THE ART OF DENTISTRY - School of Dental Medicine - Case ...

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THE SCHOOL
OF DENTAL
MEDICINE TODAY
CBCT OFFERS REAL-TIME, REAL-WORLD 3D IMAGES
BY MARGARET MULLIGAN
The Craniofacial Imaging Center (CIC)
in the School of Dental Medicine
(http://ImagingCenter.case.edu) is using
cone-beam computed tomography
(CBCT), which allows practitioners to
study a patient’s 3-dimensional (3D)
image. The technology and its use is the
primary focus of the work of J. Martin
Palomo, D.D.S., M.S.D. ’97, Associate
Professor, Department of Orthodontics.
Dr. Palomo is one of the few people who
explored computer applications in the
days when they were less than user-friendly.
“I was a computer kid,” he says. “As a
child I watched as technology made
information easier to attain and process
for many different uses. Later, I asked
myself, ‘How could I use this in my specialty
of orthodontics? How can technology
make clinical work more efficient?’ I have
worked since 1996 creating and using 3D
images of the head and neck. In the past,
the use of 3D images was not practical or
user-friendly, which prevented broader
use of such images. The development of
CBCT solved many problems not only
for dental medicine, but also for other
clinicians using head and neck images.
This allowed me to merge my interest in
computers with my work in orthodontia.
With the support of my department and
the School of Dental Medicine, we
jumped into the game early.
There are several possible ways
to visualize a CBCT image.
A) soft tissue view using the
surface mode, B) radiographic
mode, in which the 3D image is
turned into 2D as in a traditional
radiography, C) slice view,
divided by sagittal, coronal, and
axial view, D) skeletal rendering
using the surface mode, and
E) maximum intensity projection
(MIP) mode which provides a
3D radiographic view.
“We have a machine from Hitachi
Medical Systems that is serial number 1,”
he says. “We were one of the first schools
to have and use such technology, and
others have followed suit.” In less than
five years, there have been more than 800
CBCT units installed across the country.
This early involvement in the technology
growth spurt has paid off. “We have been
able to travel to Hitachi headquarters in
Japan and present [our] research findings
to their engineers,” he says. “Based on the
suggested conclusions of research projects
done at CWRU, [the engineers] modified
the machine. The impact of our research
was such that other imaging centers using
this machine subsequently asked to have
their scanners modified according to the
recommendations posed by those articles.
“Now we are taking that experience and
developing interpretation tools to further
help a multidisciplinary audience of clinicians
and researchers,” says Dr. Palomo. “In
short, we can evaluate and improve the
clinical situation, making them sometimes
less invasive and with a better prognosis.”
SHARING THE TECHNOLOGY
WITH THE COMMUNITY
The CBCT scanner is available at the
CIC at the School of Dental Medicine.
“It’s really about providing the highest
level of treatment that a patient can
attain, so we want to provide the CBCT
technology as a service to the community,”
notes Dr. Palomo. “For example, we
recently assisted in the treatment plan for
a five-year-old patient who was referred to
us from Japan. The CBCT technology
enabled her pediatric dentist to perform a
minimally invasive procedure, leaving
developing follicles untouched. Upon review
of the CBCT image, the treatment plan
was changed so that only the supernumerary
teeth were removed. The additional
information gained from the CBCT scan
allowed for the preservation of the deciduous
teeth, thus preventing a little girl from
going for more than one year without her
front teeth.
“We want to let people know that Case
Western Reserve University and the School
of Dental Medicine is a source of technology
that seamlessly fits into day-to-day clinical
routines and helps to simplify clinical
challenges,” says Dr. Palomo.
For the academic and professional
community, the CIC has produced
several peer-reviewed publications in both
medical and dental journals, presentations
in national and international venues, as
well as ongoing research grants.
Interdisciplinary collaborations have
involved several specialties of not only dental
medicine, but also medical specialties
such as Plastic Surgery, ENT, and
Anesthesiology. Other collaborations
include chapters on Craniofacial Imaging