Читать книгу Orthodontic Treatment of Impacted Teeth - Adrian Becker - Страница 89

It is only many years after treatment with any form of radiation that we see the stochastic effects, which include a higher susceptibility of the individual to various forms of cancer. It is known that these effects are amplified with increased exposure and that children are more susceptible than adults. Yet it is children and young adults who are the main patient population for orthodontic treatment. It is therefore incumbent on the practitioner to reduce this exposure to the minimum, while deriving a maximum of information adequate to the problem in hand. This is what ALARA signifies – As Low As Reasonably Achievable.

As we have already noted, there is a selection of scanning protocols and a low‐dose feature in every machine. It stands to reason, therefore, that when a CBCT scan is justified, it is because plane 2D radiography cannot maximize the information needed for that patient, or that dose risk/benefit weighs in favour of CBCT. CBCT should be performed using the scanning protocol with the most efficacious risk/benefit and the smallest FOV possible.

Unfortunately, most orthodontists are not exploiting all the benefits of the CBCT scan, despite the fact that they tend either to scan patients in‐house or refer them to an imaging centre, or to a colleague who has the facilities and the know‐how available. It is of paramount importance that this wanton and cavalier attitude to CBCT scans should be disparaged and be replaced by orthodontists themselves becoming familiar with the important advantages offered by these machines.

In order to fulfil optimal scanning requirements for accurate diagnosis, orthodontists must be involved, proactive and specific regarding FOV and all other scanning parameters, including for such simple and apparently trivial instructions as scanning a seated patient, even with machines designed for erect subjects. All video animations prepared and produced by Amnon Leitner (panorama@inter.net.il).