2022 Equipment Buyers' Guide - Vol. 1 - 8

Debating a Cone Beam Investment?
What You Need to Know
Many clinicians know that 3D imaging can be a valuable tool for
their practices when it comes to both diagnostics and treatment.
Nonetheless, many general practitioners are hesitant to invest in cone
beam computed tomography - some aren't convinced it's worth the
investment, citing it's only for implantology and specialists, while others
don't feel confident reviewing a 3D scan and are leery of liability issues.
Regardless, CBCT technology is finding a place in general dentistry
practices.
3D imaging offers a number of advantages over 2D imaging: from the
visibility of anatomy to improved diagnostic accuracy and, often, lower
radiation dose*. The biggest advantage for a GP is greater precision. For
instance, one study found that for periapical lesion detection, the 2D
intraoral X-ray - considered the gold standard in our industry - is only
25% accurate. In comparison, the cone beam offers 100% accuracy.
Additional research, published in The International Endodontic Journal,
asked clinicians to review a 2D X-ray and make a diagnosis and
treatment plan. Then, clinicians were provided with a CBCT scan of
the same region of interest and found that the doctors changed their
treatment plan 62% of the time based on the new information obtained
in the 3D X-ray.
Understanding more about how 3D imaging differs from 2D can help
you make an informed decision about whether it is right for your
practice.
What 3D imaging can do
Many dental practices purchase a CBCT with the intent to mainly place
implants. However, once they own the CBCT, they discover that it has
many other applications. For example, 3D imaging can be used for
endo treatment planning, as well as third molar extractions and apical
pathology. The cone beam also makes it easier to see apical lesions, TMJ
issues and trauma. Large areas of bone loss that may not be visible on
2D radiographs can be seen on 3D image scans. Dentists can also get a
view of the patient's sinuses and airway depending on volume size.
There are also many benefits for CBCT in orthodontics. With 3D, doctors
can determine if a tooth can be moved buccal or lingual based on the
cortical bone and alveolar housing. This relationship is not available in a
2D pan. In 2D, doctors can see tooth relationships mesial and distal, but
absolutely no information is available about the torque of the tooth as it
relates to the alveolar boundaries of the patient.
There are small, medium and large field-of-view cone beam systems on
the market, each designed to address particular needs. Today, however,
dentists are gravitating to medium and large volume systems that
allow them to do more dentistry. For example, an ideal system for a GP
might be the Planmeca ProMax® 3D Plus. It offers a field-of-view that is
similar to what a practitioner would see in a 2D pan, providing a level
of familiarity. However, if a practice wants to do orthodontic work, this
system can be upgraded to offer a 20 by 17 cm volume.
Case studies in using cone beam computer tomography
There are many examples of clinicians using CBCT in the field that
illustrate how it may augment a practice's toolkit:
* A 39-year-old patient had persistent pain on the upper left, where she
previously had root canal treatment. The dentist took a 3D scan, and,
in addition to seeing a short fill on the canal and radiolucent lesion
already visible on a periapical X-ray, the doctor was able to detect
some asymptomatic abscesses that couldn't be seen in 2D.
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* A patient, in their 30s, had pain on the upper left, which the dentist
localized to tooth number 14. With the medium field of view, the
dentist was able to see a short fill on the palatal root. The cone beam
detected an apical lesion on tooth number 19 and a bit of PDL widening
on tooth number 18 - the tooth behind it. CBCT technology identified
a few more teeth that needed to be addressed for this patient.
* An older patient sought help for jaw pain on both sides and halitosis
(bad breath). The dentist took a CBCT scan and discovered a lesion
associated with tooth number 14 and another associated with number
18. With the larger field-of-view cone beam, the dentist discovered
calcifications on either side of the airway - tonsil stones that are a
cause of halitosis. There was some flattening of the condylar head,
signaling degenerative changes in the TMJ, indicating that the patient
might benefit from an occlusal guard or night guard.
How physicians can incorporate 3D imaging into their practice
The American Dental Association suggests that CBCT be considered an
adjunct or supplement to traditional duty equipment present in your
offices on a day-to-day basis. Fortunately, it is possible to incorporate
this technology without subjecting patients to high doses of radiation.
The Ludlow Study from the University of North Carolina found that
there is no reduction of image quality when using Planmeca Ultra Low
Dose™ radiation, a technology only found on Planmeca systems. This
technology yields diagnostically valuable images at extremely low
doses, without sacrificing image quality.
Some dentists fear they are obligated to send every CBCT scan to a
radiologist, concerned they are liable for everything in the image. While
this is true, it's also true for 2D panoramic images. A good rule of thumb
is to treat a CBCT scan like a pan. For instance, you might start on one
condyle and work your way through the image to the other condyle.
While doing that, you evaluate the apices of all the teeth, looking for
asymptomatic abscesses and other pathology. If you see something you
don't recognize, you are not obliged to make a diagnosis. But rather,
those are the scans best sent to a radiologist for a review.
Conclusion
The best way for dentists to determine if 3D imaging is right for their
practice is to schedule a demonstration. A 3D specialist can show you
what is visible in a CBCT scan and how to navigate within the software.
Even better, visit a showroom, get some preliminary training and try
using CBCT to see if you are comfortable operating the machine and if it
offers the features you need.
Like any technology, CBCT requires some education. Manufacturers are
well aware of this and offer education programs regularly. Once you are
armed with the knowledge of how best to use CBCT, it can be a valuable
adjunct that helps you arrive at the most accurate diagnosis so you can
deliver the best treatment options to your patients.
* Based on volume size, image resolution and using Planmeca Ultra Low
Dose setting.
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2022 Equipment Buyers' Guide - Vol. 1

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