In another dimension

For many years, the gold standard for dental imaging was by analogue X-ray film. Therefore we relied on 2D radiographic imaging for diagnosis and treatment planning of the 3D situation in our patients. Like in other fields, the digital revolution hit dental imaging and now it is common to have 2D digital imaging in the dental practice.

With the introduction of cone-beam computed tomography (CBCT) in 1999, we now have tools available for more accurate diagnosis and treatment. The ability to look at a tooth, pathology or an anatomical situation in any direction and orientation, as well as in 3D, eliminates much of the guesswork commonly experienced with 2D radiographs.

The first and primary use of CBCT for early adopters was dental implant placement. As the scope and the value of the information became better known, dentists of all branches began to see the benefits of 3D imaging, including endodontics, oral surgery, treatment of TMJ, periodontics, orthodontics and general dentistry.

With the use of sophisticated software, the dentist is able to view information in several different views, including: axial slices (head-to-toe orientation;, coronal slices (front-to-back orientation); and saggital slices (side-to-side orientation). all known as multi-planer reconstructions (MPR).

The thickness of each slice can be varied to include more or less information. For example, the evaluation of the available bone for the initial implant placement can be crucial for the long-term success of the case. If there is inadequate bone available, grafting may be a necessity. CBCT studies render the most accurate information available at a low radiation dose.

WHY WE CHOSE THE VATECH MACHINE
The reason we chose the Vatech Reve 3D was that we wanted an all-purpose machine. The Reve 3D can take both CBCT scans of various FOV; this means we can take large volumes if, for example, we need upper and lower jaws plus scanning templates down to small volumes when we are just interested in a small area. These factors . combined with the addition of a true OPG machine and the ability for me to upgrade to a lateral ceph arm in the future . made the Reve 3D an obvious choice. Another reason for selecting a Vatech product was the good name that the company has in the 3D imaging market. I also had only ever heard good things about E-woo and Vatech.

The business decision in regards to buying an in-house CBCT was that as a referral practice, we felt we needed these tools onsite. We do a lot of complex dental implant surgery including sinus grafting, All-on-4, teeth in a day, immediate loading protocols and computer-guided surgery. For these cases we almost always require a CT scan. It is so much better for the patient and for us if this can be done onsite. We can then control exactly how the scan is taken and, most importantly, make sure we are happy with the scanning template placement prior to scanning. If the virtual planning is made for computer-guided surgery using a CBCT where the scanning template is not seated or placed correctly, then at the surgical appointment, the surgical template will be in the wrong place. This results in perfect implant placement in perfectly the wrong place!

Interestingly, we find the take-up of treatment has improved with the use of the CBCT and the 3D-imaging software, as patients can more easily visualise their specific situation and the problems associated with this. We feel this makes it easier to obtain a more robust consent, and we also use CBCT more and more even for situations where in the past we wouldn’t have. This is because we feel the judicious use of CBCT, aids in making the most accurate diagnosis and the most complete treatment plans.