The growth of cone beam computed tomography (CBCT) – Jimmy Makdissi

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  Posted by: Dental Design      20th January 2020

CBCT imaging technology offers clinicians advantages over conventional dental imaging. At a fundamental level, it provides a 3D view of dental structures otherwise visualised in 2D. It also facilitates the increased uptake of a digital workflow and surgically guided dental implantology.

Technological advancements have resulted in radiation dose reduction and improved image quality. Also, the latest innovations offer a faster scanning time. As more manufacturers are entering the market, the cost of CBCT is going down, too. Being able to use CBCT technology in treatment planning is a great benefit with the medico-legal pressures dentists face in the current climate. I also feel that patient awareness about the use of CBCT in dentistry is increasing.

For practitioners delivering dental implant therapy, being able to obtain a 3D view of dental implant sites is hugely advantageous. CBCT technology allows the dentist to take accurate measurements of ridge height and width and reliably assess bone quality. The accurate identification of vital structures also decreases the risk of iatrogenic injuries, which leads to improved outcomes and patient satisfaction.


Overcoming barriers

There are still barriers that are preventing clinicians from fully utilising CBCT imaging in their practices. A limited understanding about the extensive capabilities of CBCT in dentistry is one example, but this can be overcome by high-quality training on all the applications, benefits and limitations of the technology.

I want to pass on my knowledge and passion for CBCT, offering courses which take dental and maxillofacial radiology to a new level. I present CBCT Masterclasses and ADI Study Clubs on the topic for this reason; my aim is to increase awareness to as wide an audience as possible, from junior practitioners to clinicians in all positions of responsibility. 

I have lobbied the manufactures to offer CBCT training at the time of purchase, and whilst the initial feedback has been positive, there is still work here to be done in ensuring that training is made compulsory and readily available to all users of CBCT.


Main principles and common errors

The basic, key principles that dentists should know is that CBCT utilises a combination of cone-shaped beams and a flat panel detector. During acquisition, a simultaneous rotation of the beam and the detector occurs and the captured data is reconstructed to form a cylindrical volume of the area of interest. This volume can then be viewed in multiple planes, including axial, coronal, sagittal, panoramic and cross sections.

There are common mistakes and challenges with using CBCT and I believe that I can offer insight to help clinicians avoid them. Errors that occur most frequently at time of acquisition include: inappropriate case selection, as well as inappropriate volume size and exposure factors, leading to unnecessary radiation exposure and sub-optimal image quality.

Errors that occur most frequently after acquisition include: difficulty manipulating images to display the required area; difficulty identifying vital structures; difficulty selecting slices for appropriate measurements; and missing pathological conditions.

Training can remedy these issues and more; this modality is not to be used without proper instruction.


Clinical applications

There are a number of guidelines that describe the potential clinical applications of CBCT. It is essential that a thorough patient history and examination is conducted prior to any CBCT examination. In many cases, conventional imaging is sufficient to make a diagnosis. However, when 3D information is required or when there are contradictory clinical signs and symptoms, CBCT may be justified. Below is a summarised list for utilising CBCT:


  • Impacted teeth localisation and potential resorption of adjacent teeth
  • Third molar assessments, particularly in relation to the ID canal position
  • External or internal resorption
  • Apical disease in the presence of negative conventional radiography findings
  • Suspected root fractures
  • Cysts and tumours of the jaw
  • Maxillofacial trauma


Getting the most from CBCT

I cannot emphasise the importance of training enough. Training and more training. It will not only equip the dentist with the necessary theoretical and practical knowledge of CBCT, but it will also safeguard them against medico-legal implications.

Demonstrating the passion of ADI members for dental excellence, Dr Makdissi was one of the many speakers to present ADI Study Clubs so far this year. To discover other subjects available in the series, or additional membership benefits from the ADI, visit the website.


For information on upcoming ADI Study Clubs, or to book, please visit

ADI Study Clubs are free to members. Join online today.



The views expressed in this article are those of the author, and not necessarily those of the ADI.


Author bio:

Dr J Makdissi

Dr Makdissi, better known as Jimmy, joined Queen Mary School of Medicine and Dentistry in 2004 as a Clinical Senior Lecturer and Honorary Consultant in Dental and Maxillofacial Radiology. He directs the Dental and Maxillofacial Radiology programme of the undergraduate BDS curriculum. He completed his specialist training at Guy’s Hospital and obtained his diploma in Dental Radiology from the Royal College of Radiologists.

He served on the Education Committee of the International Association of Oral and Maxillofacial Radiology. He also served as the dental tutor for the London Deanery at Barts Health, the faculty tutor at the Royal College of surgeons and as President of the Metropolitan Branch of the British Dental Association.

He is the director of JM Radiology, a specialist dental and maxillofacial radiology service, providing scanning, reporting and training in CBCT. He is the founder of the CBCT Interpretation Masterclass, providing UK based CBCT hands on training.


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