The Importance of Knowing Normal Anatomy in CBCT Scans

The acquisition of CBCT scans is probably one of the most mundane tasks, but it an important part of the imaging process. Post-acquisition involves viewing and interpreting the scans. Although the maxillofacial region is complex, by virtue of familiarity, most dentists can interpret this area very efficiently despite the complex nature of anatomy and variances in this region. Understanding what is considered normal is the first step to identifying abnormalities that could pose a challenge in the treatment planning.

Normal anatomy can be broadly divided into the maxillary and mandibular regions.

When visualized, the upper regional anatomy is comprised of (but not limited to) the bilateral maxilla, as well as the nerves and vascular supply of the region and the maxillary sinus and other paranasal sinuses (in part or full, depending on the field of view). Along with these areas, the, Osteomeatal complex and orbits are the most significant.

Maxilla- Coronal View of Bilateral Maxillary Sinus

Maxilla- Coronal View of Bilateral Maxillary Sinus

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Which Field Of View Is Right For You?

If you are wrestling with the idea of adding a new 3D imaging system to your practice, there are a few questions you should ask yourself:

  • What do I want to do with the information that the new system will provide?
  • Am I interested in return on investment (ROI)? (Of course you are, but is there more to it than that—like broadening your skills as a clinician?)
  • Am I expanding the capabilities of my practice in the future?

How you answer these questions can help you determine which field of view (FOV) is right for you and which imaging system best fits your needs.

What Do You Want to Do?
Is it endodontics? Implants? Airway analysis? Orthodontics? The following table can help you determine what to look for in an imaging solution.

Field of View
Small FOV
(5cm x 5cm)
Medium FOV
(8cm x 9cm)
Large FOV
(up to 17 cm)
Goal
Endodontics
View one or two teeth at a time
X X
Implantology
Scan single and dual jaw; perform guided surgery
 

X

X
Oral surgery
Evaluate: trauma cases; TMJ disorders; airway/sleep apnea disorders
X
Periodontics
(including, but not necessarily only implants)
 

X

 

X

Orthodontics
Evaluate: ectopic and impacted teeth; third molars
X X X
Assess TMJ, skeletal symmetry X
Airway
Evaluate airway, sleep apnea
X

 

Is Your Objective ROI?
If you are considering a shift to in-house imaging, ask yourself how many times per month you refer patients out for a scan. If your average is four or more, it may make sense to invest in a cone beam computed tomography (CBCT) imaging system. In about a year or less, your system could pay for itself.* Continue reading

The Top Five Reasons Why You Really Do Need CBCT

The decision to add a cone beam computed tomography (CBCT) system to your practice is a significant one—and one that can have far-reaching implications. It is a sizable investment, so the concern for obtaining a return on that investment is often top of mind. The ability to accurately evaluate anatomy in 3D requires training, which is another point to consider. Logistics, such as how the system will physically fit into your office space or the impact it will have on your workflow, are additional factors that you should carefully examine.

There are definitely many considerations to take into account when making a decision like this. But for many practitioners, the choice was an easy one, because the advantages of introducing CBCT to their practice were—and still are—very compelling. Here are the main reasons why.

  1. Improved diagnostic capabilities
    The impact that CBCT has on your ability to diagnose should not be understated. In fact, some practitioners believe they can’t practice without it. CBCT imaging provides a level of anatomical detail that enables practitioners to detect clinical situations like infections, lesions and hidden anatomy. The information that CBCT reveals (when superimpositions are removed) sometimes results in practitioners changing their initial diagnoses, because what is not visible with 2D imaging is often blatantly obvious with 3D imaging.

    With improved diagnostic capabilities, you can discontinue the practice of referring patients out for scans, which helps speed return on investment (ROI). You may decide to perform more procedures—or more complicated ones—yourself because the information revealed by CBCT imaging gives you the clinical confidence to do so, which also positively impacts ROI.

