Clinical application of a new compact computed tomography system for evaluating the outcome of regenerative therapy: a case report

Comparative assessment of periodontal regeneration in periodontal intraosseous defects treated with PepGen P-15 unaided or in blend with platelet-rich fibrin: A clinical and high-resolution computed tomography scan-assisted volumetric analysis

Background:

PepGen P-15, a xenograft, has proven its periodontal regenerative potential. Platelet-rich fibrin (PRF) is an autologous platelet concentrate which too contributes to periodontal redevelopment through the release of different polypeptide progression factors. The present study intended to evaluate the regenerative potential of PepGen P-15 xenograft when used unaccompanied or in blend with PRF in periodontal intraosseous defects in humans through clinical and a novel computed tomography (CT) scan analysis technique.

Materials and Methods:

Twelve chronic periodontitis individuals with paired periodontal intraosseous defects were randomly treated either with PepGen P-15 exclusively (Control/Group A) or in concoction with PRF (Test/Group B) utilizing split-mouth study design. Pocket probing depth (PPD), relative attachment level (RAL), and relative position of gingival margin were assessed at 3- and 6-month interval, whereas the linear and volumetric bone defect regeneration were assessed at 6 months postoperatively using CT scan.

Results:

Both the groups validated statistically significant PPD reduction, RAL gain at 3 and 6 months, but on intergroup comparison, test group CT images revealed significantly greater linear bone gain and volumetric bone gain, with mean difference of 0.73 ± 0.28 (P = 0.018) and 2.70 ± 1.36 (P = 0.06) at 6 months in comparison to the baseline data.

Conclusions:

PepGen P-15 and PRF blend had better regeneration potential for the management of intrabony defects. Further long-term investigations on large sample size are recommended to authenticate the same.

Comparative evaluation of platelet-rich fibrin versus beta-tri-calcium phosphate in the treatment of Grade II mandibular furcation defects using cone-beam computed tomography

OBJECTIVE

The objective of the study was to evaluate clinically and radiographically the efficacy of platelet-rich fibrin (PRF) versus β-tri-calcium phosphate (β-TCP) in the treatment of Grade II mandibular furcation defects.

MATERIALS AND METHODS

Forty-five Grade II furcation defect in mandibular molars which were assigned to open flap debridement (OFD) with PRF Group I (n = 15), to OFD with β-TCP Group II (n = 15), and to OFD alone Group III (n = 15) were analyzed for clinical parameters (probing pocket depth [PPD], vertical clinical attachment level [VCAL], horizontal clinical attachment level [HCAL], gingival recession, relative vertical height of furcation [r-VHF], and relative horizontal depth of furcation [r-HDF]) and radiographical parameters (horizontal depth of furcation [H-DOF], vertical height of furcation [V-HOF]) using cone-beam computed tomography (CBCT) at 6 months interval.

RESULTS

For clinical parameters, reduction in PPD and gain in VCAL and HCAL were higher in Group II as compared to Group I. Change in r-VHF and r-HDF was greater in Group II as compared to Group I. Mean percentage clinical vertical defect fill was higher in Group II as compared to Group I (58.52% ± 11.68% vs. 53.24% ± 13.22%, respectively). On CBCT, mean change at 6 months for all parameters showed nonsignificant difference between the two experimental groups. Mean change in V-HOF was higher in Group I as compared to Group II, but mean change in H-DOF and furcation width was more in Group II as compared to Group I.

CONCLUSION

For both experimental and control groups, there was statistically significant improvement at 6 months follow-up from baseline values.

Cone beam computed tomography: basics and applications in dentistry

The introduction of cone beam computed tomography (CBCT) devices, changed the way oral and maxillofacial radiology is practiced. CBCT was embraced into the dental settings very rapidly due to its compact size, low cost, low ionizing radiation exposure when compared to medical computed tomography. Alike medical CT, 3 dimensional evaluation of the maxillofacial region with minimal distortion is offered by the CBCT. This article provides an overview of basics of CBCT technology and reviews the specific application of CBCT technology to oral and maxillofacial region with few illustrations.

Evaluation of accuracy of cone beam computed tomography for measurement of periodontal defects: A clinical study

Aims:

The aim of the present study was to evaluate the accuracy of Cone Beam Computed Tomography (CBCT) measurements of alveolar bone defects caused due to periodontal disease, by comparing it with actual surgical measurements which is the gold standard.

