physiological and pathological changes(116). Usually, the extraction and section cut is required to identify morphological changes, which are not always observable. Nevertheless, CBCT is a non-aggressive alternative. Discussion Since late 1990s, when this method entered dentistry, CBCT scanners have shown substantial advances in medicine and maxillofacial imaging(117). This review article indicated that recent articles were conducted on CBCT, most of which were designated to clinical applications. Most of these articles are about oral and maxillofacial surgery, root treatment, dental implant, and orthodontics. CBCT has limited functionality in restorative dentistry, which is due to its higher radiation dose than 2D radiography and its incapability in providing additional diagnostic information. Moreover, these researches are mostly in the field of restorative dentistry for exploring various privileges of CBCT. Although this review did not assess any related articles to prosthetic applications of 3D scanners, yet the standard surveillances that were conducted in prosthetic treatment could be contingent to the use of CBCT with other dental specialties. For instance, dental implant prosthetic, maxillofacial prosthetic, and TMD evaluation are applicable, which in turn by unifying the resultant data of patients with treatment plan can increase the success of prosthetic treatment. CBCT images embrace issues with medical complications, especially in cases that several teeth and bone levels should be evaluated. New CBCT systems can be utilized in specific dentistry applications. They have higher resolution power, as well as lower exposure and cost in comparison to the prior existing systems. While CBCT has various advantages over 2D radiography, there are natural limitations to this technique that require more precise consideration in the selection of criteria and indices. For example, CBCT is sensitive to removable dentures (including removable dentures peculiar to CT technology) and stiffener bars around a compact object. Overall, CBCT has low contrast and limited strength in viewing internal soft tissues. Most modern CBCT units have flat panel detectors, which are mostly inclined to the bar of stiffening artifacts and are able to provide more information. However, due to the lack of compatibility between artifacts, CBCT is not capable of precise HU measurements; therefore the bone density measurement is not reliable. We believe it is vital to take the principle of â€Å"As Low As Reasonably Achievable†, (ALARA), into consideration. The belief should not be mistakenly interpreted as a reason to avoid the use of high dose CBCT units, which provide us with credible information. There is no tough protocol concerning when the technology must be used and every dentist, oral radiologist and neuroradiologist, must actively assess his/her operational protocols. Image resolution needs an extensive knowledge of anatomy in the fields, which are commonly the domain of dentistry and neuroradiology. Accurate knowledge and experience is required for the clarification of scanned data that determines why imaging is needed. Also the clarification of implicit findings is illustrated, which are explicit in the scan beyond the common scopes of dentistry, including disorders that can be observed in any adjacent area. The fact that CBCT promotes the specialized knowledge and improves the standards of dental care is something that dentists must define case by case. Such an evaluation calls for continuous training and education for dentists and scholars. The recent upsurge in the popularity of CBCT caused many units with low variation (sometimes important though) to be resulted in uncontrolled and unobserved report of the radiation amount. This unapproved report could be due to the limited technological knowledge of medical imaging apparatus in the new units. In response, the academy of European dentistry and maxillofacial radiography has established basic principles for dental applications of CBCT. Summary Based on what has been proposed in this article, most dental CBCT applications are for oral and maxillofacial surgery specialists, root treatment, dental implant, and orthodontics. CBCT test should not be taken unless it is necessary and do more good than harm. While using this method, the whole image dataset (which is a radiology report from a dental surgeon, neurologist, or a general radiologist familiar with the head and neck anatomy) should be assessed completely to maximize the resultant clinical data and make sure that every significant implicit finding were reported. Further researches should be concentrated on the resultant accurate data regarding doses of CBCT systems in which they comprise of a size detector and a background, limited from the scanned volume and sight. CBCT systems with larger background and less metal artifacts for orthodontic and orthognathic surgeries are not available yet. Further evaluations are required for better determination of CBCT applications in forensic dentistry. [1] Implant with less than 3 millimeter diameter

The Cause of Aggression is Social Structure and Child Rearing :: Parenting Raising Children Society Social Status

