Informativeness of Cone Beam Computed Tomography in the Visualization of Injuries of Teeth and Facial Bones

Abstract

Introduction. Today, maxillofacial injuries (MFIs) remain a medical and social problem with an increasing frequency. Every year, a significant number of people receive facial injuries as a result of road traffic accidents, sports competitions, or fights. The issue of mine-blast injuries is particularly acute in the context of russia’s full-scale war against Ukraine. Today, cone beam computed tomography (CBCT) is the most informative method for imaging fractures of the facial bones, teeth, and periodontium. Considering the limitations of two-dimensional images, CBCT is the method of choice for examination of midface and orbital fractures, including visualisation of maxillofacial bones. CBCT imaging has overcome the limitations of 2D imaging by offering physicians high-quality three-dimensional images with submillimetre resolution, short scan times, and low radiation dose.
The aim was to analyse the informativeness of CBCT in cases of traumatic injuries of teeth and jaws and the process of their treatment.

Material and methods. The examination and retrospective analysis of CBCT data of teeth and jaws of 46 patients with TMJ injuries were performed. Forty patients were males and 6 were females. The age of the patients ranged from 7 to 38 years. The patients underwent CBCT during the initial examination of the trauma or the treatment process. A total of 55 examinations were analysed. The study was conducted on Morita devices using fields of 8×8, 10×12, or 10×15 cm with a 180° or 360° tube rotation, depending on the indications and the area of injury.

Results. The ratio of the causes of traumatic injuries to the TMJ was established: in (54.35 %) fights (direct blows or falls), in (32.61%) road accidents, in (6.52%) mine-blast injuries, and (6.52%) sports injuries. Isolated injuries of the teeth were diagnosed in 32.61% of cases, injuries of the lower jaw in 21.74% of cases, and multiple injuries of the facial bones in 45.65% of cases.

Conclusions. CBCT is a highly informative method for traumatic injuries of the teeth, jaws, and facial bones, which improves clinical diagnosis, provides high-quality images in a three-dimensional plane with high resolution, and has less radiation exposure to the human body. The advantage of CBCT is the ability to visualise marginal fractures of the enamel and cortical plate of the alveolar process and the position of the tooth in one of three directions, allows for a detailed analysis of the location, ratio of multiple comminuted bone fractures, structural elements of the metal osteosynthesis to the mandibular canal, obtain information about the full extent of bone damage, the direction of displacement of fragments, the presence of separated fragments, changes in the maxillary sinuses, nasal cavity and orbit. CBCT is a vital imaging method that provides accurate and detailed information in the spatial 3D representation of body parts, which is promising for using this method for planning surgical interventions.