Materials and Methods:

Hundred periodontal bone defects in fifteen patients suffering from periodontitis and scheduled for flap surgery were included in the study. On the day of surgery prior to anesthesia, CBCT of the quadrant to be operated was taken. After reflection of the flap, clinical measurements of periodontal defect were made using a reamer and digital vernier caliper. The measurements taken during surgery were then compared to the measurements done with CBCT and subjected to statistical analysis using the Pearson's correlation test.

Results:

Overall there was a very high correlation of 0.988 between the surgical and CBCT measurements. In case of type of defects the correlation was higher in horizontal defects as compared to vertical defects.

Conclusions:

CBCT is highly accurate in measurement of periodontal defects and proves to be a very useful tool in periodontal diagnosis and treatment assessment.

Diagnostic Applications of Cone-Beam CT for Periodontal Diseases

Objectives. This paper aims to review the diagnostic application of cone beam computed tomography (CBCT) in the field of periodontology. Data. Original articles that reported on the use of CBCT for periodontal disease diagnosis were included. Sources. MEDLINE (1990 to January 2014), PubMed (using medical subject headings), and Google Scholar were searched using the following terms in different combinations: “CBCT,” “volumetric CT,” “periodontal disease ,” and “periodontitis.” This was supplemented by hand-searching in peer-reviewed journals and cross-referenced with the articles accessed. Conclusions. Bony defects, caters, and furcation involvements seem to be better depicted on CBCT, whereas bone quality and periodontal ligament space scored better on conventional intraoral radiography. CBCT does not offer a significant advantage over conventional radiography for assessing the periodontal bone levels.

Is there a role for the use of volumetric cone beam computed tomography in periodontics?

Volumetric computed cone beam tomography offers a number of significant advantages over conventional intraoral and extraoral panoramic radiography, as well as computed tomography. To date, periodontal diagnosis has relied heavily on the assessment of both intraoral radiographs and extraoral panoramic radiographs. With emerging technology in radiology there has been considerable interest in the role that volumetric cone beam computed tomography might play in periodontal diagnostics. This narrative reviews the current evidence and considers whether there is a role for volumetric cone beam computed tomography in periodontics.

Three-dimensional imaging in periodontal diagnosis - Utilization of cone beam computed tomography

In the field of periodontology and implantology, assessment of the condition of teeth and surrounding alveolar bone depends largely on two-dimensional imaging modalities such as conventional and digital radiography. Though these modalities are very useful and have less radiation exposure, they still cannot determine a three-dimensional (3D) architecture of osseous defects. Hence, an imaging modality which would give an undistorted 3D vision of a tooth and surrounding structures is essential to improve the diagnostic potential. Cone-beam computed tomography (CBCT) provides 3D images that facilitate the transition of dental imaging from initial diagnosis to image guidance throughout the treatment phase. This technology offers increased precision, lower doses, and lower costs when compared with medical fan-beam CT. This review discusses all the finer details of CBCT which not only reveals 3D architecture of the periodontium but also helps to reconstruct it.

The usefulness of three-dimensional imaging in the diagnosis and treatment of clinically ambiguous gingival swelling

We evaluated and treated a 54-year-old woman with gingival swelling. Conventional intraoral and panoramic radiography did not provide sufficient information for either determining the cause of gingival swelling or planning treatment of clinical symptoms. The 3D Accuitomo XYZ Slice View Tomograph (3DX) is a compact dental computed tomography device that allowed for accurate identification and optimal treatment of the causes of gingival swelling. At four years after treatment, 3DX radiographs showed no abnormalities in treated teeth or healing of surrounding structures. We conclude that high-resolution 3D images obtained with 3DX promise to be very effective for diagnosing oral diseases and determining effective treatment.

Clinical application of cone beam computed tomography for ideal absorbable membrane placement in interproximal bone defects

When a guided tissue regeneration (GTR) membrane is placed in an interproximal area, adjustment of the membrane is difficult because of the complex anatomy of the root surface and presence of bone defects, thus prolonging the surgery. This report describes the clinical application of cone beam computed tomography (CT) images to aid insertion of a barrier membrane in the treatment of interproximal bone defects. Using CT images, the membrane can be pre-cut into the optimal shape to cover the bone defect and fit the roots tightly, thus shortening the time required to adjust the GTR membrane, and providing excellent clinical outcomes.

