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A Practice in Transition

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The curriculum at my orthodontic residency program at the University of California, San Francisco included a great deal of training in 3D imaging. This blended well with my interest in technology. I was quickly impressed with the obvious benefits in diagnosis and treatment planning. It didn't take me long to realize that I wanted to learn more about this technology, which is why I completed my thesis on the use of 3D radiology in virtual treatment planning of orthognathic surgery. I also realized that I would like to have this technology in my own practice someday. 

While at UCSF, I was introduced to a respected orthodontist, Dr. Charles deLorimier, a solo practitioner in Napa who was approaching retirement. Because our treatment philosophies were so compatible, I found that his practice was a great fit for me. Before long I had graduated, and he was transferring his patients into my care and Shanahan Orthodontics was born. Dr. deLorimier had provided superior care for his patients for 37 years, and as I started practicing, I saw the opportunity to implement some changes to increase efficiency and hopefully reduce treatment time. 

In many ways, the changes I am making to my practice mirror the changes occurring in orthodontics. Our colleagues who have been practicing longer are quite comfortable treating patients based on 2D x-rays. That's how they were trained, and they've been extremely successful treating patients in this way. Among dentists who have more recently entered practice, however, 3D is becoming increasingly popular. In certain cases, I believe it should be the standard of care for the orthodontic profession. Several factors are pointing in that direction.

The hardware and software for processing and viewing 3D scans are constantly improving. Computers are faster and more powerful than ever, which means they can support the processing power, disk space and high-resolution graphics necessary to get the most from 3D. Three-dimensional imaging systems are gaining wider market penetration, and manufacturers are offering more varieties of imaging systems to meet clinical needs. Other oral health specialties prosthodontics, oral surgery, endodontics, and periodontics have adopted 3D for many applications, and orthodontists are encountering 3D when collaborating with these colleagues on interdisciplinary cases. Also, now that 3D has become a part of the curriculum at a growing number of orthodontic residency programs, a larger number and proportion of future orthodontists are going to be well-versed in the benefits of 3D.

As I mentioned earlier, I recognized the benefits of 3D in residency and had set a goal of obtaining a system for my practice within the first few years of practice. That day came sooner than I had planned earlier this year, I purchased a Carestream Dental CS 9300C. The unit allows me the flexibility to take 2D panoramic and cephalometric radiographs plus 3D scans in seven different sizes. The unit helps me to tailor the image to my patient's needs, thereby minimizing radiation exposure. Also, the CS 9300C's dual jaw images help me serve my adult patients seeking treatment for TMJ dysfunction.

The CS 9300C supports all sorts of clinical applications. I can more accurately plan the recovery of impacted teeth, diagnose root resorption, and determine growth trajectory of unerupted teeth. I can evaluate transverse discrepancies in a way that was previously not possible. Three dimensional cephalometrics is still a wide open field of study that will continue to improve diagnostics and increase treatment efficiency. I routinely evaluate the position and condition of the condyles in my patients.

With the ability to view the root position of every tooth, I have detailed clinical and anatomic information for every patient, and encounter fewer surprises over the course of treatment. Plus, as with any digital imaging unit, it's much more convenient (not to mention a better use of space) to store all those patient images in the computer software than in rows of filing cabinets full of folders.  

The CS 9300C has also made life more convenient for my patients. Because I can now take the radiographs and perform the consultation in-house, we can accomplish more in fewer appointments and I don't ever plan to hear a patient complaining about getting his or her braces removed earlier than expected.

The 3D images make it much easier to explain pathology and treatment plans to patients. We can view their dentition from any angle and zoom in on problem areas. They look at 3D images with a sort of wonder that reminds me of how I felt when I first encountered 3D imaging during residency. And perhaps that's another reason 3D imaging is increasing in acceptance: patients today, like orthodontists, are coming to expect the latest technology to be used in all aspects of their lives, including their oral health.

Presently, I couldn't be happier with the CS 9300C for all of the reasons I have mentioned. With the new x-ray unit, I feel prepared for the future of the practice of orthodontics. Looking back on my original career choice, I feel a deep gratitude to have chosen this profession at a time when the future is so promising.


-Dr. Ken Shanahan
Napa, CA

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