Cone beam and endodontics

Dr. Ralan Wong is an endodontist from San Francisco. He spoke this morning on 3D imaging and how it relates to endodontics. Dr. Wong claims that since endodontists are visual people, cone beam allows them to see more than they would with previous technologies.

“I can look down the canal, see decay and determine whether or not perio surgery needs to be performed,” said Dr. Wong.

Dr. Wong also sees cone beam as the next progression in dental technology. Starting with film x-rays, to digital x-ray, cone beam is the next step. To hear more of Dr. Wong and his takes with cone beam and endodontics, look for a video next week on dentalproductsreport.com.

Cover your tracks

Saturday morning we had an opportunity to talk with Mr. Arthur Curley, a senior trial attorney in the San Francisco area. Defending doctors for over 30 years, he has given risk management courses throughout the United States. Curley explained to us how cone beam has changed the dental practice in terms of technology and liability.

Curley explained that with cone beam, the risks and errors typically found and assumed by patients with 2D imaging can be considered malpractice and negligence since better technology is available. Patients can assume the risk associated with using older technologies if they are uncomfortable with the price of cone beam or the radiation exposure associated with it. Curley recommends, in these cases, to document your discussion. To hear Curley’s take on cone beam and dental liability, look for our exclusive interview next week on dentalproductsreport.com.

The business side of cone beam

Investing in cone beam isn’t cheap, and some say cost is one of the main barriers keeping clinicians from adopting the technology.

Friday’s portion of the congress ended with a panel discussion that featured all of the afternoon’s lecturers, giving attendees one more chance to ask questions. One attendee wanted to discuss the business aspect of 3D dental imaging including fees and insurance.

Panelists talked about their fees, ranging from $200 to $400, but moderator Dr. Scott Ganz wanted to remind attendees where they’ll start seeing a return on their investment.

“You’re going to make your money back when you market your services that you could never do before,” he said. “That’s the power of this technology.”

Dr. Ganz asked the panel about patient acceptance, and all agreed that patience acceptance went up after they began using 3D imaging in their practice. The detailed scans make it easy to talk with patients about their case and explain to them what treatment they need,  Dr. John Flucke said.

And patients understand and appreciate that you’ve made an investment to improve their level of care. 

Dr. Walter Chitwood and Dr. Ganz both said having cone beam is a differentiating factor for their practice because patients appreciate the technology and the time it saves them.

“Perception is reality,” Dr. Michael Pikos said. “And what patients perceive is so critical.”

This technology is changing the way patients look at dental practices and it’s changing the way clinicians practice day to day. These 3D images offer so much information clinicians otherwise wouldn’t have, and Dr. Pikos said it is a tool he couldn’t practice without.

“There are so many things you can’t see until you turn it around,” Dr. Flucke said. “That amount of information changes things completely.”

The new kid in town

A little more than a year ago, Dr. Walter Chitwood was among the naysayers when it came to cone beam technology.

These days, he’s happy to tell you how the technology has changed his practice, increasing his case acceptance from 50 percent to between 70 and 80 percent.

Dr. Chitwood shared his cone beam journey during the last presentation of the afternoon, “Creating Better Communication with Technology.”

At 53, Chitwood said he didn’t want to go into more debt, and besides that he wasn’t sure where he would put the machine. But after a few visits from a sales rep and some number crunching, he realized switching to cone beam would be much more cost effective than replacing his failing pan machine.

Dr. Chitwood, who has placed implants since the 1980s, has known about the advantages of this technology for awhile but just didn’t want to make the switch. Now, he wishes he would have done it sooner.

“I have learned knowledge without action yields no realization,” he said.

During his presentation, Dr. Chitwood took a look back at old slides and old ways of placing implants, and shared some of his latest cases of patients who have benefited from the more accurate treatment planning his practice now offers.

An orthodontist’s perspective

No matter what specialty you’re in, CBCT is a hot topic.

As an orthodontist, Dr. Ed Lin relies on cone beam technology for accurate treatment planning and optimal outcomes. He offered several case examples during his Friday afternoon presentation, “Taking the 21^st Century Orthodontics in the 3D World.”

Dr. Lin showed 2D views and then 3D views of the same cases, illustrating how much clinicians can miss if they only look at the 2D version. In the 2D version it’s too easy to lose your orientation; the 3D image tells the rest of the story.

“We’re so fortunate. With the advances in technology we’ve been given the tools not to have to guess anymore,” Dr. Lin said. “It’s our responsibility to learn this.”

Entering the 3D phase

The way Dental Products Report Technology Editor Dr. John Flucke sees things, dentistry is on the cusp of a new and higher standard of care, and the ascendance of 3D imaging technology is what will eventually push it over the top.

In his presentation at the 3rd International Congress on 3-D Dental Imaging he explained how intraoral cameras and radiography brought in an imaging phase where clinicians could see things before treating. Then computerization brought in the ability to integrate various aspects of care. Now with the incredible detail available from cone beam scans, the 3D phase of dentistry will allow the industry to achieve even higher standards of care.

