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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 32  |  Issue : 4  |  Page : 366-370

Awareness of dental students towards CBCT: A cross sectional study


1 Under Graduate Student, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
2 Department of Oral Medicine and Radiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India

Date of Submission12-May-2020
Date of Decision19-Oct-2020
Date of Acceptance23-Oct-2020
Date of Web Publication28-Dec-2020

Correspondence Address:
Dr. Jayanth Kumar Vadivel
Department of Oral Medicine and Radiology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, 162, Poonamalle High Road, Velappanchavadi, Chennai, Tamil Nadu - 600 077
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_88_20

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   Abstract 


Background: Cone-beam computed tomography (CBCT) is a new technology, in which two-dimensional detectors and conical beam are used instead of fan shaped beam in conventional computed CT. In CBCT, volumetric data are collected by the rotation of beam and detectors around the desired area of interest. The principal advantages of CBCT are in the smaller footprint of the machine and lower radiation dose. The knowledge of this imaging modality is limited and hence the application in clinical practice is not fully achieved. Aim: The present study aimed to assess the knowledge about Cone Beam Computed Tomography (CBCT) among interns of two Dental colleges in Chennai and their willingness to use this piece of imaging for their routine dental practice. Material and Methods: A closed-ended questionnaire was circulated to the interns of two dental colleges after obtaining necessary consent. Results: The results showed that there is a lack of knowledge regarding the application of this imaging modality and it is being applied in some areas where it is prone to give false-positive results. Conclusion: Overall, dentists had an average level of knowledge for CBCT. It is recommended that qualification programs to held for dentists to strengthen their awareness toward cone-beam computed tomography.

Keywords: Awareness, CBCT, cone-beam computed tomography, dental students, interns, knowledge


How to cite this article:
Sangar S, Vadivel JK. Awareness of dental students towards CBCT: A cross sectional study. J Indian Acad Oral Med Radiol 2020;32:366-70

How to cite this URL:
Sangar S, Vadivel JK. Awareness of dental students towards CBCT: A cross sectional study. J Indian Acad Oral Med Radiol [serial online] 2020 [cited 2021 Jan 28];32:366-70. Available from: https://www.jiaomr.in/text.asp?2020/32/4/366/305282




   Introduction Top


The advancement of Dental Imaging took great strides with the development of 3-Dimensional (3D) imaging. This 3D imaging was not just utilized in the diagnosis of maxillofacial pathology but also used for implant planning, complex endodontic treatments, treatment planning in orthodontics, to name a few. The introduction of Computed tomography in 1973 addressed several of the aforementioned requirements, however, it had a few pit-falls in the form of a larger size of the equipment and higher radiation dose due to its larger field of view.[1] In this wake, Aria and colleagues started working on a compact version of CT for exclusive dental use which was referred to as ortho-CT.[2] In the year 2000, Morita Co Ltd with Nihon University Business Centre Incubation Centre developed the 3Dx multi-image CT.[3] This was considered as the prototype Cone Beam Computed Tomography (CBCT) machine and since then several manufacturers have come with their models improving on the resolution, reduction of artifacts, the smaller footprint of the machine, and lower cost of the equipment.

CBCT uses a divergent cone-shaped or pyramid-shaped source of ionizing radiation and a two-dimensional area detector fixed on a rotating gantry to provide multiple sequential transmission images that are integrated directly forming volumetric or three-dimensional information.[4] A complex computed algorithm is performed on this data set, permitting the operator to extract multiplanar reconstructions of variable thickness in any plane and to produce precise three dimensional (3D) images of bones and soft tissues to a very limited extent.[5] The introduction of CBCT imaging has heralded a shift from 2D to a volumetric approach in maxillofacial imaging.

Nevertheless, there is a lack of application of this technology for effective clinical practice. The main lacunae seem to be in understanding the potential areas where it could be used and the possible areas to avoid its usage. In a study in a Turkish Population[6] only 54% of the respondents were aware of the applications of CBCT and a higher percentage of people were found among the academicians.

In a Study among Swedish Dentists, there was an increased awareness of the radiation dosage of CBCT; however, 70% of respondents felt that it can be used only for implant imaging.[7] However, the study pointed out that the respondents were willing to undergo training in the form of webinars, CDE programs.[7]

In the Indian scenario, there aren't many studies focusing on the awareness of CBCT. The Dental students being the future dentists should be well acquainted with the modern digitized radiological techniques like CBCT which have increased implication of CBCT. This study aims to assess the Dental Interns who had recently finished their undergraduate course to assess their level of knowledge and their attitude about the application of CBCT in dentistry.


