Our on-site Cone Beam CT (CBCT) Scanner allows us to image the inside, and around your tooth in 3D. This enhances diagnosis as studies have shown 30%-40% of abscesses cannot be visualised through ordinary x-rays. Fractures and missed canal anatomy can also be identified bringing increased clarity to treatment planning and the chances of successful treatment.

At present, the practice is still one of only a very few endondontic practices in the UK with its own Veraview Epocs 3D scanner manufactured by Morita.
The cone beam CT scanner has been in use for over 8 years and Richard has reported on over 5000 scans of teeth with endodontic issues. His expertise in this new and effective diagnostic modality has resulted in the practice becoming a referral centre for complex cases used by both endodontists and general practitioners. The Academy has become the first endodontic clinic in the UK to run a CBCT course to teach the increased complexity of scanned images to specialists and general dental practitioners.


Overview

Root canal treatment is carried out deep inside teeth in order to remove either a dying nerve or infected material that has entered the nerve spaces. The disease process inside these spaces damages the bone of the jaw surrounding the tooth.

For decades the only way to assess these areas accurately and to diagnose disease and plan treatment is through the use of x-rays. Traditionally, an x-ray beam is passed through the jaw and teeth. The relative absorptions of the radiation are projected onto an x-ray sensitive film placed into the mouth. The resultant image, which requires developing, will show the complex shapes of the tooth in one plane only, areas of decay, and bone damage that has occurred, but sometimes only if it has progressed to a relatively advanced stage.

We have integrated into the practice the next generation of x-ray machines. A Cone Beam CT scanner – the Veraviewepocs 3D from Morita (Japan). For the first time we are now able to clearly see the complete root canal anatomy, roots and surrounding bone by taking slices through the tissues. This enhances our ability to predict what is inside the tooth, and disease around the tooth can be more accurately diagnosed. This leads to enhanced treatment planning and the ability to target treatment where it is necessary, leading to quicker and easier treatment and often reducing the overall costs of treatment.

99 Harley Street was one of the first clinics in the UK to have its own on-site Veraviewepocs 3D scanner 6 years ago. The scanned images have increased complexity, but with over 4000 scan cases treated within the practice the Academy has become the first endodontic clinic in the UK to run a CBCT teaching course for specialists and general dental practitioners.


Example

Example

Examples

This case presented in the first week of scanner use. The patient complained of pain in the lower right jaw but could not locate the source. The conventional (enhanced digital) x-ray taken suggested a problem with the back tooth, but no reason could be found for any disease with this tooth by the referring dentist.

The Cone Beam CT Scan Images clearly showed the problem to be at the penultimate tooth with abscess formation at the back root and between the roots. This could not be seen on the conventional x-ray as the thickness of bone in these regions obscured the abscess. The slices created by the scanner were absolutely clear though.

Technology

The problem with standard intra-oral x-rays, whether standard or digital, is that the image is a two dimensional representation of a three dimensional complex block of human tissue. The image flattens all the anatomical detail so that we can only guess at the true 3 dimensional shapes within. This squashed image hides the fine detail of root canal anatomy, the roots themselves, and the surrounding bone that can often be the key to diagnosing difficult pain cases. However, as the best system we have, endodontists in particular, have acquired great skills in being able to diagnose and predict the shapes beneath from these images.

Many times though we are left providing a ‘best guess’ and have to carry out invasive treatment procedures to try and learn what lies beneath. CT scanners have been around for quite some time in general medicine, but they require huge machines that deliver large quantities of radiation. The innovation of the Veraviewepocs 3D and its Cone Beam CT technology is that it is the only minor footprint 3D scanner available that can take small volume cylindrical scans of 4 X 4cm, suitable for 2-3 teeth analysis. The limited volume together with the digital plate reduces radiation to one of the lowest currently possible for a CT scan.


Dental X-Ray Radiation Risk, Background Radiation and CT machines

X-rays are present in the atmosphere (cosmic radiation) and background radiation also comes from geological structures. Medical x-ray machines produce significant amounts of radiation and the principle governing rule to exposure is to always keep this as low as reasonably possible, employing a favourable risk-benefit ratio.

The level of risk varies according to age and the parts of the body exposed to the radiation. Some areas are more sensitive to others. Dental x-rays generally carry less risk as the jaws are less sensitive areas. The table below (www.xrayrisk,com) calculates the additional risk of cancer from a 4x4cm Veraviewepocs 3D CBCT scan to an average 40 year old female. The baseline risk of a cancer is 37.5% (i in 3) for women and a scan will add a further risk of 0.000285% (1 in 350,887). That is one hundred times less risk than being hit by a meteorite (1 in 3,200).

As a comparison consider that the estimated lifetime risk of being killed in a road traffic accident in the UK is 0.42% (1 in 240 chance) or by a bolt of lightening is 0.001% or 1 in 100,000 chance.

In terms of the amount of radiation, or the dose, it might be useful to compare the doses of various sources of radiation. From dosimetry carried out on our scanner the calculated average dose of the smallest scan was 0.027mSv. Based on these figures a 4x4cm Morita Veraviewepoch scan is equivalent to 9 days of background radiation living in London or just over 1 day living in Cornwall.


Source of exposure

Dose

Dental x-ray

0.005 mSv

100g of Brazil nuts

0.01 mSv

Chest X-Ray

0.014 mSv

Transatlantic Flight

0.08 mSv

Nuclear power station worker average annual occupational exposure (2010)

0.18 mSv

UK annual average radon dose

1.3 mSv

CT scan of the head

1.4 mSv

UK average annual radiation dose

2.7 mSv

USA average annual radiation dose

6.2 mSv

UCT scan of the chest

6.6 mSv

Average annual radon dose to people in Cornwall

7.8 mSv

Taken from https://www.gov.uk/government/publications/ionising-radiation-dose-comparisons/ionising-radiation-dose-comparisons

The radiation exposure doses below are taken from a recent article in the International Endodontic Journal*.

*Patel S, Dawood A, Pitt Ford T, Whaites E. The potential applications of cone beam computed tomography in the management of endodontic problems. International Endodontic Journal, 40, 818–830, 2007


Conventional CT
Upper Jaw
1.4 mSv
Dental CT
Lower Jaw
1.32 mSv
 
Mercuray 9” FOV
0.44 mSv
 
Mercuray 6” FOV
0.28 mSv
 
i-CAT 12” FOV
0.19 mSv
 
i-CAT 9” FOV
0.10 mSv
 
NewTom 3G 12” FOV
0.059 mSv
 
Morita Accuitomo 3D
0.007 mSv
 
Standard X-ray
0.005 mSv
 
Cosmic Radiation flying round trip Paris & Tokyo
0.15 mSv

The Cone Beam CT scanner at 99 Harley Street is the Morita Veraviewepocs 3D. The Morita Accuitomo 3D is the large scale precursor version of the Morita Veraviewepocs 3D. It has the lowest radiation emitted out of all the tested Dental CT scanners, and emits only 0.5% of the radiation of that emitted during a regular CT scan.