CBCT in Modern Dental Practice

Download your FREE copy now

It is not much more than 10 years ago that CBCT in dental practice was a myth, something just appearing on the horizon where very few people could see the benefits and the advantages to such a technology that was so expensive.

Now, today in 2019 there are hundreds and hundreds of CBCT units across the UK. They have massively expanded diagnostic portfolio within dentistry and primary care.This e-book is intended to chart the progress of CBCT from 2009 until now and to answer some of the questions and de-bunk some of the myths around CBCT that still exist to this day for people entering in to the use of the technology or moving along to increase their complexity of their use.

Fill out the form to download your own copy of the CBCT in Modern Dentistry ebook now!

Introduction

Now, today in 2019 there are hundreds and hundreds of CBCT units across the UK. They have massively expanded diagnostic portfolio within dentistry and primary care.

This e-book is intended to chart the progress of CBCT from 2009 until now

and to answer some of the questions and de-bunk some of the myths around CBCT that still exist to this day for people entering in to the use of the technology or moving along to increase their complexity of their use.

Our Story

My story in CT scanning and CBCT began well before 2009 where I would send patients for CBCT scans at the local large teaching hospital in Nottingham for full medical CT scans, reported by medical radiologists. I was amazed to have meetings to discuss those images with the medical radiologist when he would tell me “It’s just not clear enough to see an inferior dental canal”. I had thought these things were bullet proof, but it turned out there was still huge interpretation, skill and knowledge to be used in decoding or deciphering these puzzles.

To this day, this is still the same.

People assume that CBCTs will provide all essential knowledge and will be absolute in diagnosis; this is simply not true. It takes experience and reflection to improve your ability to interpret a CBCT to the best interest of the patient.

Back in the mid 2000s I tried to convince my then boss, in a mostly NHS practice, to let me buy my own CBCT scanner and install it in his practice giving him 50% of any profits that we might have. He was not keen as he didn’t see a future for this technology. I had to wait until I was my own boss in 2009 until I could bring my own CBCT into what is now The Campbell Clinic.

Our first iteration of CBCT in 2009 moved on from our Carestream 8000 OPG machine to a Carestream 9000 CBCT machine.

This was a cool bit of kit which only took small volume CBCT in 5 x 4 cm volume, but with software that had the ability to stitch the volumes together to see a full arch.

It later became evident that a stitched full arch would not be appropriate for guided surgery planning, but we ran this Carestream machine for 5 years. It was my apprenticeship in CBCT.

At that stage, I paid little attention to dose value, except for a paper ludlow at that time which said that Carestream was acceptable. I took for granted what the manufacturers told me about the machine and used it extensively for patients in my practice for implant planning, trauma cases and oral surgery assessments. We were the first referral practice for CBCT in Nottingham and were successful on that basis for a while.

In 2014, I decided to change machines, to move into the world of digital implant planning and guided surgery. At that stage, to me, it seemed like the best option was Sirona. We changed our Carestream 9000 for a Sirona 3D XG and full CEREC set up to allow us to (eventually) mill every one’s surgical guides in practice.

This started our guided surgery journey which continues to this day.

It catapulted us forwards, being one of the first practices in the UK to use the CEREC Guide 2 technology.

This year, we moved on again to a Planmeca Promax to allow us to advance and improve our CBCT scanning once more. Better image quality and hugely lower doses to allow us to expand the portfolio of CBCTs that we take.

We also were impressed with the software integration package that came with Planmeca because the software and hardware issues of CBCT are some of the hardest bits to overcome.

In this e-book, we will use the experience that we have as a group over the past 10 years of scanning and investigating the market place to give you a heads up and answer questions about CBCT.

Simple Infrastructure

Taking the leap and investigating in CBCT technology in a dental practice is no small decision.

Nowadays the prices of CBCT scanners have dropped and you can pick up a pretty reasonable machine for around the £40,000 - £50,000 mark (some for less than this) but that does not tell the whole story.

