If you have visited any of the recent dental exhibitions or conferences or read any of the dental press you cannot have failed to see the large number of companies promoting their latest 3D Cone Beam CT systems. Cone Beam Computerized Tomography (CBCT) is one of the most exciting technologies to reach dentistry in decades. Whilst primarily used by implant practices the newer systems can be applied to every aspect of dentistry, from general practice to periodontics, endodontics, orthodontics and oral maxillofacial surgery. This wide range of applications has changed dentistry into a three-dimensional world.This does not mean the end for 2D radiography but could make the selection of your next extra oral imaging machine more critical.
Today there are a wide number of digital panoramic (OPG) systems on the market so it can be difficult to choose which system suits your practice's current and future needs. Entry level systems normally take just adult, child and TMJ images. The next level up will take additional sectional images (left, right or anterior). The high end systems have enhanced image quality and some special functions like adaptive layer control, which removes image blur, and special scanning modes of the incisors, maxillary molars and the mandibular canal (fig 1).
To make your choice a little easier there are now a number of manufacturers who offer a digital OPG that can be upgraded to a 3D system. You can pay a premium but it gives the benefit of extending the diagnostic capabilities of your extra oral radiography system and normally offers an easy upgrade path to 3D CBCT imaging. It is advisable to obtain the definite upgrade costs and current upgrade options prior to any purchase (fig 2).
The capability of taking 3D radiographs could benefit your practice clinically and financially but it is a considerable investment so here are factors to consider. They are in no particular order as different dentists will have different needs but I suggest that number one should be the primary consideration.
1. Why do I need it?
2. How good is the image?
3. How easy is it to use software and hardware?
4. What level of training is provided?
5. What level of support is provided and are the factory trained engineers based in the UK?
6. How compatible is it with other applications?
7. What is the warranty of the product?
8. How big is the product, will it fit in my practice?
9. How much is the product?
10. What choices of image modality does it offer (multi fov).
The final question relates to how big of a field of view you need the 3D image to be. There are many available varying from small FOV 5cm x 5cm up to large FOV 20cm x 19cm. The larger field of view generally means the more expensive the machine. If you carry out a high number of full mouth implants then you probably need a minimum FOV of 8cm x 8cm. The size of the FOV also closely relates to amount of radiation dose the patient receives and this dosage differs from machine to machine. The most common approach manufacturers have adopted is to offer systems with multiple FOVs so you can select the minimum size to suit your diagnostic requirements. Some manufacturers offer systems with small fields of view (4cm x4cm) and then the option of taking multiple images that are stitched together to produce a medium field of view.
Once you have researched your options and are still seriously considering adopting this exciting new technology it is then often a good idea to speak to as many of your peers or colleagues who are already using a 3D CBCT system in their practice. You may now be keen to go ahead but are still unsure of the benefits and the return on investment it will bring.
One manufacturer is backing their belief and passion that 3D imaging can be beneficial and affordable to most practices by offering a six month 3D trial for any clients who purchase their new upgradeable Flex digital panoramic system. Vatech, formerly Ewoo, has quickly established themselves as one of the leading providers of 3D Dental CT. Flex is the latest addition to their range and was designed to be a versatile but cost effective multiple modality extra oral radiography system (fig 3).
You still have to purchase the Flex digital OPG but if you are considering a new digital OPG and are interested in bringing the advantages of CBCT to your practice, now or in the future, it should be worth considering.