The focus of this paper is to determine why certain societies are violent, judging from the way their society is structured to the psychological aspects of the individuals. The structural roots of internal and external conflict differ by most factors that were researched. Internal violence derives from weak cross-cutting ties, strong localized male groups (in uncentralized societies) and polygyny, whereas external conflict is seen in societies that are high on socioeconomic complexity, and low in polygyny and as cross-cutting ties. From the 186 societies, only a handful of them fell into the category of the variables this paper is centered upon high ext. vs. int. war were the Yanomamo, Comanche, Maori, Jivaro, and Somali. In Ross's article about conflict and violence, a measurement of internal and external violence was done using 44 variables for the 90 societies. The areas of interest for the table are those measuring internal and external violence. The factor loading is determined by the sum of the scores of each society for each variable and is weighted individually for each society. The six variables in the internal violence and conflict scale, in descending order of importance, are/:/./ The severity of conflict between different communities of the same society (v767), the acceptability of violence when directed against members of the same society outside the local community (v782), frequency of internal warfare (v773), the same severity of conflict within the local community (v764), the extent to which physical force is used as a mechanism for the dispute settlement (v770), the acceptability of violence when directed against members of the local community(v781) and degree of compliance wit h community norms and decisions by members of local communities(v775). Societies that scored high on this end of the scale, for example Jivaro or Somali, frequently engaged in violence and internal warfare both within and between communities of the same society. Societies that fell into the middle of the scale engaged in regular conflict, but internal warfare and violence in local disputes occur less frequently than the previous category of societies. The 3 variables that compose the external warfare and conflict scale are frequency of external warfare(v774), degreee of hostility(v780), and the acceptability of violence directed to people in other societies(v783). The Maori, Comanche and Jivaro are societies of the high end of the scale. From the large amount of research done on violence and conflict, there exist 3 characteristics of societies that are agreed upon by the majority.