Your practice needs to be ‘IT ready’ for CBCT and your machines need to be able to view the images and manipulate the images with good graphics capability.

You must have a ridged and structured storing capacity with a back-up system, and ideally a central server system which is well protected.

You will want to look at offsite cloud storage of your images and data going forwards.

With IT upgrades comes cost and heartaches. You need to be very comfortable and confident in your IT supplier to provide you hardware that can make full use of the fancy new piece of kit that you have purchased.

The scanners themselves are not without their unpredictable nature, and they can have maintenance issues, software issues or hardware issues that can be expensive, time consuming and very inconvenient.

Finally, there will be other hard/software brands you will be interested in for potentially guided surgery planning or interpretation of your scans, these must be investigated fully.

Once up and running though it changes your practicing life to have CBCT at your fingertips.

It was certainly one of the biggest leaps forward in my clinical practice that I’ve ever known in 2009.

How to Choose a CBCT Machine for Your Practice

At The Campbell Clinic we feel quite self-righteous about this topic because we have done the due diligence through the market place on three separate occasions in the last 9 years.

There are many manufacturers and the market is brutal; everyone has to fight for business. Some of the main players in the UK at the moment are the following:

Carestream (formally Kodak), a big player in CBCT and intra oral scanning and practice management software; an American company with a $6 billion turnover.
Sirona (formally Siemens), makers of CEREC, now owned by Dentsply, a global organisation with a very ridged structure.
Vatech, an Asian company that have been in CBCT for a long time and got into the market early on.
Planmeca, a Finnish company, previously more famous for making dental chairs and standard dental equipment with a huge imaging portfolio and an expanding range of high tech and innovative products together with their brilliant software system.

Others include Morita and Gendex.

When you begin to choose which CBCT machine to have in the practice there are several questions you will need to answer carefully before you start.

Do I have a budget and if I do what is it and why?
Have I done the business calculations on a CBCT machine in my practice and is it more valuable than referring out?
What exactly do I want to use the machine for now and in the future?
Does the machine have a warranty or guarantee in case it breaks?
How good is the imaging?
How clear are the images and how easy is the machine to use?
How well does this machine link with other technologies?
What are the dose implications for my patients and how do I mitigate these?

One of the best ways to answer these questions is to ask someone who has already done this, or to go to practices who already have this.
In these circumstances though, remember to be careful of the old cognitive dissonance where people will tell you things are great just because they have spent a lot of money on them.

Also, don’t believe the hype when you chat to the suppliers. Even someone who is ‘independent’ may have a bulk order of machines to shift and will try to push you in that direction. It’s very important that you get the machine that you want in these circumstances.

Uses for CBCT in Practice

The classic use for CBCT and the main driving economic factor in the growth of CBCT has been dental implant planning.

In 2009 CBCTs were used to just assess bone volume and local anatomy with very little in the way of diagnostic planning and ideal prosthetic positions.

The growth of the intra oral scanner and the expansion of STL (Stereolithography) files meant that digital diagnostic wax ups could be hooked onto CBCT files (DICOM-Digital Imaging and Communications in Medicine).

With these expansions, it was able to use CBCT to carefully prosthetically plan feasibility of dental implant treatments and ultimately design surgical guides for guided surgery planning.

These are not the only options for CBCT usage in dental medicine though, and other uses include:

Assessment of patients suffering trauma and for injuries in areas which cannot otherwise be seen.
Difficult and curious endodontic cases. Good imaging on good CBCT scanners can give a huge amount of information on some endodontic cases. CBCTs are still not routinely used for endodontic cases but can be used in areas with difficult morphology, missed canal or large apical lesion.
Orthodontic assessment of patients with impacted teeth.
Oral surgery, including assessment of impacted teeth, assessment of the proximity of anatomical features including nerves and sinuses, extension of cysts and other bony morphology.
For the assessment of neoplasm and other abnormality of the jaws.

It’s important to remember that CBCTs are radiographic examinations and doe nog not give much, if any, indication of soft tissue to any diagnostic quality.

CBCT