The Synergy of 3D Cone Beam Imaging                                          attenuations vs radiation

By Duane Grummons, DDS, MSD

Adding new technologies to my practice is all about synergy — about continually striving to raise my practice to new levels of excellence in patient care. i-CAT 3D cone beam imaging has helped me to achieve this synergy. I have had an i-CAT system for 6 years, and have experienced benefits and shared many insights from the scans with referring colleagues.

When most people think of investment, they think of a monetary aspect, but 3D imaging means so much more than that. When I first got the i-CAT, besides using the unit for my orthodontic practice, we set up an imaging center for dentists in the community. The imaging center staff was motivated, inspired and thrived on the interesting dental information that was discovered day after day. For the imaging center, have a maxillofacial radiologist review the scans to ensure that they are interpreted correctly. Their input has been very productive for us. Every read that we have gotten is a tutorial, and we have become stronger on our own interpretation of the scans as a result of this process.

Our referring practitioners also understand the advantages of 3D. We have been analyzing breathing for almost 30 years, working closely with ENTs, pediatric doctors and other dentists. 2D imaging left us with incomplete knowledge. When working with ENTs, now we know exactly the extent of the obstructive problem and the degree of measurement, and we can use computations to get more exact and direct in the care that we provide. This has helped immensely to improve our clinical effectiveness.

i-CAT imaging allows me to see clinical anatomy that would not be visible with 2D imaging. In the TMJ area, that includes previously undiscovered fractures and degenerative conditions on airways and sinuses. We have seen lesions or tumors that extend into the cranial base of the skull that are actually putting life at risk for some patients. Some frustrated patients have visited multiple doctors with a problem, and from the scan we discovered the issues that allowed the specialist to understand the anatomy of the condition. Then, we can help co-manage these conditions. After all, tumors and cysts around teeth must be treated first, before orthodontics can begin. 3D imaging helps me to outline a course of orthodontics for a challenging case and make it navigate well, or if treatment is not going according to course, we can find the reason and modify our approach.

Patient education is an important part of our practice, and teaching about radiation exposure is a priority. We don’t wait for patients to ask. We educate them right away before an image is even taken, and we discuss why the size and resolution that we are choosing for the scan is best for their individual needs or for the needs of their child. We explain by comparing the radiation from a scan to other things in the everyday environment, such as an extended flight on an airplane or daily ambient radiation. 3D users must be ready to inform our peers about radiation comparisons as well. If another dentist says that the panoramic image is good enough, we must know enough about 3D imaging to explain the difference between radiation from a 2D X-ray and a 3D scan and then compare how much more 3D benefits our diagnosis and treatment planning. The technology just keeps getting better. The newest 3D CBCT from i-CAT, the i-CAT FLX, offers a QuickScan+ feature that captures a full-dentition 3D scan at a lower dose than a panoramic image.

Once patients see the incredible amount of information we can gain from the scans, they understand that there is more benefit than risk. As a part of the imaging education and the clinical process, we apply software such as Anatomage and Dolphin 3D to manage the data and formulate presentations. We can zoom in on certain areas and rotate the 3D volume 360 degrees to show every angle of the teeth and how we are going to move them for our desired outcomes. As as result, patients become excited and enthusiastic about beginning treatment.

Keeping educated on the various aspects of 3D imaging is an ongoing commitment. I am also dedicated to investing in seminars for me and my staff, both in person and online to be strong in our knowledge and to apply it well. Once you are in the “pro-league,” you just want to learn more and be able to lead the way. I feel that i-CAT sets the standard for 3D CBCT imaging, and we want to offer those high standards to our patients as well.

Author and physician Oliver Wendell Holmes, once said, “Man’s mind, once stretched by a new idea, never regains its original dimensions.” The added dimension of 3D cone beam imaging has stretched the capabilities of my practice, and I belief it will continue to expand my practice’s possibilities. The future is now; together, we lead the way with i-CAT cone beam and related technologies in modern orthodontic practice.

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