The extra dimension

30 July 2012
Volume 28 · Issue 7

John Anderton highlights the benefits to a practice of introducing 3D digital imaging.

If you place implants in your practice, then adding the ability to take 3D cone beam CT radiographs will benefit you clinically and financially. The extra dimension it delivers greatly increases your diagnostic ability of the anatomical oral structure. There is no image distortion on a Cone Beam Computerised Tomography (CBCT) image, and the multi-planar reconstruction of the 3D image allows you to view slices of your area of interest from three different planes. When planning implant placement you can check the bone quality of the mandible, the position of the ID canal, nasal cavities and the position of the maxillary sinus. The software helps you prepare a treatment plan before any surgical procedure takes place.

The technology helps your practice attract new patients, retain existing patients, look more professional, and offer more treatments and services. Taking the images in-house means your patients no longer have to travel to another practice, hospital or imaging centre for the service and as such removes the risk of them choosing the other practice, which has 3D imaging, for their treatment. The immediate ability to diagnose the images and carry out implant planning on-site lets you present the treatment plan for a speedier consent. Plus, you can become a referral centre for practices in your area without 3D CBCT. The new cost-effective systems, now available, mean you only have to take around two scans a week to see a substantial return on investment.

If you have visited any of the recent dental exhibitions, 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. Whilst primarily used by implant practices, the 3D images from the new systems can also 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, as all of the new systems should also deliver high quality 2D panoramic and cephalometric images.

Today there are a wide number of digital panoramic (OPT) systems on the market, so it can be difficult to choose which system suits your practice's current and also future needs. There are new digital OPT systems which are now the same price you would have previousy paid for your film OPT. This next generation take superb high definition panoramic images and now include many additional imaging modes. Sectional OPTs, bitewing, Temporomandibular Joints (TMJs) and sinus modes extend the use and diagnostic ability of these system. There are also new high-definition digital OPTs, which allow you to choose from multiple image layers to select the best projection for your diagnostic needs.

To make your choice a little easier, there are now a number of manufacturers which offer a digital OPT that can be upgraded to a 3D system. You pay a small 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 cone beam CT imaging. It is advisable, however, to obtain the definite upgrade costs and current upgrade options prior to any purchase.

It is a considerable investment, so here are number of factors to consider. They are in no particular order, as different practitioners will have different requirements, but I would suggest that number one should be the primary consideration.

  • Why do I need it?
  • How good is the image?
  • Is it easy to take an image and use the software?
  • What level of training is provided?
  • What level of support is provided?
  • How compatible is it with other applications?
  • What is the warranty of the product?
  • How big is the product and will it fit in my practice?
  • How much is the product?
  • What choices of images does it offer?

The final question relates to how big an area (Field of View - FOV) you need the 3D image to be. There are many fields of view available, varying from small FOV (5cm x 5cm) right up to large FOV (20cm x 19cm). The larger the FOV generally means the more expensive the machine. If you carry out a high number of full mouth implant cases then you probably need a minimum FOV of 8cm x 8cm. The size of the FOV also closely relates to the 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 fields of view, so that you can select the minimum size to suit your diagnostic requirements. Some manufacturers offer systems with small fields of view (4cm x4cm). Some offer the option of taking multiple small images and then stitching them together to produce a medium field of view, but the majority offer multiple fields of view so you can take one image at the minimum size for your clinical area of interest.

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, as possible. There are a lot of high quality systems offered by well-established and specialist suppliers. In today's current economic climate many are offering great deals and some are even offering deferred payment options, so you can experience all of the benefits before paying the whole purchase price.