Clinical, tomographic, and histological assessment of periosteal guided bone regeneration with cortical perforations in advanced human critical size defects

BACKGROUND

Large osseous defects that fail to heal spontaneously require ridge augmentation prior to implant placement. The periosteum can act as an effective barrier membrane. Little is known about the influence of bone decortication in enhancing guided bone regeneration outcomes.

PURPOSE

The aim of the present study was a clinical, tomographic, and histological evaluation of bone healing in large defect sites treated with cortical perforations without the use of other membranes but the periosteum.

MATERIAL AND METHODS

Ten consecutive patients undergoing ridge augmentation on the pre-maxilla due to severe bone loss were followed for an average of 35 months. Recipient sites were cortico-perforated and augmented using a combination of autogenous particulate and block grafts. The periosteal membrane was preserved and it fully covered the autografts. Histological analysis was performed in four sites from a trephine core taken at the time of implant osteotomy preparation. Tomographic assessment (computed tomography [CT] scan) at baseline and post-augmentation evaluated graft volume maintenance.

RESULTS

Recipient sites were re-entered for implant placement showing good incorporation of the grafts with minimal volume loss. Biopsy specimens showed viable bone rich in osteoblast-like cells with little or no inflammatory cells. Clinical exam revealed absence of implant transparency, mucosal recession, mobility, bleeding on probing, or suppuration at follow-up. CT scan evaluation showed an average increased bucco-lingual width at the recipient site of 8.1 mm ± 0.9 (2.5 fold) versus a 3.2 ± 0.9 at baseline (p < .0001; CI 95%: 4.04-5.71 mm), maintaining on average 98% of the augmented width at 2.9 years.

CONCLUSIONS

Periosteal preservation seems to be sufficient as a barrier membrane to protect particulate or block osseous grafts provided that good primary closure is achieved. Bone decortication may enhance clinical and histological outcomes. Graft viability (biopsy specimens) and volume maintenance (CT evaluation) remained stable 35 months post-augmentation.

A randomized clinical trial of autologous platelet-rich plasma in the treatment of mandibular degree II furcation defects

AIM

A combined technique using a platelet-rich plasma (PRP)/bovine porous bone mineral/guided tissue regeneration membrane was found to be an effective modality for the treatment of mandibular grade II furcation defects. To elucidate the role played by each component, the present randomized, double-blind study is designed to evaluate the effectiveness of autologous PRP alone in the treatment of mandibular degree II furcation defects compared with open flap debridement (OFD).

MATERIAL AND METHODS

Using a split-mouth design, 40 mandibular degree II furcation defects were treated either with autologous PRP or OFD. Plaque index, sulcus bleeding index, vertical probing depth, relative vertical and horizontal clinical attachment level and gingival marginal level were recorded at baseline and 6 months post-operatively. Vertical and horizontal defect depths were also recorded using spiral computed tomography.

RESULTS

A statistically significant difference was observed in all the clinical and radiographic parameters at the sites treated with PRP as compared with those with OFD. However, all the furcation defects retained their degree II status.

CONCLUSION

Despite a significant improvement, lack of complete closure of furcation defects implies a limited role of autologous PRP as a regenerative material in the treatment of furcation defects, necessitating further long-term studies.

Conebeam CT of the head and neck, part 2: clinical applications

SUMMARY

Conebeam x-ray CT (CBCT) is being increasingly used for point-of-service head and neck and dentomaxillofacial imaging. This technique provides relatively high isotropic spatial resolution of osseous structures with a reduced radiation dose compared with conventional CT scans. In this second installment in a 2-part review, the clinical applications in the dentomaxillofacial and head and neck regions will be explored, with particular emphasis on diagnostic imaging of the sinuses, temporal bone, and craniofacial structures. Several controversies surrounding the emergence of CBCT technology will also be addressed.

