Ahead in Imaging

The British Society of Dental and Maxillofacial Radiology

Ahead in Imaging

The British Society of Dental and Maxillofacial Radiology

CBCT in practice: the clinician's perspective

Introduction & Welcome

Dr Jimmy Makdissi

President of BSDMFR


Dr Makdissi joined the Institute of Dentistry, Barts and The London School of Medicine and Dentistry, in 2004 as a Clinical Senior Lecturer and Honorary Consultant in Dental and Maxillofacial Radiology. He directs the Dental and Maxillofacial Radiology programme of the undergraduate BDS curriculum. He completed his specialist training at Guy’s Hospital and obtained the Diploma of Dental Radiology from the Royal College of Radiologists. He has served on the Education Committee of the International Association of Oral and Maxillofacial Radiology. He has also served as the Dental Tutor for the London Deanery at Barts Health, the Faculty Tutor at the Royal College of Surgeons and as the President of the Metropolitan Branch of the British Dental Association. In addition, he is the founder of the Cone Beam Computed Tomography (CBCT) Interpretation Masterclass providing UK-based CBCT hands-on training along with a collection of e-learning modules. Jimmy is currently doing his PhD on the use of MRI in Dentistry. 

CBCT and Periodontics


In Periodontics, the use of radiographs is related to the diagnosis of periodontal and peri-implant diseases, but also for monitoring of the disease progression as well as for treatment planning purposes. Furthermore, in terms of treatment, the type/morphology/angle of a periodontal bone defect (as radiographically delineated) is used to decide the surgical technique in periodontal regenerative procedures. 

In the field of Implant Dentistry, the use of CBCT is almost a routine in terms of treatment planning. However, in cases of biologic complications around implants, the possibility to evaluate the 3D image of the defect may be of importance in the type of treatment to be provided. 

Therefore, taking into consideration the importance that radiographical imaging has within the every- day clinical practice, it would be interesting to evaluate the additional support that CBCT can provide in terms of diagnosis and treatment. In this lecture, an overview of the clinical challenges in the field of Periodontics will be presented and discussed through a series of clinical cases.  

Learning aims & outcomes

To facilitate understanding of the clinical challenges in periodontics that CBCT could be required

To enhance diagnosis in Periodontics and Implant Dentistry through the use of CBCT

Professor Nikos Danos

Professor & Chair Periodontology and Implant Dentistry, Lead Centre for Immunobiology & Regenerative Medicine, Head Centre for Oral Clinical Research
Barts and the London School of Medicine & Dentistry 


Professor Nikos Donos is the Chair of Periodontology & Implant Dentistry, the Director of Clinical Research, the Head of the Centre for Oral Clinical Research and the Lead for the Centre of Oral Immunobiology & Regenerative Medicine at the Institute of Dentistry, Barts & The London School of Medicine and Dentistry, Queen Mary University of London (QMUL). Prof. Donos is also the Director of the ITI scholarship Centre and the Director of the Osteology Research Scholarship Centre, both at QMUL. Furthermore, he is an Hr Consultant in Periodontics at Royal Dental Hospital, BartsHealth Trust.

In 2009, Professor Donos was awarded the title of Honorary Professor at the Faculty of Dentistry in Hong Kong, in 2012 the title of Adjunct Professor at the Dental School, Griffith University, Australia,  in 2015 the title of Honorary Professor at UCL-Eastman Dental Institute and in 2019 the title of Honorary Professor, School of Dentistry,  University of Queensland, Australia.

In 2011, Professor Donos was awarded the prestigious IADR-Periodontology Group Award in Periodontal Regenerative Medicine. Professor Donos is the President (2020) of the British Society of Periodontology (BSP), a board member at the Osteology Foundation and the Academic Representative at the Committee for Association of Dental Implantology (ADI)(U.K).

Professor Donos is involved as editorial board member in a number of international peer-reviewed journals in the field of Periodontology and Implant Dentistry where he has published more than 220 scientific publications.

The clinical expertise of Professor Donos is in the field of Periodontics and Implant Dentistry. Within the clinical setting, Prof Donos provides advanced treatment modalities to patients suffering from severe periodontal disease which include periodontal and bone tissue regeneration, implant related surgical procedures, as well as, treatment of peri-implantitis which are topics that he regularly lectures on a national and international level.



