Monday, February 11, 2008

Technically Speaking: 3D imaging

Here is an article that I wrote recently for DPR. If you'd like to check out the new DPR website click here.

New cone beam computed tomography promises unparalleled gains in diagnostics, treatment planning.


Last October, I sat in a darkened lecture room of a hotel on the Country Club Plaza in my hometown of Kansas City. I was attending a talk at the annual meeting of the American Academy of Oral and Maxillofacial Radiology (AAOMR), and I had one burning desire: I wanted to see what the experts were doing with Cone Beam Computed Tomography (CBCT) and how it would change the way we view diagnostic imaging in dentistry.

As we all know, in the past few years we’ve seen an explosion of dental technology come to the marketplace. It seems that every magazine, every trade show and every lecture has some new device or a program that helps us in some way provide better treatment or run our practices more efficiently. The integration of lots of our clinical technologies is happening at a very rapid pace, and that makes it easier and less stressful to head for the world of chartless dentistry.

Quantum leap

Now, you’re about to see the diagnostic imaging aspect of our profession take a quantum leap forward as more and more of us learn about CBCT.

What is this technology? In a nutshell, it is a single 360-degree scan that utilizes a “cone” of x-rays. These x-rays strike a sensor that also rotates around the patient’s head. The device takes single images at many points as the device rotates. Once the scan has been completed, software takes all of the individual images and combines them into a 3D image.

Once the software has assembled the images, these “slices” become an amazing 3D model of the patient’s hard and soft tissues. What does this mean to the practicing clinician? Imagine being able to pick up an image of the patient’s skull and rotate it 360 degrees in the X, Y, and Z axis! Or imagine being able to rotate a tooth to be able to see it from the occlusal surface and then descend through the tooth all the way to the apex.

Need a diagnostic image of the TMJ? CBCT will give you amazingly accurate images of both the hard and soft tissue elements of the joint.


Do you perform third molar extractions? Imagine the confidence you would gain by not only having the information available to you from a standard panoramic radiograph, but also having the ability to see each individual third molar in all three dimensions. You could easily tell where the teeth are located, their proximity to the inferior alveolar canal, the chances of complications, etc. Moreover, you receive all of this information preoperatively.

However, perhaps the best part of the technology is to aid in the treatment planning and placement of implants. The ability to see the area to be treated, as it truly exists, is a great benefit to both the doctor and the patient. Being able to accurately assess the location of the mandibular canal, the sinuses and other important structures can greatly simplify implant choice and placement. It can also help with decreasing the risk of improper placement.

The 3D information can now be sent to companies that will create surgical guides custom built for each patient from the scans. These guides provide accurate depth and diameter for the implants selected by the doctor. This greatly reduces guesswork and simplifies the surgical placement phase of the implant procedure.

CBCT is the next “big thing” in dentistry. I can see a time in the not too distant future when these scans will be routinely used for many dental procedures. I’m currently in the construction phase of a new office and I’ve allowed space in the new facility to accommodate a cone-beam imaging unit.
When you consider the advantages of what all of this information can do to help you and your patients, it’s easy to see why I’m excited about this new dental imaging technology. As the new season of dental trade shows gets underway, make sure you stop by a couple of booths and see one of these amazing devices and what they can do. I guarantee you that you will be amazed at what you’ve been missing.

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