Self-calibration of a cone-beam micro-CT system

Use of cone-beam computed tomography (CBCT) is becoming more frequent. For proper reconstruction, the geometry of the CBCT systems must be known. While the system can be designed to reduce errors in the geometry, calibration measurements must still be performed and corrections applied. Investigators have proposed techniques using calibration objects for system calibration. In this study, the authors present methods to calibrate a rotary-stage CB micro-CT (CBmicroCT) system using only the images acquired of the object to be reconstructed, i.e., without the use of calibration objects. Projection images are acquired using a CBmicrouCT system constructed in the authors' laboratories. Dark- and flat-field corrections are performed. Exposure variations are detected and quantifled using analysis of image regions with an unobstructed view of the x-ray source. Translations that occur during the acquisition in the horizontal direction are detected, quantified, and corrected based on sinogram analysis. The axis of rotation is determined using registration of antiposed projection images. These techniques were evaluated using data obtained with calibration objects and phantoms. The physical geometric axis of rotation is determined and aligned with the rotational axis (assumed to be the center of the detector plane) used in the reconstruction process. The parameters describing this axis agree to within 0.1 mm and 0.3 deg with those determined using other techniques. Blurring due to residual calibration errors has a point-spread function in the reconstructed planes with a full-width-at-half-maximum of less than 125 microm in a tangential direction and essentially zero in the radial direction for the rotating object. The authors have used this approach on over 100 acquisitions over the past 2 years and have regularly obtained high-quality reconstructions, i.e., without artifacts and no detectable blurring of the reconstructed objects. This self-calibrating approach not only obviates calibration runs, but it also provides quality control data for each data set.

Optical approach to the periodontal ligament under orthodontic tooth movement: a preliminary study with optical coherence tomography

INTRODUCTION

Optical coherence tomography (OCT) is a diagnostic tool that can make near-histologic tomographic images without a biohazard. Due to its high resolution (average, 4 microm) and safety (using light as the source), it has been applied widely in medical fields to replace invasive biopsies. But the trials in dentistry have been restricted to mainly detecting dental caries and oral cancer. In this preliminary study for successive human studies, we tried to evaluate whether OCT can be helpful in determining tooth movement under light orthodontic forces.

METHODS

Orthodontic distraction forces (0, 5, and 10 g) were applied to the mandibular incisors of 6 white rats (10 weeks old) for 5 days by using individualized loop springs (round Elgiloy, 0.018-in diameter, Rocky Mountain Orthodontics, Denver, Colo). The changed periodontal ligaments were imaged with OCT and digital intraoral radiography 2 dimensionally. Both tensile and compressive ligaments were measured and compared.

RESULTS

With OCT images, we could measure changed ligaments from all directions; radiography could not show the portions overlapped by teeth. The averages of measured ligament width in OCT were larger than those from radiography in all groups.

CONCLUSIONS

This preliminary study shows the possible evaluation and prediction of precise tooth responses under orthodontic forces by using real-time OCT.

Observer reliability of three-dimensional cephalometric landmark identification on cone-beam computerized tomography

OBJECTIVE

To evaluate reliability in 3-dimensional (3D) landmark identification using cone-beam computerized tomography (CBCT).

STUDY DESIGN

Twelve presurgery CBCTs were randomly selected from 159 orthognathic surgery patients. Three observers independently repeated 3 times the identification of 30 landmarks in the sagittal, coronal, and axial slices. A mixed-effects analysis of variance model estimated the intraclass correlations (ICC) and assessed systematic bias.

RESULTS

The ICC was >0.9 for 86% of intraobserver assessments and 66% of interobserver assessments. Only 1% of intraobserver and 3% of interobserver coefficients were <0.45. The systematic difference among observers was greater in X and Z than in Y dimensions, but the maximum mean difference was quite small.

CONCLUSION

Overall, the intra- and interobserver reliability was excellent. Three-dimensional landmark identification using CBCT can offer consistent and reproducible data if a protocol for operator training and calibration is followed. This is particularly important for landmarks not easily specified in all 3 planes of space.

Cone-beam computed tomography in assessment of periodontal ligament space: in vitro study on artificial tooth model

The aim of this in vitro study was to compare cone-beam computed tomography (CBCT) to conventional radiography (RG) in the assessment of the periodontal ligament space. A phantom with a variable "artificial" periodontal ligament space (0, 100, 200, 300, and 400 microm) was used as a model. The examinations were performed simultaneously with RG and NewTom 9000 digital volume tomograph. Assorted after increasing widths, 15 RGs and 15 CBCT images were presented for judgment to 20 dentists (DD), 20 dental assistants, and 20 dental students. Several weeks later, the same images were randomly mixed and presented to the same 20 DD again. The trial shows that RG gaps wider than 200 microm could be correctly identified by all participants with an accuracy of nearly 100%. A significant difference was observed between the modalities (p<0.05 and p<0.001) where conventional RGs performed better than CBCT for assessment of periodontal ligament space. Interobserver variation in relation to each technique was evaluated and no significant difference was found (p>0.05). In subjective evaluations of image quality with CBCT, the results were basically inferior for images of artificial periodontal ligament space, regardless of the experience of the observers.

