Original Article

KNOWLEDGE AND ATTITUDE OF DENTAL PROFESSIONALS

TOWARDS CONE BEAM COMPUTED TOMOGRAPHY
A STUDY DONE AT AFID
1
TABASUM JALIL
2
HIRA ZAMAN
3
MARIA SHAKOOR
4
COL MUBASHIR SHARIF
ABSTRACT
The aim of this study was to assess the knowledge and attitude of dental professionals towards cone
beam computed tomography. The questionnaire based on 20 questions related to cone beam computed
tomography (CBCT) was distributed among 390 dentists of AFID. The attitude of present day dentists
and their knowledge with respect to their education level was assessed using questionnaire. Out of
390 questionnaires, 40 were incompletely filled so they were excluded. Out of 350 dentists, 305 (87.1%)
preferred to use digital imaging radiography because it is less time consuming and is of low radiation
dose. Out of 340 dentists, 215 (61.4%) heard about CBCT (cone beam computed tomography) from
faculty lessons. Most of the dental professionals (44.3%) used CBCT for implant cases. Interestingly,
100% of the dentists are interested in learning this new technology and most of them wanted it to be
included in clinical dental education. Out of 340, 48.6% (n=170) of the dentists responded that their
faculty does not provide adequate education regarding CBCT. Results of the current research showed
that the importance of CBCT in dental practice and different dental education programs regarding
digital imaging radiography should be conducted to increase knowledge and practice of dental fra-
ternity so that they will be able to use this technique in an efficient way to improve the accuracy and
reliability of their diagnosis, treatment planning and outcomes.
Key Words: Oral radiology, knowledge, cone beam computerized tomography.

INTRODUCTION of the images in different planes, interactive display

In addition to history and examination,
radiographic imaging is an important diagnostic tool.
Traditionally, dental education was based on two-
dimensional radiographs because of lack of resources
and non-availability of more precise equipment.
Mozzo et al1 in 1998 and Arai et al2 in 1999 reported
independently the use of cone beam computed
tomography (CBCT), sometimes referred to as cone
beam volumetric imaging (CBVI).3
High sharpness of axial images, adjustment of
radiation doses, less exposure time, cross-sectioning
1
For Correspondence: Tabasum Jalil, BDS, C-IMPLANT,
MCPSR Prosthodontics, Armed Forces Institute of Dentistry
Email: drtabasumfarhan@gmail.com Cell: 0334-066-6322
2
Hira Zaman, BDS, C-IMPLANT, member ICOI, MDSR Opera-
tive Dentistry, Shaheed Zulfiqar Ali Bhutto Medical University
(PIMS)
3
Maria Shakoor, BDS, FCPSR Prosthodontics, Armed Forces In-
stitute of Dentistry
4
Col Mubashir Sharif, Head of Department, Prosthodontics,
Armed Forces Institute of Dentistry
Received for Publication: November 11, 2016
Revised: December 6, 2016
Approved: December 7, 2016
models and beam confined to head and neck region
only are few main advantages of CBCT. In recent
years, all these advantages make CBCT a convenient
technology.4
In dentistry CBCT is indicated for dental
implant placements, assessing dento-facial complex
for orthodontic treatment, diagnosis of osseous
degenerative changes in TMJ, cysts and tumors and
to check out the proximity of vital structures while
doing surgical procedures.5 On the other hand, for
interpretation of the information obtained from
CBCT, an expert or trained personnel is required
otherwise, there are high chances of missed or false
positive diagnoses.6
Despite of the fact that CBCT is gaining popularity
in Pakistan, there are no such specific standardized
training modules or workshops nor is it added in
undergraduate and postgraduate curriculum in
detail. Hence, this study was carried out to assess the
Knowledge and attitude of dental fraternity towards
cone beam computed tomography in AFID.