Dr. John Flucke talks about how a general practitioner can benefit from cone beam technology

“I’m big on technology because the right technology can have a tremendous impact on your patients,” he said.

While Dr. Flucke said cone beam scans intimidated him at first, he adopted the technology because it provides him with more information on which to base his clinical decisions, and thus allows him to make better decisions for patients and prevent bad outcomes because there are fewer surprises.

As a general practitioner he uses the scans for treatment planning and they allow him to keep more endo and perio cases in his practice. The images provide details missed by traditional 2-dimensional pans and radiographs. He even lets other area clinicians book time to take scans on his Gendex GXCB-500 unit, which helps him defray the cost.

“It’s not that hard to be involved and to do this,” he said.

The scans also allow him to stay more involved with cases he refers to specialists. He can provide them with a scan and everyone involved with an aspect of the case can work from the same 3-dimensional images to plan each phase of care.

“Often times in a referral situation the general dentist gets left out,” he said.

The images also impress patients and increase their understanding and case acceptance. He said he takes extra time for appointments to explain the scans to the patients and to let them see and understand the details of their case.

Tip of the iceberg

Drs. Jack Krauser, James Mah and Scott Ganz (from left) lead a panel discussion on cone beam imaging technology.

The first panel discussion at the 3rd International Congress on 3-D Dental Imaging featured Drs. Scott Ganz, Jack Krauser and James Mah leading the audience in a lively and far ranging discussion on both clinical use and practical aspects of cone beam technology.

Saying, “This is still the tip of the iceberg,” and “There is so much more than we have to learn,” Dr. Ganz pointed out that the technology is still new and the standards of care it allows still need to be defined.

Some audience members expressed concerns over liabilities for pathologies in scans that might not be noticed by dentists, and one GP even said he sends all his scans to a radiologist for evaluation and in three instances the scans have revealed arterial calcifications in areas not typically reviewed by a dentist.

Still, the potential in 3D dental imaging is too great for the technology not to be widely used. Dr. Mah pointed out that scans can be critical in examining the shape of an airway and planning treatment for sleep apnea cases. He said snoring and sleep apnea treatment will be, “the next big thing in dentistry.”

While Dr. Mah and many dentists in the room discussed the frustration of working with colleagues who are unprepared to work with the cone beam images he takes and sends them, Dr. Ganz said educating those clinicians on how to read and use the detailed information from the scans is the key to furthering use of the technology. However, with communication devices like the iPhone growing more efficient and prevalent transfer and use of high quality dental image files will only become easier and more common as time goes on.

Cone beam myths debunked

There are plenty of misconceptions about cone beam imaging swirling around the dental industry these days, and Dr. James Mah did his part on Friday morning to debunk some of those myths.

During his presentation, “Lies, Damned Lies and Cone Beam,” Dr. Mah told attendees it’s their duty as dental professionals to learn the truth about this technology and to not perpetuate what he described as lies. These lies, he said, are among the barriers to clinicians adopting this technology in their practice.

Dr. James Mah hit on various cone beam myths during his presentation Friday morning.

Clinicians need to look at the scientific evidence, he said, and not overlook the advantages of cone beam technology because of an article they may have read.

“For people who have told me over the years ‘What I have works,’ I would say the scientific evidence is against them.”

He covered myths associated with patient perception, TMJ, orthodontics and endodontics. He offered several examples of what can happen when clinicians are misguided or don’t have the information they need going into a procedure, information they would have had if they used cone beam technology.

3D Dental Imaging Congress underway in Chicago

About 120 dentists representing every specialty gathered in Chicago Friday morning for a common goal: To take in everything they could about 3D treatment planning.

Those attending the 3rd International Congress on 3-D Dental Imaging have the opportunity to sit in on various presentations and panel discussions during the two-day event, as well as visit the nearly 20 exhibitors who are ready to show what they have to offer. KaVo, Anatomage and Nobel Biocare are among the companies that are part of the congress,

which is hosted by Imaging Sciences International and Gendex Dental Systems.

The congress kicked off with a morning presentation from Drs. Scott Ganz and Jack Krauser. The presentation, “Lessons Learned: Incorporating Cone Beam CT and 3D Implant Planning, the Good the Bad and the Ugly” offered attendees a variety of case examples to illustrate what can go right and what can go wrong in 3D treatment planning, and that the learning is continuous.

A slide from Drs. Jack Krauser and Scott Ganz’s presentation shows different implant placements.

“Once i-CAT is installed it’s not the end of the deal,” Dr. Ganz said. “It’s an ever expanding learning experience for you and your patients.”

The doctors presented a variety of examples, including single-tooth and full-mouth cases. They showed scans from the i-CAT and talked about the importance of using every view for treatment planning.

“It’s an unbelievable tool,” Dr. Ganz said of the technology. “It allows us to come up with these treatment plans.”