   Materials and Method Top


An online survey was done with the Dental students who were doing their internship in two Dental Colleges in Chennai. A total of 185 interns were surveyed using the questionnaire through Survey Monkey. The sample size was calculated for a power of 80 and the final number arrived at was 163. Due to availability the final sample size was 185.The survey was conducted during the period between December 2019 and March 2020. The survey aimed at assessing the depth of knowledge of the students about Digital imaging and CBCT. The students were given a specially designed questionnaire that had 10 questions related to CBCT [Figure 1] and [Figure 2]. The questionnaire had two parts with one part focusing on the knowledge and potential applications of CBCT (questions 1-8) and the second part on the educational teaching of CBCT.(questions 9-10) The questionnaire was a self-formulated questionnaire and the validity of the questionnaire was done by discussing the questions with senior Professors of Oral Medicine. The survey was approved by the Institutional Ethics committee with the referral number SDC/SIHEC/2020/0619-0320. Prior to the approval informed consent was obtained from the participants that their survey responses will be used for scientific research without revealing personal details. The study was conducted by following all the protocols and principles under the purview of Helsinki declaration (1964 and later).
Figure 1: Page one of the questionnaire

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Figure 2: Page 2 of the questionnaire

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The questions in the questionnaire were based on their basic awareness and attitude towards digital imaging, 3D imaging, usage of CBCT in implant imaging, endodontics, jaw pathologies, and TMJ disorders.

The final part of the questionnaire contained questions related to the manner of imparting education about CBCT to Dental Undergraduates, the year in which the students need to be taught about CBCT and their willingness to attend CDE programs after their graduation.

At the end of the questionnaire, information was provided on the need for conducting the survey, and how the information obtained from this survey would be used for educational purposes.

The Inclusion criteria were Interns from the two Dental Colleges and who had expressed a willingness to be a part of the survey.

The students who were not willing to be a part of the survey were excluded.

Though the name, age, and gender of the participants were collected during the survey, the age, and gender were not used for any discriminatory purpose in the survey and strict confidentiality of the names of the students was maintained during the study.

The collected results were fed into Microsoft Excel 2019 Home and Student version (Microsoft Corporation, Redmon, WA, USA), and the percentage prevalence of each category was enlisted in the results section.

A sample of the questionnaire with the sample consent form is given in [Figure 1] and [Figure 2].


   Results Top


The questionnaire was circulated online and a total of 201 respondents had responded during the stipulated period of December 2019 to March 2020. Among that list 15 expressed their non-willingness to be a part of the survey and were excluded from the list. One respondent's complete sheet had an error and had to be excluded from the final results. Among the 185 responses analyzed, 138 (74.5%) were females and 47 (25.5%) were males. All the respondents were in the age group of 22-24 years of age.

The first part of the questionnaire (questions 1to 8) analyzed the basic knowledge of the respondents to CBCT. In this group, 5 questions were of the Yes/No type and the results of the same are enlisted in [Table 1].
Table 1: Results of the bimodal answers the questionnaire

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These questions were assessing the basic knowledge and method of working of the machine. Invariably, when it came to the working principle of the machine only around half of the sample (51.4%) were aware of the working principle of the machine. It is surprising to note that majority of the participants felt that CBCT could be used for TMJ imaging and cancer staging.

For the question on the imaging modality which is a 3D modality, a majority had indicated for CT and CBCT and the results were statistically significant when calculated by one-way Anova (p < 0.05) [Table 1]. The question on the principal application of CBCT indicated that it is being mainly used for implant imaging and the results of which were significant when calculated by one way Anova (p < 0.05) [Table 2] and [Table 3].
Table 2: Which radiographic technique is digital and record tissues in three dimensions

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Table 3: What are the indications of the usage of CBCT in Dental Practice

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With regards to the application of CBCT in endodontic practice, a vast majority of the respondents had indicated that it is used in the detection of the number of canals and the canal morphology [Table 4].
Table 4: What would be the best usage of CBCT in Endodontics

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The second part of the questionnaire indicated that a vast majority of the respondents were willing to learn about this new piece of equipment [Table 1] and had indicated that it is preferable to learn about this imaging modality in the third year of undergraduate curriculum [Table 5].
Table 5: In which year of undergraduate dental education should teaching of CBCT be included

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For the last question of how many were interested to learn about CBCT a large majority had indicated their willingness to learn this imaging technique.


   Discussion Top


Cone Beam Computed Tomographic (CBCT) imaging is the most significant technological advancement in maxillofacial imaging since the introduction of orthopantomography. CBCT was initially used by Cardiothoracic Surgeons for angiographic purposes but later they had dropped it due to the development of multidetector CT.[8] Subsequently, the technology was adopted by the Dentists for imaging the maxillofacial region in the late 1990s. It became commercially available from the turn of this century for maxillofacial diagnosis.[1],[2] CBCT units use a cone-shaped beam of divergent X-rays emanating from the X-ray source. In CT machines the detector is in the form of a linear array but here it is in the form of a flat 2Dimensional (2D) panel. In this manner, a volume of tissue can be covered in a single rotation around the head and neck region. This technique allows us to construct a 3 D image volume from a 2D dataset.[9],[10],[11]

The usage of CBCT is being expanded daily to newer aspects of dentistry. In the initial days, it was mainly used for implant imaging but now the applications have expanded to all specialties of dentistry. But there exists lacunae in the effective usage of this imaging modality by the Dentists. They are not fully aware of the limitations of this piece of imaging. One of the main limitations is the presence of numerous artifacts and limited soft-tissue resolution. Also, there is a lot of misconception regarding the dosage considerations for this imaging modality.[12]

This study attempted to assess the knowledge of the Interns from two Dental Colleges regarding the understanding of the principles and applications of CBCT in Dental practice and their willingness to learn and constantly update their knowledge about CBCT.