Professor Ghassan Alusi

Consultant ENT Surgeon
Barts and the London NHS Trust

Professor Gus Alusi is an eminent Ear Nose and Throat Surgeon. He is a Consultant at Barts and The London NHS Trust and is deeply involved in research into image guided surgery, for which he was awarded a PhD by University College London. Professor Alusi is an Honorary Senior Lecturer at UCL. Professor Alusi manages all adult and paediatric general ear nose and throat conditions and has a special interest in complex head and neck surgery. He is a senior surgeon within the Head and Neck Unit at Barts and The London NHS Trust and has a special interest in thyroid and complex sinus surgery and in rhinoplasty.

Professor Alusi’s general training was at The Royal National Throat, Nose and Ear, St Bartholomew’s, The Royal Marsden and The Royal Free Hospitals. He became a Consultant at St Bartholomew’s and The Royal London Hospitals in 2000. He has further pursued his interest in research as Supervisor for ENT surgical trainees undertaking postgraduate degrees through collaborative work with the Institute of Cancer Research Fund. This work has produced a vast number of peer reviewed publications.

CBCT and Oral Surgery


Cone‐beam computed tomography (CBCT) is an exciting technology that is much talked about and increasingly used by oral surgeons. The advantages are obvious in terms of image quality and three‐dimensional representation, but does its use make a difference to the clinical decision being made and the patient outcome? This presentation discusses the ‘need’ and ‘demand’ for CBCT scan imaging in oral surgery. 

One of the most common areas of dentistry to exploit CBCT imaging is dental implantology. The ability to accurately assess the bone volume prior to surgery, and in particular, the position of the inferior alveolar nerve canal or the position of the maxillary sinus, is a huge advantage in surgical planning but an understanding of the clinical anatomy and surgical experience are also key to a good outcome.

CBCT is also being used more and more commonly after a dental panoramic radiograph has revealed that a lower third molar tooth has a close association with the inferior alveolar nerve canal. The question is, what difference does this make to the surgical plan? Perhaps if a root or the roots of a lower third molar are so close to the canal that nerve injury is highly likely, then it is preferable to plan to retain the root apices in order to reduce the risk. This decision could be made using the plain film. How would this decision change with CBCT imaging? Is this use of CBCT ‘need’ or ‘demand led'? The use of CBCT in cases where there are unerupted and impacted maxillary teeth in the palate is helpful in identifying resorption of adjacent tooth roots that may not have been apparent using conventional radiography.

If CBCT imaging has the potential to change the patient management, then it should be considered. It is important however to remember that there is a responsibility to report all images.

Learning aims & outcomes

Understand the concept of ‘need’ and ‘demand’ for CBCT scan imaging in oral surgery

Appreciate the value of CBCT in surgical planning but also the limits in terms of surgical outcome

Recognise the responsibility to report all images or have them reported

Understand the limits of research evidence for CBCT guidelines

Professor Paul Coulthard 

Dean for Dentistry and Institute Director Professor of Oral and Maxillofacial Surgery Honorary Consultant in Oral Surgery
Queen Mary University of London

Professor Paul Coulthard was appointed Dean for Dentistry and Institute Director, Institute of Dentistry, Queen Mary University of London, in January 2019. He is Professor of Oral and Maxillofacial Surgery. The Institute of Dentistry at Queen Mary University of London has an impressive history and strong reputation and Professor Coulthard’s impact has been to build on existing achievements, fostering and developing excellence, innovation and global reputation in teaching, learning and dental and oral research that is collaborative and embedded into wider medicine.

He was previously Vice-Dean of the Faculty of Biology, Medicine and Health at the University of Manchester and Head of the School of Medical Sciences. This School consisted of the Research Institutes of ‘Cancer Sciences’, ‘Cardiovascular Sciences’, ‘Developmental Biology & Medicine’, ‘Diabetes, Endocrinology & Gastroenterology’ and the ‘Manchester Medical School’ and ‘Manchester Dental School’. Prior to this he was Dean of the Manchester Dental School of five years.

Professor Paul Coulthard undertook General Clinical Training as a General Dental Practitioner in Manchester and Sheffield and was awarded the Membership of the Faculty of General Dental Practitioners. His Basic Surgical Training took place in Manchester, Carlisle and London and he undertook a resident training post in Anaesthesia. He also spent a short time working overseas. Professor Coulthard completed Higher Specialist Surgical Training in academic Oral and Maxillofacial Surgery in Manchester in 2000. This training included surgery of the mouth, surgery for facial injuries and fractures, surgery for facial disfigurement and surgery of the salivary glands and jaw joint. He was awarded the Fellowship in Dental Surgery of the Royal College of Surgeons and subsequently his Specialty Fellowship in Oral Surgery by the Royal College of Surgeons Intercollegiate Board.

