Table Of ContentInterpretation Basics of Cone
Beam Computed Tomography
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Interpretation Basics of Cone
Beam Computed Tomography
Second Edition
Edited by
Shawneen M. Gonzalez
DDS, MS, Diplomate,
American Board of Oral and
Maxillofacial Radiology with
invited Contribution from
Gayle Tieszen Reardon
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This edition first published 2021
© 2021 John Wiley & Sons, Inc.
Edition History
John Wiley and Sons Inc (1e, 2014)
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Library of Congress Cataloging‐in‐Publication Data
Names: Gonzalez, Shawneen, author, editor.
Title: Interpretation basics of cone beam computed tomography / edited by
Shawneen M. Gonzalez.
Description: Second edition. | Hoboken, NJ : Wiley-Blackwell 2021. |
Includes bibliographical references and index.
Identifiers: LCCN 2021028942 (print) | LCCN 2021028943 (ebook) | ISBN
9781119685845 (hardback) | ISBN 9781119685852 (adobe pdf) | ISBN
9781119685876 (epub)
Subjects: MESH: Cone-Beam Computed Tomography. | Radiography,
Dental–methods. | Craniofacial Abnormalities–diagnosis. | Facial Bones
Classification: LCC RC78.7.T6 (print) | LCC RC78.7.T6 (ebook) | NLM WN
230 | DDC 616.07/5722–dc23
LC record available at https://lccn.loc.gov/2021028942
LC ebook record available at https://lccn.loc.gov/2021028943
Cover Design: Wiley
Cover Image: © Shawneen M. Gonzalez
Set in 10/12pt Sabon by Straive, Pondicherry, India
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Contents
Preface to the Second Edition ix
Acknowledgments xi
About the Companion Website xiii
1. Introduction to Cone Beam Computed Tomography 1
Shawneen M. Gonzalez
Introduction 1
Conventional Computed Tomography 1
Cone Beam Computed Tomography 2
Conventional CT versus Cone Beam CT 2
Viewing CBCT Data 4
Artifacts 7
References 11
2. Cone Beam Computed Tomography Recommendations 13
Shawneen M. Gonzalez
Introduction 13
Endodontics 13
Orthodontics 18
Periodontics 24
References 30
3. Legal Issues Concerning Cone Beam Computed Tomography 33
Shawneen M. Gonzalez
Introduction 33
Standard of Care 33
Recommendations 34
Summary 36
References 37
4. Paranasal Sinuses and Mastoid Air Cells 39
Gayle Tieszen Reardon
Introduction 39
Anatomy 39
Inflammatory Disease of the Paranasal Sinuses 56
v
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vi Contents
Intrinsic Disease of the Paranasal Sinuses 60
Postsurgical Changes of Paranasal Sinuses 69
References 70
5. The Sinonasal Cavity and Airway 73
Gayle Tieszen Reardon
Introduction 73
Anatomy 73
Surgical Variations 87
Inflammatory Diseases 89
The Pharynx 91
The Nasopharynx 92
The Oropharynx 93
The Hypopharynx (Also Called Laryngopharynx) 95
The Parapharyngeal Space 95
References 96
6. Cranial Skull Base and Orbits 97
Shawneen M. Gonzalez
Introduction 97
Anatomy 97
Anatomic Variants/Developmental Anomalies 106
Incidental Findings 111
References 113
7. Soft Tissues 115
Shawneen M. Gonzalez
Introduction 115
Pathosis—Arterial Calcifications 115
Pathosis—Other Calcifications 122
Incidental Findings—Soft Tissue of the Brain 126
Incidental Findings—Orbital Cavity 133
Incidental Findings—Face 136
References 138
8. Cervical Spine 141
Shawneen M. Gonzalez
Introduction 141
Anatomy 141
Anatomic Variants/Developmental Anomalies 147
Pathosis 153
References 158
9. Maxilla and Mandible (excluding TMJs) 161
Shawneen M. Gonzalez
Introduction 161
Anatomy 161
Anatomic Variants/Developmental Anomalies 167
Pathosis 169
Incidental Findings 178
References 182
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Contents vii
10. Temporomandibular Joints 183
Gayle Tieszen Reardon
Introduction 183
Normal Anatomy and Function 183
Developmental Abnormalities 187
Soft‐Tissue Abnormalities 192
Remodeling and Arthritis 194
Trauma 204
Tumors 206
References 207
11. Implants 209
Gayle Tieszen Reardon and Shawneen M. Gonzalez
Introduction 209
Imaging for Implant Purposes 210
CBCT Image Development 214
Gray Values and Hounsfield Units 214
Bone Density: A Key Determinant for Treatment Planning 215
Linear Measurement Accuracy 216
