3D Dentistry Incorporating CBCT Technology into Your Practice

Author : Dental Product Shopper
Published Date 02/25/2011
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A new technology is changing the way general dentists and specialists look at their patients. No longer do they need to rely only on 2D x-rays for diagnosis, treatment planning, and patient education. X-rays now come in 3 dimensions, including manipulation of those images with new programs to produce images that can assist the clinician.

3D Dentistry: Incorporating CBCT Technology into Your Practice

A new technology is changing the way general dentists and specialists look at their patients. No longer do they need to rely only on 2D x-rays for diagnosis, treatment planning, and patient education. X-rays now come in 3 dimensions, including manipulation of those images with new programs to produce images that can assist the clinician.

Cone-beam computed tomography (CBCT) in dentistry is high-resolution, low-distortion, digital imaging of the hard and soft tissues of the head. Instead of pixels, the resolution is measured in voxels, and often is sharper than a conventional CT. Cone-beam refers to the cone shape of the x-ray beam, unlike conventional CT, which uses a fan-shaped beam to create multiple thin slices.

CBCT produces panorex and cephalometric projections, which become 3D when the data is reformatted in a volume. The images that result can be manipulated with the machine?s visualization software from any point of view: in the axial, coronal, sagittal, and crosssectional planes.

How It Works

CBCT equipment uses a rotating x-ray beam, in conjunction with a computer, to provide diagnostic cross sectional images of the body organs and tissues. With MRI, only blood vessels and soft tissue can be viewed with clarity. However, CBCT uses a cone-shaped x-ray beam aimed at an image sensor, rotating 190 to 360 degrees around the region of interest for typically under a minute. The computer then packages the data to create high-resolution, 3D images.

Implementation of CBCT into Your Practice

It?s no wonder that CBCT systems are being adopted in ever-increasing numbers on a global scale. It is important to realize, though, that CBCT systems are evolving quickly, and so are the software systems that control them. Initially, CBCTs were dedicated 3D-only systems, and the best software was expensive and hard to learn. More often than not, these systems were large, expensive technologies, with a greater-than-desired field of view for the task at hand. This provided initial barriers to CBCT adoption and made these systems difficult to incorporate into many practices. Additionally, these early systems could subject the patient to an increased dose risk and leave the practitioner with the responsibility to review and report on anatomical areas outside of their comfort zone, or require the services of a radiologist.

There are many things to consider when adding CBCT to your practice. It is important to know if there are any regulatory restrictions or requirements that you must consider and abide by. For example, Michigan and Connecticut require a certificate of need application. Barring regulatory restrictions, the location of the unit within the practice is an important consideration. Often, depending on the available space and state shielding requirements, a hybrid type CBCT may fit nicely in space occupied by a previously owned panoramic system, or you may need to speak with your contractor. It is a good idea to have the manufacturer conduct a site survey to assist in assessing the preferred location.

Prior to purchase, you must also determine the appropriate field of view for your imaging needs. What is the vertical height you require in a 3D volume? Are you interested in placing implants using a surgical guide? The answers to these questions will steer you toward the right technology. As a rule of thumb, the larger the field of view, the higher the dose risks to the patient and the greater the professional responsibility for reviewing and reporting on the volume of data. Sometimes less is more.

Training is another consideration. Before you and your staff can gain maximum benefit, they will need to navigate the 3D learning curve and be trained in acquiring and visualizing the 3D data. You will want to know how to ?construct? traditional distortion-free 2D views and how to locate and identify common anatomical structures and pathologies. The process starts with manufacturers providing in-office training and continues with online tutorials and taking CE courses.

With 3D imaging becoming the preferred diagnostic and planning tool for many dentists, companies like 3D Diagnostix provide support to help offset the learning curve. At a recent hands-on lecture at the Greater New York Meeting, I was able to place 8 TSI OCO Biomedical dental implants (Figure 1) using the virtual treatment plan and surgical guide created by 3D Diagnostix that was scanned with the Kodak 9000 3D (Figure 1A).

Exciting Innovation

CBCT is by far the most exciting innovation in radiographic imaging in the past decade. It promises much in the form of accuracy, diagnosis, and ease of use. CBCT promises not only to give us a clearer path to diagnosis, but it also elevates dental imaging from the realm of pure diagnosis to guided image-based treatments such as endodontics and implant dentistry. If you are in the market, do your homework upfront so you will be able to maximize your return on investment. It?s surely just a matter of time until low-dose CBCT becomes the standard of care for the diagnosis and treatment of many dental conditions.

However, as with most technological breakthroughs, one must bear in mind the caveats. CBCT images provide an enormous amount of data, much of which is beyond the knowledge and understanding of the general dentist practitioner. There are several courses taught at the International Congress of Oral Implantologists Symposiums by world leaders in the field such as Drs. Mike Pikos, Alvaro Ordonez, and Scott Ganz that I have personally attended that have helped me become more aware of CBCT and how to utilize it within my practice. I highly recommend attending one of these courses.

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