  2. Patient education and case acceptance
    CBCT imaging facilitates patients’ understanding of your treatment plans. Because patients can more easily visualize the area of interest in 3D than 2D, they are better informed about the diagnosis and feel more included in the diagnostic process. As a result, they are more likely to accept the treatment proposal. In addition, better education allays patient concerns, resulting in a more positive patient experience.
  3. Marketing
    New technology is a great differentiator, and the addition of CBCT to your practice provides you with the perfect opportunity to promote your capabilities. When technology-savvy patients are looking for doctors who are on the cutting edge of their profession, they may choose you over the practitioner around the corner who hasn’t added CBCT to his/her practice. For specialists, this technology can attract more referrals, too.
  4. Referral relationship
    As a general practitioner, it’s important to me to refer my patients to specialists who have the most up-to-date technology and who can provide the level of care my patients have come to know and expect. On the other hand, as an implant specialist, I know that doctors refer their patients to my practice because I am able to clearly visualize implant treatment and placement.

    In addition to increasing referrals, CBCT imaging enables you to more easily collaborate with referring doctors on your recommended treatment plans and final outcomes. Seeing is believing, and the ability to reference a CBCT image can greatly simplify what may otherwise seem like a very complex treatment plan. Referring doctors will likely feel more comfortable with your treatment choices and enjoy the ability to collaborate on treatment plan options through the virtual treatment plans in the 3D software.

  5. Workflow
    CBCT can enhance your workflow by keeping patients within the practice for imaging—eliminating the extra step of sending them out for a 3D scan. When patients go from initial appointment to 3D imaging to treatment planning—all in one appointment—the time savings is enormous.

    Not only that but, when chosen wisely, CBCT systems can streamline your workflow by working seamlessly with your imaging and practice management software. And, depending on the procedures performed in office, CBCT scans can also be merged with digital impressions from an intraoral scanner to improve implant planning, surgical guide fabrication and more.

If you’ve already incorporated CBCT into your practice, what are some additional benefits you have experienced as a result?

The Secret to Choosing the Right CBCT Unit [Video]

When it comes to cone beam computed tomography (CBCT) imaging systems, there’s a number of bells and whistles to choose from. In this video, Jordan Reiss, Carestream Dental’s North American Sales Director for 3D Imaging, provides his advice on how to choose the right unit to meet your practices needs.

Whether you’re currently in the market for a 3D unit, or you already have one, what do you consider to be the most important criteria for choosing a system?

Baby, You Can Drive My CBCT System

In the 1950s, America saw the beginning of “car culture,” and today there are roughly 210 million licensed drivers in the United States. Driving is almost second-nature. However, if you’re used to driving a Volvo and I give you the keys to a Mercedes, it may take a moment or two of adjustments before you’re ready to cruise down the highway. It’s not because you don’t know how to drive; it’s just a matter of learning a new system.

A cone beam computed tomography (CBCT) system is not unlike becoming comfortable with a different make and model of car. I’ve been operating my system for years now, and can comfortably “turn on a dime” or “shift gears.” However, when I invite a referring doctor to “go for a drive,” e.g., share the 3D imaging software for collaborative cases or email a screenshot of a scan, there may be a bit of a learning curve. But once the general practitioner learns to properly view the scans, it not only helps me build stronger relationships with them, but allows for me to gain greater future referrals.

resportion-incisorFirst, CBCT allows me to view a patient’s anatomy in stunning 3D detail, and can reveal much more than what a traditional panoramic X-ray could. I share these CBCT scans with the referring doctor and usually get one of two responses—“Yes, good, proceed with treatment,” or “Your system showed you all that?! Tell me more…” Of course, it’s perfectly acceptable for the referring doctor to trust my judgment and go with my proposed treatment. However, there’s something to be said about the GP who wants to gain a better understanding of the CBCT findings.  Also, greater communication, increases the chances that future treatment will have less hurdles.

So if that’s the case, I take the time to meet with the general practitioner in person to go over the scan in more detail. For example, a CBCT can elucidate a proposed implant site with a buccal-lingual cross cross-sections for both horizontal measurements and for visualizing the distance from the crestal bone to the nerve canal.  My 3D imaging software is also easy to share, which gives the GP a bit more freedom to play around in the scan and take the CBCT for a “test drive.” Continue reading

Human Evolution or a Technological Revolution?

In the 1960s, root canal morphology was looked at differently than today. The common thought was that molars generally had three canals. Today, we know that there are often four, sometimes five canals. Have humans genetically evolved in the past 50 years? No. But new technology, such as cone beam computed tomography (CBCT), reveals minute details of root morphology like never before.