Tuned-aperture computed tomography for detection of induced mid-buccal/lingual alveolar bone defects

BACKGROUND

The detection of bone loss in mid-buccal and lingual crests is impossible using conventional radiographs because of the superimposition of overlying anatomy and lack of three-dimensional information. The purpose of this study was to compare the diagnostic efficacy of tuned-aperture computed tomography (TACT) and conventional two-dimensional direct digital radiography (DDR) in an in vitro environment.

METHODS

A total of 45 mandibular molars had 0.8-mm lesions on mid-buccal/lingual crestal areas. Half of the sites received defects, whereas the other half served as controls. Nine DDR images were used to generate TACT slices that were further subjected to iterative restoration (TACT-IR). Eight observers used a confidence rating scale to record diagnoses. Receiver operating characteristic (ROC) analysis was done, and areas under the curves were computed (A(z)) as indicators of diagnostic accuracy. Analysis of variance (ANOVA) was used to test for effects of observer, imaging modality, and location on the detection of lesions.

RESULTS

TACT-IR performed significantly better than DDR. There was a significant difference in the accuracy of diagnosis based on observers (P <0.001).

CONCLUSION

TACT-IR appears to be the imaging modality of choice for the detection of small osseous changes on crestal bone in mid-buccal/lingual sites.

Effectiveness of dental computed tomography in diagnostic imaging of periradicular lesion of each root of a multirooted tooth: a case report

Radiography by use of the three-dimensional (3D) Accuitomo XYZ Slice View Tomograph (3DX), a device for compact computed tomography in dentistry, was performed as a new diagnostic imaging technique for a patient who needed endodontic therapy. The 3DX was used for examining and diagnosing the presence and expansion of periradicular lesions in each root of a multirooted tooth. High-resolution 3D images were observed and compared with those obtained by routine conventional radiography. It was difficult to diagnose the cause of clinical symptoms by general examinations including the usual intraoral radiography and panoramic radiography. The images obtained by the 3DX, however, clearly showed the apparent presence and expansion of a periradicular lesion in only one root of the multirooted tooth. The 3DX, a newly developed dental computed tomography, provides abundant new image information not attainable by either intraoral radiography or panoramic radiography, and its application for clinical use is very effective for examining and diagnosing regions of interest for endodontic therapy.

Digital Volume Tomography in the Diagnosis of Peri-Implant Defects: An In Vitro Study on Native Pig Mandibles

BACKGROUND

The aim of this study of native pig mandibles was to investigate the accuracy and quality of the representation of peri-implant defects by intraoral radiography (IR), panoramic radiography (PR), computer tomography (CT), and digital volume tomography (DVT).

METHODS

The examination was carried out on 19 native pig mandibles. In the toothless sections of the mandibles, one or two implants were inserted. Following the standardized preparation of peri-implant defects (11 each of dehiscences, fenestrations, and 2- to 3-walled intrabony defects), IR, PR, CT, and DVT were performed. The peri-implant defects were measured using appropriate software on the digitized IR and PR image programs. As a control method, the peri-implant bone defects were measured directly using a reflecting stereomicroscope with measuring ocular. The statistical comparison between the measurements of the radiographic scans and those of the direct readings of the peri-implant defects was performed with Pearson's correlation coefficient. The quality of the radiographic scans was determined through the subjective perception and detectability of the peri-implant defects by five independent observers.

RESULTS

In the DVT and CT scans, it was possible to measure all the bone defects in three planes. Comparison with the direct peri-implant defect measurements yielded a mean deviation of 0.17+/-0.11 mm for the DVT scans and 0.18+/-0.12 mm for the CT scans. On the IR and PR images, the defects could be detected only in the mesio-distal and cranio-caudal planes. In comparison with the direct measurements of the peri-implant defects, the IR images revealed a mean deviation of 0.34+/-0.30 mm, and the PR images revealed a mean deviation of 0.41+/-0.35 mm. The quality rating of the radiographic images was highest for the DVT scans.

CONCLUSIONS

Overall, the CT and DVT scans displayed only a slight deviation in the extent of the peri-implant defects. Both radiographic imaging techniques permitted imaging of peri-implant defects in three planes, true to scale, and without overlay or distortion. The DVT scans showed the best imaging quality.

