The current imaging method of choice is conventional dental radiography. Needed information regarding impacted teeth cannot be obtained adequately by lower dose conventional (traditional) radiography. Should the indication to use cbct be emphasized?
Current guidance states that CBCT may be indicated for the localized assessment of an impacted tooth (including consideration of resorption of an adjacent tooth) (The SEDENTEXCT Project, 2011). CBCT has been shown in Serrants study to be superior to HP/VP, the smallest volume size compatible with the clinical situation should be selected to minimize the radiation dose for the patient where there is any suspicion of resorption of an adjacent tooth root.The use of conventional radiography is this specific situation should be discontinued.
I think it boils down to radiation dosage protection. The general trend would be to use the panorex first, then if that could not localise a line of arch impaction, HP/VP (per guidance) then if it is a dead end, revert to CBCT. Not first line use, although it is much more informative, but the main guiding factor is dose.
This is a paper summarising the radiation dosage for different films.
The compounding of the obvious ones in terms of radiation dosage, does not even match 1 whole CBCT exposure.
http://www.ncbi.nlm.nih.gov/pubmed/14703331
UP TO ALQERBAN CBCT should be used in cases with more severe symptoms of maxillary canine impaction. The use of CBCT will improve the diagnostic capabilities and the chances of success in more difficult cases to a level similar to that of simpler cases treated on the basis of 2D information.
If 3D information is needed for the management of the impacted tooth CBCT is indicated (This conclusion can be drawn on conventional X-ray imaging and clinical examination (palpation)).
If a 4cmx4cm volume is made with 90kV, low tubecurrent (2 to 3 mA) and limited arch rotation (180 degrees 9 seconds) this exposure can be made safely in children (dose aruond 10 micro Sievert).
This volume will not be crisp and sharp but it will give you the information at the lowest dose (ALADA as low as diagnostically acceptable).
If on the other hand the exposure is made with a large volume and custom parameters the dose can be 10 to 40 times higher.
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