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.
- 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 does, 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.
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.
To learn more about the Planmeca ProMax 3D Plus, visit www.henryscheindigital.com/promax2021.
* Based on volume size, image resolution and using Planmeca Ultra Low Dose setting.