Cone beam computed tomography is being more readily adopted in many general dental practices, as clinicians look for more accurate information to use in diagnosing and treating patients. It is very important for all dentists to get familiar with it, as it is now a permanent part of the landscape.
3D imaging is vital for diagnosing patients and creating treatment plans. In many cases, CBCT provides information that isn’t available on a 2D radiograph. The more information you can have as a practitioner, the easier it is to make the best treatment decisions for your patients.
Is CBCT right for your general dental practice? To make an assessment, it is helpful to understand where it is being used and when.
What a CBCT unit can do
CBCT is now being used by dentists who are involved with implants and periodontics, extracting impacted teeth and performing TMJ and sinus assessments.
The American Association of Oral and Maxillofacial Radiologists will tell you that if a patient comes to the office with a toothache, taking a periapical radiograph to assess the apical teeth in the area is sufficient. The CBCT comes into play when a patient has any atypical symptomology. Taking a small field of view CBCT of the area can provide valuable information to a dentist that might otherwise be missed.
Here’s why: When you're looking at the mouth or at a tooth, you're looking at a three-dimensional object. With 3D imaging, you can see the exact representation of what is in a patient’s head, without the distortion that occurs when it is viewed two-dimensionally. That can help dentists become far more effective, given that roughly 25-28% of patients are walking around with necrotic teeth that are unable to be seen on 2Ds, according to literature published on this topic.
Let’s consider one recent case where the CBCT became critically important. When a 24-year-old woman came into the office, an odontogenic infection of tooth number 15 resulted in the left orbit being nearly pushed out from her face. She was admitted to the emergency room, where a multidetector CT showed radiolucency close to the nerve. The patient had acute sinusitis, and the ER team tried to place some drains.
In addition to the multidetector CT, the patient had an MRI, to make sure the infection had not spread to the brain. Fortunately, it had not. The data from these two sources told us what we needed to know. We determined that the best course of action was to extract the tooth and for an ENT to clean the sinus. This is an example of how a CBCT machine can unite all of the scans you take, so you have all the information you need at your fingertips.
In another case, a patient had a radiolucency at the clinical crown level, with a necrotic tooth. The CBCT showed that the patient had more than one problem going on — something that likely would not have been apparent with 2D imaging. One issue was a large area of decay with a nerve involved; a sign that the patient needed a root canal. Beyond that, on the mesial/distal dimension, there was more expansion mesiodistally than buccopalatally. After biopsy, it was confirmed to be a benign keratocystic odontogenic tumor. The tumor was removed, as the root canal would not have taken care of it. As a result, the CBCT allowed for the most accurate future follow-up.
Key considerations in buying a CBCT unit
Even with these benefits, a CBCT is a substantial investment, so it is important to evaluate your options carefully. It is recommended that you get training in using any machine you are considering, prior to purchasing it. That way, you can experience what it is like to perform several different functions, such as taking a panoramic radiograph or learning how to use it in a diagnosis of TMJ, before you commit to it.
Here are three factors to consider as you investigate your options:
Price: Prices have come down in recent years, and options are available in several price ranges, but a CBCT machine is a major purchase. For many practices, financing a machine makes sense. Keep in mind that insurance will cover part of the cost of using it. For instance, if you’re taking 10 or 20 panoramic radiographs a month, and you charge $125 or $150 for each, insurance will likely cover some of the cost.
When you weigh the pros and cons of buying a CBCT machine, also consider the potential costs of not having one. If you don’t have a CBCT in your office, someone else will, sooner or later. If something goes wrong, you’ll eventually see the 3D image of the patient or of your procedure. That’s an uncomfortable position and one that could leave you exposed to liability. Proper documentation offers some protection.
Software: How comfortable are you with the software that comes with a CBCT machine you are considering? That will be a big factor in whether you use it.
Some software may be too limited in its functions to allow you to use it the way you would like. Perhaps you cannot easily rotate images, or the software doesn’t offer you a wide range of images to create. Make sure you test the software to ensure you’ll be able to perform the functions most important to your practice.
Service: If your CBCT doesn’t work and you dial the company for help, will someone answer your call? CBCT units on the lower end of the pricing scale may offer less value if they offer zero technical support. Look into how much technical support is available before you make a purchase.
As Warren Buffet once said, the best investment is in yourself. CBCT is here to stay, and investing in it can help give you a better view of what is going on in the patient’s mouth so you can make the best possible decisions. Ultimately, once you’re trained in using it, it can be very beneficial for you, your patients, your treatment plans and your practice.
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