Alongside surgical training, Professor Coulthard undertook research training leading to the award of an MDS in Oral and Maxillofacial Surgery and a PhD in Neuroscience. He was promoted to the position of Senior Lecturer and Head of Department in 2000, Honorary Consultant Oral Surgeon in 2001 and Personal Chair in 2004.

Professor Coulthard is an Editor with the Cochrane Collaboration Oral Health Group (impact factor 5.340). He was Editor-in-Chief of journal Oral Surgery 2013-18 and is an Editorial Board member of the International Journal of Surgery. He was a Senior Editor for the Journal of the Chinese Medical Association. Professor Coulthard is currently the Dental Anesthesiology Research Group Councillor with the International Association for Dental Research (IADR) having previously been group President and Institutional Section Councillor. He was previously a member of the Licensing Board, Centre for Healthcare Planning & Quality, Dubai Health Care City. During his period as Dean at the Manchester Dental School he developed Memorandum of Understanding with several prestigious international institutions.

Professor Coulthard has chaired several committees for NHS England that have published reports changing the delivery of clinical care in England, especially the ‘Guide for Commissioning Oral Surgery and Oral Medicine’ and ‘Commissioning Dental Services - Conscious Sedation in a Primary Care Setting’. He has also contributed to guidance produced by the Scottish Dental Clinical Effectiveness Programme (SDCEP) including, ‘Conscious Sedation in Dentistry - Dental Clinical Guidance’, 2017 and ‘Mitigation of Aerosol Generating Procedures in Dentistry – a Rapid Review’ 2020 and updated 2021.

He is President of the ‘British Association of Oral Surgeons’ and was President of the ‘British Dental Association Hospital Group’. He previously chaired the ‘Dental System Leadership Group’ for Greater Manchester Health & Social Care Partnership, with representatives from the Local Authority, Primary Care Medicine, Managed Clinical Networks, Commissioning, Health Education England NW, Dental Advisory Group, Dental Public Health and Local Dental Committee.

Professor Coulthard has provided complex oral surgery care to patients with secondary/tertiary referral for many years. His special interest has been patients with congenitally absent teeth/associated tissues or who following cancer surgery or trauma require reconstruction with bone graft surgery and advanced oral implant surgery. He has been ‘Clinical Lead’ for Oral Surgery Services and ‘Training Programme Director’ (TPD) for Oral Surgery, Oral Medicine, Dental and Maxillofacial Radiology, Oral and Maxillofacial Pathology, Special Care Dentistry and Dental Public Health.

In 2019 Professor Coulthard was awarded the FDS,RCPS(Glas) for his contribution of distinction to specialty and dental profession by the Royal College of Physician and Surgeons of Glasgow. In 2020 he was awarded the FFDT,RCS (Ed) for commitment to excellence in education and training by the Royal College of Surgeons of Edinburgh. In 2021 he was awarded the FDSRCS(Ed) without examination.

CBCT and Endodontics


Dr Lessani will be presenting her journey in using CBCT in private endodontic practice, discussing its use in daily private practice where she utilises it for either diagnosis, treatment or follow up. The current guidelines for endodontics and its ethical use will also be discussed.

Learning aims & outcomes

To understand the use of CBCT in a private endodontics practice

Dr Maria Lessani 
BDS, MFDS, RCPS, MClinDent (Endo), MRD, RCS

Specialist Endodontist
The Endoclinic 

Maria qualified from Birmingham Dental School in 1996, following which she worked as a Vocational Trainee in an NHS practice in East London. Maria won an award as VT of the year in 1997. In 1998 Maria started a two-year full-time MClinDent (Endodontology) program at the Eastman Dental Institute. Maria gained the MFDS (TC White Medal) from Glasgow. Her name has been included on the GDC Endodontics specialist list since 2002. Currently Maria’s time is divided between endodontic practice and teaching. She has taught undergraduates and continues to teach postgraduates at Eastman Dental Hospital (UCL) and University of Birmingham. Maria is also the President Elect of the British Endodontics Society.