Essentially, CBCT allows us to miss less of what we did in the past by giving us high-resolution, three-dimensional scans of patient anatomy. Focused fields of view mean endodontists can review highly detailed images with up to 75 μm resolution (0.075 mm slices). Plus, when the doctor is able to see the root of the problem, it means a more comprehensive, and therefore successful, treatment plan and often times less post-operative pain for the patient.

Technology has changed dramatically over the past decades to allow us to diagnosis and treat patients in a way never thought possible. My partner recently retired, and in over 50 years, he rarely ever saw a tooth with five canals; whereas, my CBCT system has revealed dozens of cases with five canals. It’s just an amazing example of how CBCT is changing the way endodontists practice. Who knows what revolutionary technology will reveal next?

Tips for Choosing the Best CBCT System for Your Practice

When choosing technology for your practice you want to ensure you’re not only getting the best price, but the best fit for your practice workflow. A cone beam computed tomography (CBCT) system can be a big investment so you’ll want to consider many factors when shopping for a new unit.

Size

Let’s start with the obvious: Does your practice have the space for a CBCT system? Even if you think you don’t, technology has come a long way. CBCT systems released in the past few years can now literally fit inside closets. I’ve seen “before and after” pictures of cluttered bookshelves tucked in a corner one day and a compact 3D imaging system the next. Look for small footprints if you’re buying a new system, or ask if your existing pan system has the ability to upgrade to 3D. Continue reading

Using CBCT to Present “Scary” Treatment Plans

Very few people like to visit the dentist. Now, imagine how much less they like visiting an oral surgeon. In the patient’s mind, surgery involves scalpels, anesthesia and recovery time—it’s far more involved than the biannual dental prophy. However, I’ve found when it comes to a “scary” treatment, such as an autogenous bone graft, using cone beam computed tomography (CBCT) helps me calm the fears and address the concerns of my patients. Not only that, CBCT improves patient understanding of their treatment and can increase case acceptance.

Borrowing Bone “in the Neighborhood”

Let’s say that a patient is interested in implants. However, a CBCT scan, which lets me view the oral cavity in 3D from any angle, reveals there isn’t enough bone present. To proceed with treatment, an autogenous bone graft is necessary. When discussing bone grafts with patients, their response is typically: “Gosh, that sounds terrible; taking bone from one part of my body to another?!” However, as I’ve discussed previously, the accuracy of CBCT reveals possible donor sites within the same maxillofacial region. It’s almost like moving a puzzle piece from one area of the puzzle and snapping it in to another area to make it fit. I reassure the patient by explaining: “Actually, we’re going to borrow a little bit of your own bone while I’m ‘in the neighborhood’.” That sounds far better to a patient than informing them we’re going to go to their hip or leg to take bone. Continue reading

The Value of CBCT in Autogenous Bone Grafting

When placing implants, I try to answers the questions of “how many,” “where” and “what size.” When asking “where,” bone volume plays a huge role. If I find bone deficiencies or inadequacies at the implant site, the treatment plan can go from very basic to very involved, as an autogenous bone graft may be necessary. Fortunately, cone beam computed tomography (CBCT) lets me view multiple planes in 3D. It not only reveals if there is a need to regenerate or augment bone, but also helps me identify possible donor sites for a bone graft.

The “Gold Standard”

Of course, there are is a cache of treatment options—autogenous, bone substitutes, ridge splitting, guided bone regeneration, block grafting, tissue engineering, mesh, etc—but for an oral surgeon the gold standard is the autogenous bone graft. A bone graft can stabilize the jaw, correct deformities and preserve the jaw in preparation for the next step of treatment, i.e., the implant. Continue reading

The Use of CBCT in Identifying Endodontic Lesions

Editor’s note – We recently had the opportunity to speak with Dr. Jeffery B. Price, Clinical Associate Professor and Director of Oral & Maxillofacial Radiology at the University of Maryland School of Dentistry, regarding his work in co-authoring the first chapter of Clinical Applications of Digital Dental Technology. Featuring CBCT scans captured by the CS 9300 system, we asked Dr. Price to explain a little more about the clinical case behind the images.

CBCT image of the posterior left mandible scanned on a CS 9300 unit

CBCT image of the posterior left mandible scanned on a CS 9300 unit.
Images courtesy of Dr. Price from Clinical Applications of Digital Dental Technology

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