Using Panoramic Radiographs: Should I Switch to CT Scans?

I recently added 3D imaging (cone beam) and have now done several implant cases using computer made surgical guides. The cases go extremely well, great accuracy, and confidence as to the surgical case, and I have been able to place implants where I would not have done so previously. I think it is a great addition Dr Y

Dr Y, I may be a great example of using technology (CT scan) for placing implants. I had only placed 4 implants when using Implant Logic's software, stent, and drills, I successfully placed 6 implants in the maxilla, and all have integreated. For an additional $300 the CT scan cost the patient he got precisly placed implants with much reduced risk. This is a no-brainer for me for cases that might involve an inferior nerve canal, a sinus, or multiple implants that need to be as parallel as needed. The time saved and the reduced pucker factor was a great benefit to me. The cost of the software will be parceled over many cases. It is already being discussed whether this will become the Standard of Care.

Does anyone know about the Sirona Galileo CT scan and had any experience using it vs. ICAT? TK

CT is the most advanced radiographic methodology for dental implant diagnosis. The use of CT provides a 3-D view that can be displayed electronically on a computer with implant planning software. There are a few commercially available software programs that achieve similar goals. All reconstructed images as well as 3-D virtual reconstructions are visible, and measurements of bone height, width, and density are always available. Tracing of anatomical landmarks such as the mandibular nerve is possible, and placement of virtual implants to select an appropriate size and position is simple. Cone-beam CT has become the most advanced type of radiographic technique when compared to traditional spiral and helical CT. Radiation exposure is higher with CT than with other radiographic methods, and patient referral to large centers can be difficult. Thus, CT for dental implant diagnosis is limited to advanced cases such as large restorations as well as those requiring extensive grafting procedures. Panoramic x-rays are the most commonly used radiographs available in the field of implantology. This method is useful in providing diagnostic information regarding identifiable landmarks, pathology, and initial estimates of bone availability. It is readily accessible, simple, and emits acceptable amounts of radiation, but, the use of this radiograph becomes limited in advanced implant treatment planning. Because of a lack of three dimensional viewing, panoramic view provides limited information regarding anatomical limitations, such as maxillary sinus involvement, bone height estimate, buccolingual dimensions, concavities, and inferior alveolar nerve proximity. Linear tomography can be used in the planning of dental implants for a buccolingual estimate of bone, but it does not provide accurate imaging, nor does it produce volume images of adjacent structures for precise planning and placement in advanced cases.

from a technical point of view, what's going well for you is surely ok, and perhaps if you feel confortable with this that's mean it's the best way for you to work, perhaps also in the future you'll find a limit case in which you'll feel necessity to use advance strategies of planning? personnly I'm using ct scan for diagnosis, and not for planing: I need this to feel comfortable. perhaps I also will get this progress in the future? you are probably more skilled and experienced than me. my fear is more about the sues that could come: if you don'd use a ct scan and have a problem, it could be difficult to argue you've worked with required precautions...

When does 3-D imaging become the standard of care? It has already. What is the first question a lawyer will ask you if you place an implant and cause damage to a patient? "Doctor, did you use all the tools at your disposal to plan this case carefully? Doctor are you aware that a CT scan would have shown the nerve branch that you violated and saved Mrs. Smith from permanent numbness and drooling?" Yes, we have been placing implants with PA's and Pans, but we have better tools today. Tools that can avoid unnecessary harm to a patient. Many surgical complications can be avoided with 3-D imaging. What do you do when the pan and the PA show plenty of height and width of bone and you proceed to lay a flap only to find that the ridge is knife edge with only cortical bone. You close the patient up and say, "I'm sorry Mrs. Smith, I can't place an implant to replace the central incisor you lost in the accident, you will either have to have a bridge made or you will need extensive bone grafting procedures." Meanwhile you gave her anesthesia and cut her open to learn what you could have learned from a $350 20 second scan. Ask Mrs. Smith if she would have preferred to be cut open or to pay $350 to find out she wasn't a good candidate for an implant. And what about your time and your staff's time and the room setup that was wasted? You certainly won't charge the patient for that visit. Why do endodontists use microscopes and apex locators? For many years they did just fine without them. Because they improve their success rates and make their work easier and more efficient and more productive. The same holds true for 3-D imaging. Plan your cases with 3-D imaging (and even better use a computer generated surgical guide) and you will cut your surgery time to less than half, and you will find it easier and less stressful. There is no more time to think about adopting this technology. The time is NOW!

Dear All, I am thinking of getting a 3 in 1 system. So far, i know that there are 3 system in the market, a ewoo picasso, j-morita and planmeca. Can anyone advice me on which system should i go for and what is the difference.

Dear TMK0427, I work in the dental industry and have worked with many different orthodontists and oral surgeons who have started using CT technology in their practices with excellent results. Because of my position, I've been able to see a number of different types and styles of units. The biggest difference between the Sirona and planmeca machines and the i-CAt, NuTome, and Ewoo, Belmont, etc is that they require the patients to remain standing for the scan. CT scans are longer than panoramic x-ray exposures, and many doctors have had difficulty with patient movement affecting the image quality while trying to stand through such a long exposure. Seating the patient whenever possible is a major part of achieving success with optimal image quality. Best of Luck!

Daniel: I agree with you, The NewTom provides for the patient to stand, sit or even handicap wheel chair access with any modifications. daniel

Dear All, I am currently looking to switch from digital panorex to cone beam CT. Does anyone have a machine with a "disadvantage" they would like to share? Thanks!

I don't know if you are still looking at this thread, but what you say about of Sirona... and the problems of the long long time exposure, is not so correctly. The exposure time for a complete panoramic exposure is from 13 to 14 seconds.. and for a sirona exposure is the same, 14 seconds.. so you have the same time but with a lot of more informations. this was just a clarification Regards

There is no justification for spending 70-120k for a scanner to place implants in uncomplicated cases. The only ones who are advocating this as the "Standard of Care" are one of two types: 1) Legitimate surgeons doing advanced reconstructive work and 2)those with poor spatial cognition who got sucked into paying through the nose for a system they didn't need and now want to lock-out the competition.

Dear All, I first purchased a Newtom Scanner 10 years ago the first of the CBCT which had a bed to lie on and the scan took 70 secs. This a decade ago was a great kit to have. There were 2 problems; one, when large patient lie down the breathing caused a great deal of noise due to the movement, couldn't get their head in the scanning area and the quality of the scans were variable. Last year I installed the Serona Galileo Comfort. This in my opinion is a superb machine with the benefit of low dose, short scan time, this gives a Panoral as well as the 3D images. This helps in all types of dentistry and not just confined to advanced implant dentistry. This is the Future embrace it you wont regret it.