CBCT and Oral & Maxillofacial Surgery

Professor Kaveh Shakib 

Professor of Oral and Maxillofacial Surgery

Professor Shakib is a leading Oral and Maxillofacial Surgeon, a field covering specialist treatment for the mouth, jaw, face, or neck.

A quite personal area of medicine, where Professor Shakib’s ability to build relationships with patients is helpful. As is his extensive experience in maxillofacial surgery, for those he treats and for his profession.

Involvement in research over two decades has seen Professor Shakib receive a number of awards, including twice winning the Paul Toller Research Prize, from The British Association of Oral & Maxillofacial Surgeons.

Sharing knowledge and supporting colleagues is important to him. He is a teacher and mentor for trainee specialists, a welcome presenter at medical conferences and has published a number of papers in scientific journals.

Professor Shakib’s own studies began by graduating as a Bachelor of Dental Surgery in 1993. In 1996, he was awarded a fellowship in Dental Surgery at the Royal College of Physicians & Surgeons of Glasgow and then with the Royal College of Surgeons in England.

Time spent studying pre-clinical medicine followed, at the Royal Free Hospital. In 1998, he was selected for the prestigious PhD program at UCL, becoming a Doctor of Philosophy in Molecular Medicine in 2002, a Bachelor of Medicine and Bachelor of Surgery with Distinction in 2003.

Professor Shakib was awarded membership of The Royal College of Surgeons of England in 2006 and a Specialist Fellowship in Oral and Maxillofacial Surgery in 2010. He has served as an examiner at the RCS since that time.

Throughout his career, ensuring patients are well served has been the focus. This includes treating over 1000 people requiring dental implants, often including bone augmentation and carrying out many other procedures, such as salivary gland, or micro-vascular surgery.

Advanced treatment has been a key part of his work. From skin cancer surgery, to life changing support for patients with facial, or jaw deformity and others in need of facial reconstruction.

Dual qualification in medicine and dentistry is unusual, reaching the stage of being on the specialist register with both The General Medical Council (GMC) and the General Dental Council (GDC) is quite rare.

As an Oral & Maxillofacial Surgeon, Professor Shakib has few peers. Being asked to review medical journals and share his skills are a natural result, although using those skills to help people will always be Professor Shakib’s first wish.

CBCT and Orthodonics


Dr Sharma will outline the use of CBCT in orthodontic practice, in particular focus on the use of CBCT in diagnosis and treatment planning. He will highlight contemporary use of CBCT as part of interdisciplinary team planning and outline how CBCT has enhanced orthodontic clinical practice with its use in clinical research.

Learning aims & outcomes

To understand the use of CBCT in orthodontics

Dr Pratik Sharma
BDS(Hons.) MFDS RCS(Ed.) MSc M.Orth RCS(Ed.)  FDS Orth RCS(Ed.) FHEA 

Senior Clinical Lecturer and Honorary Consultant in Orthodontics


Dr Sharma qualified as a dentist at Guy’s Dental Hospital in 1999 obtaining his Bachelor of Dental Surgery Degree with Distinction and his postgraduate dental fellowship from the Royal College of Surgeons from Edinburgh in 2001.

He went on to complete a three-year full-time specialist orthodontic training program at The Royal London Hospital. During this period, he obtained a Master of Science degree in Orthodontics from the University of London achieving a distinction for his research thesis and subsequently went on to complete his Membership in Orthodontics from the Royal College of Surgeons of Edinburgh.

He is heavily involved in teaching undergraduate Dental students and training postgraduates in Orthodontics, including those training to become hospital consultants.  

As a hospital consultant he is also involved in treating patients presenting with complex malocclusions including those requiring Jaw surgery.

Dr Sharma has published a number of articles in peer – reviewed journals and has been invited to give lectures at national orthodontic meetings.  He is on the Specialist Register (orthodontics) of the General Dental Council and is a member of the British and European Orthodontic Societies.

In 2020, Dr. Sharma was awarded B.F. and Helen E. Dewel Award for clinical research from the American Journal of Orthodontics and Dento-facial Orthopaedics as well as the Chapman Prize Award from the British Orthodontic Society.

CBCT and Paediatric Dentistry


There is limited evidence and guidelines on CBCT in Paediatric Dentistry compared to other specialties. Dr Gallichan will reflect on the evidence and advice available and discuss a few case studies which illustrate how CBCT influenced decision making and treatment planning in children. 