While some questions were formulated to know the attitude of interns about the importance and use of CBCT in their future career and to explore their attitude about the inclusion of CBCT-based curricular activities and workshops in the undergraduate training course. Our study showed that majority of students knew about digital mode of imaging and about CBCT as an imaging modality in oral and maxillofacial region. But there is a need of providing adequate knowledge about the principle used in CBCT based imaging as well as the reason for the preference of CBCT over CT in maxillofacial imaging.

This study revealed that the majority (97.3%) of the respondents was aware of this piece of imaging but from the knowledge regarding the working principle of CBCT was just around the halfway mark. From the survey, we found that only 51.4% of respondents were aware of the working principle of CBCT. In a study by Lavanya et al.[12] among the post-graduate students in India, only 68.2% of the respondents were aware partially of the working principle of CBCT. However, they have not categorized the postgraduate students according to the year of study. Hence we feel that the awareness level of 51.4% among the interns seems agreeable. A significant difference noted for this question between our study and the study by Lavanya et al.,[12] was the question in their study was subclassified as partial knowledge and complete knowledge. However, the criteria to define the same has not been validated. A study by Ambeiter et al.[13] showed that 82% of the individuals were aware of the imaging modality in a study conducted in the European Population. The reason for discordance can be attributed to the difference in the level of a professional career and, as our study was carried out in interns and their study was carried out in practicing postgraduates.

In our study, we found that the undergraduates were aware of the fact that 3D imaging is possible only by CT, CBCT, and MRI. The cumulative responses to this question were 94%. This is following a similar study carried out by Beals et al. in the United States.[14] The response of the interns to what would be the primary application of CBCT In dentistry, a majority said it was in implantology followed by its use in detection of cysts and tumors. This study by us showed that 81.62% of patients referred for CBCT imaging was for implant assessment. This depicts the clarity about the usefulness of this tool for advanced procedures. The results are in accordance to the study by Beals et al.[14]

In our study, it was found that undergraduates felt CBCT is better over 2-D imaging in diagnosing pathologies of jaws and about the application of CBCT in imaging TMJ disorders. It was evident from our study that the majority of the undergraduates will be using CBCT in their future clinical practice. The results are in concordance with the results of study carried out by Roshene etal.[15] in interns and final year students.

In our study it was we found that 85.4% of the respondents had said that CBCT could be used for cancer staging. An ideal image for cancer staging should give an excellent soft--tissue resolution and CBCT imaging has a limited soft-tissue resolution.[16],[17] The literature has several studies that shows the soft tissue resolution of CBCT is highly compromised and cannot be used.[8],[18]

The usage of CBCT in endodontics is a highly debated question. The presence of Gutta Percha and other restorative materials severely restricts the usefulness of CBCT in imaging purposes by the creation of artifacts.[19] In our study, a majority of respondents stated that CBCT could be used for the diagnosis of missed canals. However, literature states the usefulness of the usage of CBCT for diagnosis is limited in missed canal cases.[20],[21]

In our study majority of undergraduates suggested that there is a need for more frequent workshops and CDE programs to be conducted for a better understanding of CBCT and the lectures about CBCT should be included in the curriculum in the third year of BDS course. This result also depicts there is a lack of knowledge among undergraduates about the importance of CBCT as an advanced imaging modality.

Limitations and Future Prospects

The study was conducted in one institution making it an unicentric study. The curiculum for the undergraduates can be modified to include the proper applications and contraindications of CBCT.


   Conclusion Top


This study was carried out in Dental Colleges which have their own in house CBCT facility. There seems to be a good awareness of the usage of CBCT but some cardinal limitations are not well understood by the student population. However, a positive trend noted is their willingness to enroll in Continuing Dental Education programs. Hence the need of the hour would be to increase the awareness of the usage of CBCT through CDE programs, webinars, and other online modes. These programs would require a pre-test assessment and post-test assessment to check the level of understanding of the attendees.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Beals DW, Parashar V, Francis JR, Agostini GM, Gill A. CBCT in advanced dental education: A survey of U.S. postdoctoral periodontics programs. J Dent Educ 2020;84:301-7.  Back to cited text no. 14
    
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Parker J, Mol A, Rivera EM, Tawil P. CBCT uses in clinical endodontics: The effect of CBCT on the ability to locate MB2 canals in maxillary molars. Int Endod J 2017;50:1109-15.  Back to cited text no. 20
    
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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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