Pakistan Oral & Dental Journal Vol 36, No. 4 (October-December 2016) 661
 Cone beam computed tomography

METHODOLOGY and analyzed using SPSS 23.0 (IBM, New York, NY)
in view of the objectives of the study, using descriptive
A self-administered anonymous questionnaire con-
analysis.
sisting of 20 multiple choice questions was designed and
administered voluntarily to 350 (275 female, 75 male) RESULTS
dentists at Armed Force Institute of Dentistry. Dentists
Among the total sample of 350 dentists, 75 (21.4%)
were divided according to their academic qualification
were males and 275(78.6%) were females. Final year
into final year students, graduates, postgraduates and
students were 15 (4.3%), Postgraduate dentists were
dentists with postgraduate qualification.
120 (34.3%) and graduates were 205 (58.6%) and 10
There was no compulsion for answering the ques- (2.9%) were postgraduate residents. Details of results
tionnaire and it was ensured to dentists that results can be seen in Table 1-7 and Fig 1-2.
of the present study will not be used for reporting any
personal information about individuals but used only TABLE 1: DATA REGARDING THE NUMBER OF
for dental societys educational purpose. In addition to DENTISTS/STUDENTS USING DIGITAL
collecting demographic information, the questionnaire IMAGING TECHNIQUES
gauged the respondents' general awareness, knowledge
and attitude towards CBCT. It can be broadly classified Do you use digi-
into four parts. (Fig. 1) tal imaging tech-
niques for taking
First part included Demographic details of the den- radiographs
tist regarding the gender and academic qualification No Yes Total
(Question 1, 2). Second part was related to dentists
Educa- Final year 40 15 55
attitude assessment toward digital imaging (Question tion
3 to 7). Third part depicted evaluation of dentists Postgradu- 0 120 120
level ate dentists
knowledge toward CBCT usage (Question 8 to 15) and
4th part included assessment of dentists attitude to- BDS 5 160 165
ward CBCT in their future dental career (Question 16 MDS/FCPS 0 10 10
to 20). The data collected were sorted out, tabulated, Total 45 305 350

TABLE 2: REASONS FOR USING DIGITAL IMAGING TECHNIQUES

Educa- Please check reasons for using digital imaging techniques

tion Radi- It takes There There It is Adjust- There All of Op- Total
level ation short is no is no easy to ments are no the tions
dose is time to de- wast- store & mea- artifacts above 1-7
much per- velop- age in images sure- related
less form ing devel- ments to de-
process oping can be veloping
pro- done process
cess & on
does images
not
cause
pollu-
tion
Final 0 10 5 0 0 0 0 0 0 15
year
Post- 15 50 5 0 5 5 0 40 0 120
gradu-
ate
BDS 10 50 15 10 5 10 5 65 35 205
MDS/ 0 0 0 0 0 0 0 10 0 10
FCPS
25 110 25 10 10 15 5 115 35 350

Pakistan Oral & Dental Journal Vol 36, No. 4 (October-December 2016) 662
 Cone beam computed tomography

TABLE 3: SOURCE OF OBTAINING

INFORMATION REGARDING CBCT

Frequency (n) Percent (%)

faculty lessons 215 61.4
seminars 35 10.0
internet 40 11.4
others 40 11.4
Option 1-3 20 5.7
Total 350 100.0

TABLE 4: MOST IMPORTANT ADVANTAGE OF

CBCT OVER MEDICAL CT
Fig 1: Reasons for using CBCT by dentists with
Frequen- Percent different level of education
cy (n) (%)
Lower radiation dose 80 22.9
Shorter scanning time 35 10.0
Less expensive 10 2.9
Easier to maintain 10 2.9
Imaging process is easier 30 8.6
due to limited beam
Data reconstruction can be 55 15.7
done on a personal computer
No idea 100 28.6
All 1 to 6 30 8.6
Total 350 100.0
TABLE 5: DATA REGARDING THE OPINION
FOR WHAT CASES WOULD YOU CHOOSE TO
USE CBCT IN YOUR FUTURE CLINICAL Fig 2: Method of obtaining information regarding CBCT
DENTAL CAREER?
DISCUSSION
Frequen- Percent
The present study was conducted in Armed Forces
cy (n) (%)
Institute of Dentistry in the year 2016 in order to
Implant dentistry 155 44.3
assess the Knowledge and attitude of dental frater-
Extraction of impacted teeth 20 5.7 nity towards cone beam computed tomography at
Evaluation of patients with 55 15.7 different levels of their education. The sample size
tumors or cysts of the study was 350, including 58.6% graduates,
All of the above 120 34.3 34.3% Postgraduates, 4.3% final year students and
Total 350 100.0 2.9% trainees.