Learning aims & outcomes

To reflect on the indications for CBCT in Paediatric Dentistry

To improve understanding on how CBCT influences decision making in Paediatric Dentistry

To be aware of possible challenges for CBCT and paediatric patients

Dr Nathalie Gallichan 

NIHR Academic Clinical Fellow & StR in Paediatric Dentistry
Liverpool University Dental Hospital & Alder Hey Children's Hospital

Nathalie Gallichan is an NIHR Academic Clinical Fellow in Paediatric Dentistry based in Alder Hey Children’s Hospital and Liverpool University Dental Hospital. She is currently also undertaking a doctorate with the University of Liverpool on the management of Traumatic Dental Injuries in children, as well as being an honorary clinical lecturer and examiner for the undergraduate BDS programme, secretary for the British Society of Paediatric Dentistry Merseyside Branch, treasurer of Child Oral health NatioNal rEsearch CollaboraTive (CONNECT) and North West representative for Dental Trauma UK. 

Graduating from the University of Leeds in 2013 Dr Gallichan undertook Longitudinal Foundation Training in Yorkshire followed by multiple DCT posts in the North West, before  working as a specialty dentist at Liverpool University Dental Hospital for two years before starting her clinical and academic training in Paediatric Dentistry.

Dr Gallichan grew up on the beautiful island of Jersey and her surname is one of the oldest family names! 

CBCT and Implants and Guided Surgery


Implant dentistry can become more predictable with the use of CBCT.  Dr O'Connell will describe how she uses CBCT to enhance diagnosis, to aid treatment planning, to carry out extractions and guided surgery simultaneously.  

Learning aims & outcomes

Understand how to integrate use of CBCT into general practice to help deliver more predictable outcomes

Dr Eimear O'Connnell

Principal Dentist
Bite Dentistry

Dr O’Connell received her dental degree from University of Edinburgh. She has run her own private dental practice in Edinburgh for 25 years.

She has received her MFGDP and FFGDP from the Royal College of Surgeons London and her Diploma of Implant Dentistry from the Royal College of Surgeons in Edinburgh.  She is currently President of the ADI.

In 2014 Dr O’Connell won a UK business award from Software of Excellence as well as winning Best Overall Practice in Scotland. In 2015 her practice won Best Patient Care Award.

She is a KOL for Dentsply Sirona in the field of digital dentistry and implant dentistry. In her spare time she looks after her three daughters.  Her interests outside dentistry include hockey, sailing, skiing, reading and enjoying the great outdoors. 

CBCT and Oral Medicine


Dr John Buchannan

Clinical Senior Lecturer / Honorary Consultant and Clinical Lead for Oral Medicine
Barts and The London School of Medicine and Dentistry / Barts and the London NHS Trust

John Buchanan is a Clinical Senior Lecturer / Honorary Consultant and Clinical Lead for Oral Medicine at Barts and The London School of Medicine and Dentistry / Barts and the London NHS Trust. He is also Lead for Quality Assurance in the Dental Institute, Lead for Quality Assurance for LDS, Deputy Lead for Quality Assurance for the Overseas Registration Examination.

He studied dentistry and medicine at the United Medical and Dental Schools of Guys and St Thomas' Hospitals, University of London. During his dental studies he additionally obtained an intercalated BSc in Anatomy and Basic Medical Sciences.
Prior to undertaking specialist training in Oral Medicine he obtained general medical experience and was awarded MRCP(UK) in 2001. He undertook specialist training in Oral Medicine at the Eastman Dental Hospital, London between 2002-2005. He was awarded FDS RCS Eng Ad eundem in 2010.  He was elected FRCP London in 2014. In 2018 he completed an MSc in Medical Education at the Royal College of Physicians / University College London and acts as an invited teaching facilitator on the RCP’s Peer Support Network course. He is an External Examiner for Peninsula Dental School.

During the period 2013-18 John Buchanan was a Board Member on the Specialist Advisory Committee in the Additional Dental Specialties (SACADS) representing the Royal College of Physicians & Surgeons of Glasgow. Since demitting, he has continued to play an active role in Oral Medicine Specialist training in the United Kingdom and acts as an external representative on Oral Medicine Annual Review of Competency Progression panels. He is educational supervisor for an Oral Medicine trainee at Barts Health NHS Trust.