Mandibular Canal 217
Virtual Implant Placement Software 218
References 221
Appendix Sample Reports 223
Shawneen M. Gonzalez
Introduction 223
General Health Report 224
Pathology Report 226
Endodontic Report 231
Index 237
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Preface to the Second Edition
It is the goal of this book to help practitioners and students gain a better
u nderstanding of anatomy and common disease processes that frequently present
on cone beam computed tomography (CBCT) scans. This book seeks to fill the gap
in the current literature where little is presented on common radiographic appear-
ances on CBCT. In addition to this book, there are sample cases with videos online
at www.wiley.com/go/gonzalez/interpretation, where you can practice working
your way through regions and entire scans using the knowledge you acquire in this
book.
The beginning of the book covers general information about different CBCT unit
parameters and recommended uses from specialty organizations. The third chapter
covers legal considerations of owning a cone beam CT, referring patients for a cone
beam CT scan, and/or interpreting cone beam CT scans in the United States. This
information is lacking in the current literature and is something many professionals
should be aware of before purchasing or using a cone beam CT unit.
Each book chapter from the fourth chapter on is an anatomical region covering
the topics of anatomy, common anatomic variants/developmental anomalies, patho-
sis, and other findings. The first regions presented are the paranasal sinuses and
mastoid air cells and nasal cavity and airway, which are intimately involved with
each other. The anatomy section covers pertinent anatomy to evaluate when inter-
preting or reviewing a scan. The next section covers common anatomic variants with
various images showing how they appear on axial, coronal, and sagittal views. The
last section covers commonly seen disease processes, such as sinusitis, that should be
noted on a written radiology interpretation.
Chapter 6 is on the cranial skull base and orbits. There are many anatomical land-
marks in the cranial skull base such as canals, foramina, air cells, and more, making
this a difficult region to interpret. Key anatomy is shown on various views (axial,
coronal, and sagittal) to aid CBCT users in orienting themselves on the scan.
All soft‐tissue findings are moved into one chapter. There is no anatomy as CBCT
is a hard‐tissue imaging modality. All findings are listed as pathosis or other findings
and appear as calcifications in the soft tissues.
The region of the cervical spine covers anatomy to disease processes such as
degenerative joint disease. Degenerative joint disease is progressive with multiple
appearances based on the degree of bony damage. This chapter has many example
images of degenerative joint disease at various points in the disease process.
The last region covered is the temporomandibular joints, which is very thorough
thanks to the contributions of Gayle Reardon, who has studied and continues to
ix
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x Preface to the Second Edition
study this region in depth. The temporomandibular joints have a unique set of
d isease processes and developmental appearances beyond arthritic changes. This
chapter covers entities CBCT users should be aware of even if they are not seen in
daily practice.
The appendix shows example written reports of CBCT scans to view and consider
when writing radiology interpretations.
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Acknowledgments
I’d like to thank Gayle Reardon for her contributions to this book and sharing her
knowledge of the paranasal sinuses, nasal cavity and airway, temporomandibular
joints, and implants. Thanks to the staff at Wiley for guidance and support in the
creation of this book. Last, a giant thanks to my family (Max, Max, and Rugen) for
their love, support, and encouragement throughout this entire process. I would not
have been able to complete this without them.
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