The increase in accessibility and capabilities of computed tomography (CT) technology has understandably led to a growth in its use in the veterinary industry across a variety of applications. Dentistry is an area where CT imaging can be particularly useful, capturing small details to provide an intricate diagnostic resource. CT in dentistry is likely to continue gaining popularity, and by reviewing the available technology, clinical applications and benefits to veterinarians, patients and owners, that trend makes perfect sense. As CT technology becomes more accessible, it is increasingly being utilized as a well-rounded imaging modality for dental applications. Photo courtesy Imaginalis Technology with teeth One of the driving factors in the increased presence of CT scanners in veterinary clinics is the recent addition of a new CT modality to the market. High-definition volumetric imaging (HDVI) builds a 2D and 3D image dataset of the animal patient’s whole density, rather than the traditional method of stacking individual image slices. This provides veterinarians with a much finer level of detail, capturing spatial resolution down to 100 microns within safe radiation levels. Analyzing small and intricate anatomy is a well-known challenge in the veterinary industry, and dentistry is certainly no exception. An HDVI scan captures the detail necessary to diagnose conditions in tiny structures, like teeth roots in small animals, making it ideal for dental procedures, including: Tooth extraction planning. Identifying root fractures, ankylosis and abnormal root morphology, and locating retained roots after incomplete extraction. Periodontal disease assessment. Evaluating bone loss patterns around teeth and detecting early or hidden lesions not visible in an X-ray scan. Endodontics. Visualizing pulp chamber anatomy, root canals, and periapical lesions, and assessing healing after treatment. Oral tumor diagnosis and surgical planning. Determining tumor extent, invasion into the bone, and surgical margins, and mapping complex resections involving the mandible or maxilla. Jaw fracture repair. Precisely identifying fracture lines, fragment displacement, and dental involvement, and planning fixation without damaging the tooth roots. Orthodontics/malocclusion cases. Assessing unerupted or impacted teeth and measuring jaw symmetry and tooth alignment in 3D. Resorptive lesions. Detecting early lesions under the gumline and guiding decisions on extractions or crown amputations in this common feline condition. Pre- and post-surgical follow-up. Confirming full removal of diseased tissue and monitoring healing and bone regeneration. As much of the damage from periodontal conditions happens below the surface of the gumline, it may be easy to forget just how big an impact it can have on veterinary patients. A study on dogs shows regular dental cleanings and treatments of periodontal disease are linked to patients living up to 20 percent longer compared to canine patients that did not receive dental care.1 This translates to an additional two to four years to the expected lifespan in some breeds.1 Cats with untreated dental disease are at a higher risk of kidney disease, heart problems and weight loss, conditions that can significantly shorten the animal’s life and increase pain and discomfort.2 Bob, a mixed-breed canine, exhibits signs of widespread periodontal disease, specifically stage 4 periodontitis, characterized by tooth and bone loss visible from every angle. Photo courtesy Imaginalis This technology can also be applied to exotic patients. “I’ve had some rabbits in the last year that had very vague signs, things like not eating very well. Looking at their teeth, their dental issues seemed mild, or their teeth looked fine on awake oral exams. I even did a sedated exam, and I didn't see anything,” says Sari Kanfer, DVM, who practices at Exotic Animal Veterinary Center in Pasadena, Calif. “Then on CT, I could see the last lower molar was a little infected and loose, so I was able to then put them under anesthesia, extract the tooth and the problems were fixed.” Animals often hide dental pain, an instinct that can cause both owners and veterinarians to overlook potential issues that impact their quality of life. CT scans can help remove that barrier and provide a full assessment of the animal’s periodontal health, allowing earlier detection and intervention before the condition requires a major procedure. A 3D image of this feline patient can be manipulated to analyze dental health, as well as conditions in the surrounding facial structures. Photo courtesy Imaginalis Evidence of periodontitis stage 2 can be seen in the upper and lower incisors. Photo courtesy Imaginalis More than just lip service In addition to detailed imaging for these and other conditions in the mouth, an HDVI dental scan also captures the fine details of the ears, eyes, and nasal passage. Veterinarians can view the entire skull in 2D and 3D with clear resolution, including both hard and soft tissue details. This provides more context for the patient’s condition and can help further elevate care. HDVI CT scans are also used for chest, abdominal, and orthopedic imaging in general practice clinics that provide dental services, creating more opportunities for the modality to be utilized and to establish its place in the imaging suite. As CT technology has continued to evolve, it has also seen improvements in its usability in veterinary settings. Modern machines are significantly faster than previous iterations or other imaging systems used today for dental applications. Oral radiographs on a dental patient can take up to 30 minutes, while an HDVI scan can be completed in less than five minutes. This enables veterinarians to access more detailed diagnostic information more quickly, facilitating rapid assessment and treatment implementation. The need for anesthesia, a hindrance that can occasionally impede veterinarians’ use of CT scanning, is also not an issue in dental care. Patients are already under anesthesia for the dental exam and cleaning, and a veterinarian can take advantage of this fact by capturing an HDVI scan to visualize everything below the gumline and other surrounding structures and tissues. Lower cost has been another shift that increases accessibility to CT technology, giving veterinarians more information and power at the point of care. These savings are, in turn, passed on to the client, who can be assured their provider has the data they need to provide informed treatment without an impossible price tag attached to it. Owners also benefit from the extra visibility provided by CT imaging, particularly HDVI CT. When a veterinarian can use an image to more clearly illustrate a pet’s condition to the owner, compliance with treatment recommendations can increase exponentially. Not only are HDVI scans high-resolution, capturing even the tiniest details, but they can also be rendered in 3D and colorized. The problem can be clearly visualized and explained, allowing the veterinarian to more easily obtain permission to complete the necessary treatment. Capturing both 2D and 3D scans enables a comprehensive and thorough analysis of dental conditions. Photo courtesy Imaginalis On the cuspid of greatness The advancement of CT technology and its subsequent growth as a cornerstone in veterinary dentistry have already brought it into the spotlight as the gold standard for patient images, and this trend has every indication of continuing. Ultrasound saw a similar trajectory over the past few decades. In the 1990s and early 2000s, only specialty clinics offered ultrasound machines; now, virtually all veterinary practices have an ultrasound system they use daily. Dental CT is already a much more established clinic staple than it was just a few years ago. For example, one veterinary group with over 30 locations across the Western U.S. has made dental imaging with an HDVI unit a standard component of all new patient intakes, in addition to regularly using it for diagnosis on existing patients. This is a relatively new and niche feature to offer patients, but as technology continues to become more affordable with additional capabilities like pairing with surgical planning software, it will likely continue to be adopted into more clinics. December of this year will mark 130 years since Wilhelm Röntgen took the first X-ray. In just a handful of decades, the capabilities of this technology have absolutely skyrocketed from blurry low-contrast pictures to interactive 3D models that accurately illustrate even the tiniest anatomical details. No one knows what the next innovation will be or how it will elevate the tools and information available to veterinarians. However, what we can say with some degree of certainty is that good things are coming in the realm of HDVI, and the next couple of decades will see an even greater improvement in accessibility, capability, client confidence, and patient outcomes. With nearly three decades in the animal health industry, Robert Whitaker is an experienced animal imaging technician and veterinary business professional. Whitaker has made significant contributions to advancing imaging in food animal, large animal, and small animal applications since 1995. He is the business development director for Veterinary in North America at Imaginalis. References https://pubmed.ncbi.nlm.nih.gov/11263700/ https://us.swedencare.com/pet-life/longevity-in-cats-how-dental-health-impacts-lifespan-and-wellbeing/