TABLE 6: DATA REGARDING THE OPINION WHICH YEAR OF DENTAL EDUCATION

SHOULD INCLUDE LECTURES ON CBCT?

Education level Total

Final year Postgraduate BDS MDS/FCPS
Which year of dental Preclinical phase 5 35 75 0 115
education should include Clinical phase 5 55 105 10 175
lectures on CBCT?
Internship 0 0 15 0 15
PG 5 30 10 0 45
Total 15 120 205 10 350

Pakistan Oral & Dental Journal Vol 36, No. 4 (October-December 2016) 663
 Cone beam computed tomography

TABLE 7: WILLINGNESS OF DENTISTS IN OBTAINING UPDATED INFORMATION REGARDING CBCT

Are you willing to obtain any updated information Total

regarding CBCT?
No Yes No idea
Education Final year 0 15 0 15
level Postgraduate 5 115 0 120
BDS 0 185 20 205
MDS/FCPS 0 10 0 10
Total 5 325 20 350

In the present study, statistically significant num-
ber of dentists (87.1%) prefers to use digital imaging
radiography over conventional radiography. Graduates
(52.5%) and postgraduates (39.3%) were the top ones to
use CBCT showing their keen interest in this upcoming
technology. According to Wenzel and Moystad7 only
14% of the dentists prefer to use digital radiography.
A slight higher percentage (67%) of digital imaging
radiography users was seen in the study conducted
by Do leko_glu et al.8 The most common reason of not
using CBCT reported by non-users (12.8%) was the cost,
higher than conventional radiography. Same results
were reported by other authors.9,10
Although a great number of dentists (77.1%) pre-
ferred CBCT over conventional CT for their patients to
undergo 3D imaging, 28.6% of dentists failed to explain
the advantage of CBCT over CT. These results shows
lack of awareness and practical education regarding
CBCT in institutions and few dentists also pointed
out the reason of non-availability of CBCT in dental
institutes. Reddy et al10 carried out a study to evaluate
knowledge and attitude of dental fraternity towards
CBCT in South India and found that there was low
awareness amongst the dentists regarding use of CBCT.
The possible causes for low awareness mentioned in
the study were lack of availability of CBCT in India as
well as non-inclusion of CBCT training during dental
education.
Literature shows wide range of uses of cone beam
computerized tomography.11,12 Most of the responses
regarding the indications of CBCT were only in favor
of implant dentistry (55.7%). The responses to the
above questions highlighted the absence of complete
and precise information regarding CBCT. Technol-
ogy can only be a part of practice when there is an
understanding of the technical nuisances related
to it. Thus, efforts should be carried out in order to
fulfill the gap of knowledge to make dental future
more successful.
One of the reasons of lack of awareness is that CBCT
is not included in dental curriculum and faculty also
does not provide adequate training as shown by our
results. Dentists (48.6%) responded that their faculty
did not provide adequate education regarding CBCT.
Similar reason was reported by Aditya et al.12
Another study done in Turkey by Kamburoglu et
al advocated that efforts should be made to increase
students understanding regarding CBCT and that
the dental school curriculum should dedicate more
curriculum time to this new technology.13
Majority of dental health professionals (92.9%) was
willing to obtain updated information regarding digital
radiography showing their thirst of getting modernized
information related to this evolving technology. There-
fore, it is recommended that refresher programs must
be held for dentists to increase their awareness toward
cone beam computed tomography.
CONCLUSION
Cone beam computed tomography is the latest
advancement in the field of dentistry and is becoming
a right hand tool among dental practitioners. Results
of this research showed that there is a great need of
conducting different dental education programs for
awareness of dentists regarding CBCT as well as it
should be included in the curriculum for undergraduate
students. By improving this, the dentists would be able
to do their practice in a more efficient way and in return
it will be of great benefit for the patients as well.
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CONTRIBUTIONS BY AUTHORS
1 Tabasum Farhan: Data collection
2 Hira Zaman: Statistical analysis, literature review, article writing
3 Maria Shakoor: Topic selection, literature review
4 Col Mubashir Sharif: Supervision, final review
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Cone beam computed tomography
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