Last week during a CBCT training on the Prexion Excelsior Pro, I came across a great example of the benefit of varying slice thickness in CBCT software. CBCT volumes show 3 different 2D perspectives (axial, sagittal, and coronal) of the same location. Because a CBCT volume is a composite of many "slices" in the same plane, CBCT x-ray allows the user to vary the thickness from a single voxel slice to a composite view of multiple slices in the same plane. A digital PA will look similar to a composite view of many slices.
Understanding how to vary slice thickness and why and when you want to do that. I realized that for those that are new to CBCT the concept of slice thickness is foreign and needs further explanation.
CBCT is quickly becoming the standard of care for dental radiographs. As more dentists experience the radiographic information that CBCT offers, they are realizing that doing certain procedures without CBCT increases the risk of failure. If you are new to CBCT or are considering purchasing a CBCT unit, the following information may be helpful in preparing you for what you should learn at a minimum.
Many Dental offices consider themselves to be “digital” offices. They have incorporated computers at
the front desk and in the treatment rooms and have software that manages their practice
and electronic images – both camera and radiographic. The dentists with such offices have invested
time, money, and often times have endured a good amount of frustration to get there. In addition,
many high- tech offices are under utilizing their systems and only deriving a fraction of the benefit that
could be garnered with the correct “vision of utilization” and “proper training” to achieve it.
Implant dentistry was once left to periodontists, and prosthodontists. Today, a growing number of general dentists are also placing implants. With the proper education, a general dentist can add thousands of dollars of revenue every month by adding implants to the office procedures. One tool that is key to making the process more certain and predictable is CBCT technology. With a CBCT scanner it is possible to create a surgical guide even in heavily restored cases. Today we will illustrate the process of using the J.Morita R100 CBCT scanner to scan a heavily restored patient with a scan appliance. The scan appliance allows for the alignment of the CBCT (Dicom infoormation) information and the digital model (STL file) that is created and use BlueSky Bio software to use the CBCT information in designing and printing a surgical guide for implant placement.
A primary challenge of using CBCT for implant planning is managing image scatter due to restorations. Scatter appears as rays of distortion as the x-ray photons do not penetrate radiopaque restorations and instead reflect at the surface. This can make it difficult for the software to match the CBCT information (subginigival info) with an intraoral model(scanned or stone). At Dental TI, we have created and educate on a protocol that provides accurate surgical guides, even on heavily restored patients. With the J.Morita R100 CBCT unit, a surgical table, and a scan appliance, and using BlueSky Bio software, you have the full technology package to plan and create surgical guides and place implants with dramatically improved accuracy and success.
One of Dental TI's clients , Esteban Velez DDS, who practices in Avon Indiana, shares a case below where he used his J.Morita R100 and a scan appliance to create a surgical guide. The detailed steps of the case and corresponding images are below.
We deal with dentists everyday who are considering CBCT. The questions are always "should I get a CBCT and which one." For this discussion I will assume that the first question is yes and give some pointers in making the decision process easier.
1 – DETERMINE THE FOV THAT FITS YOUR NEEDS
When looking towards a CBCT investment start with the end in mind. Why are you thinking about CBCT and what will you be using it to accomplish? For many general dentists the answer is predictably placing implants. If this is your motivation, then it is safe to say that guided implant surgery may also be something that you are pursuing to achieve the highest degree of a predictable outcome.
One of the most frustrating aspects to digital x-ray technology is having a sensor fail outside of warranty. Most manufacturers will state that the average life of a sensor is three to five years with normal wear and tear. This is true regardless if you use the SuniRay2, UniRay 1.5, QuickRay, EI, XDR, Schick CDR or 33, Dexis Platinum, etc. However, many dental offices have experienced failures before the average life expectancy. The following are tips to help your office get the most life from your sensor.
Interest in CBCT technology in dental has grown substantially as more general dentists place implants and recognize the value of virtually planning the procedure for the best treatment results. There is no substitution for being able to accurately measure bone level and thickness prior to placing an implant.
Most CBCT software allows for the virtual placement of the implant so that the exact best placement can be determined prior to the actual procedure. The peace of mind that this kind of precision offers helps dentists placing implants avoid sleepless nights wondering about the success of difficult procedures. Buccal perforations and angulation errors become a thing of the past with a properly used CBCT scan.
There are a lot of claims about digital x-ray quality with some companies claiming that they have the best image quality. In this particular study soon to be graduates from the University of St. Louis'
Endodontic Program compared 6 sensors to see how much difference there really is among sensors. A pig jaw was used and a #6 file was inserted in a canal to be x-rayed. Each sensor was exposed using the same position and an exposure level that was deemed ideal for that sensor. The results are in the image below. The first group is "native" or unenhanced while the second group has been sharpened. The sensors evaluated were: Dexis Platinum, Poloroid Sensor, Quickray, SuniRay2, XDR.