When on site CBCT technology systems first became affordable the early adopters were implantologists. The significant improvement a 3D view brought to the accuracy and success of implant preparation was immediately apparent, and encouraged investment in the new technology. However a CBCT 3D scan can bring the same benefits to other dental procedures, in particular to endodontics.
I am the founder and principal endodontist at the Bristol Specialist Dental Clinic. The clinic has been developed to offer patients state of the art excellence. For the past 20 years we have offered solutions to complex endodontic problems.
I decided to invest in my own CS 9000 3D system (was originally Kodak now Carestream Dental) in January 2012. An important consideration when choosing the CS 9000 3D was its ability to produces high definition 76 micron images focused on a 3.5x5mm quadrant view with no distortion in length and angulation. This ensures truly accurate images with no magnification or distortion. The effective patient dose is similar to a conventional panoramic scan and so justifies its use for a wider range of cases.
The in-house 3D imaging service attracts those patients for whom diagnosis of complex endodontic failures and atypical anatomical anomalies is rendered transparent using the new technology. With the introduction of 3D scanning, endodontists now have the ability to critique their work in much greater detail. Often a shocking realisation is that what appears to be an excellent result in a 2D parallel radiograph, when viewed in a 3D format reveals an aspect of anatomy which highlights deficiencies that would otherwise go undiagnosed. This is best illustrated by the following case.
A referred case of an upper first molar previously root treated some two years earlier showed a well adapted root filling with perhaps a slight indication of an area which may have healed or still be in the process of resolving. Intermittent mild symptoms had prompted the patient to return having had no sensation from other root fillings completed within our clinic. As a precaution a 3D scan was taken which shockingly revealed the extensive unresolved apical infection. The cosy appearance of a 2D radiograph disguising extensive lesions is perhaps a much more common occurrence. The dedicated endodontic journals are now littered with articles on the nature of complex endodontic lesions, resorption and anomalies which quickly establish that a procedure is either likely to succeed or fail before the patient is subjected to an expensive and perhaps fruitless procedure.
So 3D CBCT allows us to offer better, more accurate diagnosis and enhances the patient’s perception and confidence in the knowledge that their endodontic needs are being met in a safe and thoroughly professional environment.
When I originally invested in the CS 9000 3D system I fully expected it to be monopolised by the oral surgeon. It proved to be an important adjunct to many oral surgery procedures but surprisingly about 80 per cent of the use has been dedicated to endodontic diagnosis. The CS 9000 3D offers an unprecedented vision into the heart of the root canal anatomy which using the 3D rendering is a veritable revelation to patients to whom regular radiographs often remain a black and white mystery. With the rendered image we can easily explain what needs to be done and why. Complex surgical problems are easily understood and treatment plans more readily accepted.
I chose Hulbert Dental as the supplier of my CS 9000 3D and I believe this was just as important a consideration as choosing the equipment itself. Training and support is essential when introducing any new technology to your clinic. This was very competently supplied by Tony Hulbert himself. Since then Tony and I have formed a partnership supported by Carestream Dental to provide CBCT application and compliance training to all those who are now incorporating 3D imaging in their practice. The courses are suitable for those dentists either considering investing in their own systems or referring patients.