Life Imitates Art, Movies Imitate Life Essay

Imagine a world where clothes were non-existent, and it did not matter if your outfit was the current flair, or if your shoes were the latest style. Our culture would halfway cease to exist. The western culture puts so much emphasis on fashion, our lives begin to move and mold themselves around it. Fashion is like art on the body, and making a masterpiece out of what you wear. â€Å"From the materials employed in clothing manufacture to the process by which our garments are made to the social values that dictate what we â€Å"should† look like, fashion has surrounded us and consumed us for generations. (Shmoop Editorial Team 2008) A perfect example of popular culture can be revealed in American Fashion. This is impeccably displayed in the motion picture, based on the novel written by Lauren Weisberger, produced by Wendy Finerman, The Devil Wears Prada. The basic plot of the movie and novel is about a plain jane, just out of college, smart, not fashion savvy, woman (Andrea Sachs) who applies for a job as junior assistant to the editor-in-chief (Miranda Priestly), at a fashion icon magazine â€Å"Runway†, in New York and gets it. She is told repeatedly â€Å"a million girls would die for [her] job† (Finerman, 2006) and if she lasts a year, she will be able to get a job at any magazine. Andrea, in her own way is a counterculture of the people at Runway magazine in the movie. She deviates from the norm of the fashion and mainstream subculture. She tolerates their demanding ways, and demeaning comments of her diet and style, until she breaks and gives in and asks for help. She is given a makeover, by the art director, Nigel, and her new style and job begin to strain her relationship with her boyfriend and her friends. The few scenes that depict her break down and her makeover, is when people begin to notice her, and treat her better once she is wearing the latest fashion. Her hair was cut and styled, she started to watch what she ate, and shaped herself into a fashionista. She began to adapt to their standards, and dressing. She sticks with the job and increasingly spends more time working, whilst climbing the career ladder. This is set perfectly with our commercial culture and the ideology of humans and how our world works. Andrea was a non-conformist in the beginning and frowned upon because she did not wear the latest fall fashion. Once she started to wear the clothes, and shoes, she became well liked. She ultimately conformed to the fashion world. While at a benefit, Andrea ends up being Miranda’s saving grace and is offered to take the other assistants (Emily) spot to Paris. Andrea refused at first, in fear of hurting Emily’s feelings, and is forced to give in because if she does not go, Miranda will terminate her. Before leaving for Paris she takes a break from the relationship with her boyfriend. During her trip to Paris, she has relations with another writer she had met through her work and finds out about a plot to ruin her editor-in-chief. She tries to warn her and ends up finding out Miranda knew the whole time. Miranda ends up fixing her situation by double-crossing her art director, Nigel, and giving a job promised to him to someone else to save her job. Andrea is floored and cannot believe Miranda would do that to her friend. Miranda points out to Andrea that she already did, she did it to Emily. Right there Andrea quits, and leaves it all behind. Once Andrea returned to New York, she reunites with her boyfriend. In the conclusion, she is at a job interview when she is told her previous employer stated â€Å"she was by far her biggest disappointment, but that he would be an idiot not to hire her. † (Finerman, 2006) Throughout the entire movie Andrea is immersed in the fashion world. In the beginning of the movie there is a scene where the art director, Nigel, gives Andrea a pair of black, sling back stilettos. She at first refuses and says â€Å"I don’t think I need these. Miranda hired me, she knows what I look like. He responds â€Å"Do you? † (Finerman, 2006) This one scene indicates a perfect example of ideology. Nigel is setting the social order, because it is the norm of which the people in their occupation wear. I believe it is best stated by Shmoop University, â€Å"From our underwear to our Levi’s to our sneakers, what we wear has, for centuries, spoken volumes about who we are, what we do, and what we want. Whether Americans have dressed to make a political statement, to assert their class status, or simply to be irreverent, every style has carried a certain social meaning. (Shmoop Editorial Team 2008) The entire movie is immersed in popular culture and culturalism. In every scene there is examples of mass culture, commercial culture. It can even be said that ethical egoism is also expressed in the film. Ethical egoism, in short, is the view that perhaps not all persons seek their own self-interest but all should do so (Lee Archie and John G Archie, 2003). This is best represented when Miranda betrays Nigel in the end, in order to retain her job. She may not have had ill intentions and most likely did not want to make that decision, but in the end for her own self-interest, she made someone else sacrifice for her. The film reflects attitudes of our American Society. It depicts how simple a dress can make and transform a woman. Another movie and television series that is popular and uses fashion to influence, is â€Å"Sex in the City. † The show would emphasize certain brands, names, and styles and it caused a massive explosion of commercial paraphernalia. It clearly articulates how fashion matters in our day to day lives. Some people would like to disagree, but we even base our terms and language on fashion. â€Å"Terms like â€Å"white collar† and â€Å"blue collar† connote not just a line of work but a person’s class status, and remind us that we tend to make assumptions about a person’s income, line of work, and social position based on the way he or she dresses. † (Shmoop Editorial Team 2008) Regardless of your gender, sexuality, race, religion, pop culture exists in your life more than you know.

Ethical dilemmas in social work and theories - 1832 Words

ETHICAL DILEMMA in social work This essay will address the ethical dilemmas faced by social workers and how they address these ethical dilemmas when working with service users and carers. It will be illustrated that codes of practice and codes of ethics are of paramount importance when dealing with these dilemmas as they are ones that guide social workers as to how they should try and solve these dilemmas. Social workers encounter ethical dilemmas every day during their work. Banks, in her explanations says these are occurrences whereby a social worker encounters two unwelcoming situations and there is a conflict of moral values, and there is no clear choice as to which decision to make.(Banks, 2006).To elaborate on this , Banks implies†¦show more content†¦Utilitarianism is one common one used, whose idea is based on the idea that ‘the greatest is good for the greatest number’ (Beckett, Maynard, 2005).This theory was formulated by Jeremy Bentham (1748-1882), Bentham s principle of happiness was to always do what will result in happiness of the majority (Clark, 2000). Postmodernists think there is no single truth therefore ethics are not at all relevant in modern society.as they do not replicate modern society and tend to ignore individualism, and ignore cultural diversity but reinforce the oppressive and dominant voices of those in power (Bowles, 2006)Bowles argues they are rarely used so they are not relevant at all Ethical theories are however debatable and usually mean different things to different people. It is therefore essential for social workers not to base their decisions solely on these theories, but make use of Codes of practice when faced with ethical dilemmas. Codes of practise are there so service users and carers are informed and know what to expect from social workers and hence there will always be trust between service user and client. According to Banks, values are regarded as those beliefs people regard as worthy or valuable (Banks, 2012).Some values are personal, yet some are culturally/ societally shared. 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