Maxillary sinusitis and periapical abscess following periodontal therapy: a case report using three-dimensional evaluation

BACKGROUND

Maxillary sinusitis may develop from the extension of periodontal disease. In this case, reconstructed three-dimensional images from multidetector spiral computed tomographs were helpful in evaluating periodontal bony defects and their relationship with the maxillary sinus.

METHODS

A 42-year-old woman in good general health presented with a chronic deep periodontal pocket on the palatal and interproximal aspects of tooth #14. Probing depths of the tooth ranged from 2 to 9 mm, and it exhibited a Class 1 mobility. Radiographs revealed a close relationship between the root apex and the maxillary sinus. The patient's periodontal diagnosis was localized severe chronic periodontitis. Treatment of the tooth consisted of cause-related therapy, surgical exploration, and bone grafting. A very deep circumferential bony defect at the palatal root of tooth #14 was noted during surgery. After the operation, the wound healed without incidence, but 10 days later, a maxillary sinusitis and periapical abscess developed. To control the infection, an evaluation of sinus and alveolus using computed tomographs was performed, systemic antibiotics were prescribed, and endodontic treatment was initiated.

RESULTS

Two weeks after surgical treatment, the infection was relieved with the help of antibiotics and endodontic treatment. Bilateral bony communications between the maxillary sinus and periodontal bony defect of maxillary first molars were shown on three-dimensional computed tomographs. The digitally reconstructed images added valuable information for evaluating the periodontal defects.

CONCLUSION

Three-dimensional images from spiral computed tomographs (CT) aided in evaluating and treating the close relationship between maxillary sinus disease and adjacent periodontal defects.

Digital volume tomography in the diagnosis of periodontal defects: an in vitro study on native pig and human mandibles

BACKGROUND

The aim of this study of native pig and human mandibles was to investigate the accuracy and quality of the representation of periodontal defects by intraoral radiography (IR), panoramic radiography (PR), computed tomography (CT), and digital volume tomography (DVT) in comparison with histologic specimens.

METHODS

Following the standardized preparation of periodontal defects (14 dehiscences, fenestrations, 2- to 3-walled intrabony defects, respectively; Class I, II, and III furcation involvement) in six pig and seven human mandibles, IR, PR, CT, and DVT were performed. The histologic specimens were produced by cutting blocks with the individual defects out of the mandibles, embedding them in acrylic, and producing sagittal and axial microsections. The intrabony defects were measured using appropriate software on the digitized IR and PR images programs. The histologic sections were measured by reflecting stereomicroscopy. The statistical comparison between the measurements of the radiographic images and those of the histologic specimens was performed with Pearson's correlation coefficient. The quality of the radiographic images was determined through the subjective perception and detectability of the intrabony defects by five independent observers.

RESULTS

All intrabony defects could be measured in three planes in the CT and DVT scans. Comparison with the histologic specimens yielded a mean deviation of 0.16 +/- 0.10 mm for the CT scans and 0.19 +/- 0.11 mm for the DVT scans. On the IR and PR images, the defects could be detected only in the mesio-distal and craniocaudal planes. In comparison with the histologic specimens, the IR images revealed a mean deviation of 0.33 +/- 0.18 mm and the PR images a mean deviation of 1.07 +/- 0.62 mm. The quality rating of the radiographic images was highest for the DVT scans.

CONCLUSIONS

Overall, the CT and DVT scans displayed only a slight deviation in the extent of the periodontal defects in comparison with the histologic specimens. Both radiographic imaging techniques permitted imaging of anatomic osseous structures in three planes, true to scale, and without overlay or distortion. The DVT scans showed the best imaging quality.

Do We Need Three-Dimensional Computed Tomography in Maxillofacial Surgery?

In a retrospective clinical study (2000-2003), 121 patients' radiographs and computed tomography scans were reviewed to establish the clinical value of three-dimensional computed tomography. Eighty patients had computed tomography scans; 48 had three-dimensional computed tomography scans for diagnosing facial fractures, 3 for diagnosing temporomandibular joint ankylosis, 1 for tumor with bone destruction, and 1 for a mandibular cyst. It is concluded that axial, coronal, and three-dimensional computed tomography is of crucial importance and should be mandatory for all suspected comminuted and displaced midface fractures instead of plain radiographs. Three-dimensional computed tomography is also recommended for comminuted mandibular fractures and temporomandibular joint ankylosis. Three-dimensional computed tomography is not recommended for the diagnosis of minimally displaced fractures.