3D Imaging Equipment
Safely perform advanced procedures with better imaging
Olga Malkin, DMD
The presence of 3D imaging equipment in dental practices has become much more common in recent years. Once only employed for implant treatment planning and restorations, technological advancements have increased 3D imaging quality and provided practices with many more uses for this type of equipment.
In the treatment planning phase of implant restorations, 3D imaging has become a standard of care. With 3D imaging we are able to fully diagnose the position of vital anatomic structures, such as the maxillary sinus and inferior alveolar nerve.1 In addition, 3D imaging gives us a full assessment of bone quality and quantity, and also makes it possible to treatment plan and perform fully- and partially-guided implant surgery.2
Providers who perform endodontic procedures find 3D imaging equipment particularly useful because it allows them to diagnose periapical pathology that is not visible on regular x-rays. A flat, 2D image of the periapical x-ray often doesn’t reveal the extent of the pathology, as there is bone both in front and behind the pathology that gets in the way. With 3D imaging, they can see the extent of the pathology at the tip of the root and use that visual information to decide the best course of action. They can determine if the tooth needs to be removed or if it can be saved.
Root fractures can also be diagnosed using 3D imaging.3 Diagnosis was previously done on a symptomatic basis. Treatment for a root fracture could only begin after the patient reported symptoms that matched the known symptoms of a fractured tooth. Now, high-quality 3D imaging gives endodontists the ability to physically see fractures, allowing for faster and more effective treatment.
Nerve canals can be diagnosed in a similar way. For example, a mesiobuccal canal on the maxillary molar is often difficult to locate using 2D x-ray technology, but 3D imaging makes them easier to find.
Significant Price Drops for More Accessible Equipment
Additional applications are a significant factor in the recent popularity of 3D imaging equipment, but an even bigger factor is that this equipment costs a lot less than in previous years.
As recently as 2014, most cone-beam computed tomography (CBCT) systems were incredibly expensive, but these prices have dropped dramatically in the past 2 years. Now, basic 3D systems are available for under $100,000, making 3D imaging equipment more accessible to practices than ever before.4
Costs to Consider
There are multiple factors that a practice must consider when they are in the process of selecting which make and model of 3D imaging equipment they will purchase.
For example, in addition to the cost of the equipment itself, the cost of software may or may not be included. This is similar to how the practical cost of a personal computer can be made more expensive if it does not come pre-packaged with a standard software suite like Microsoft Office.
Also, software is not always a one-time expense. Practitioners need to know how often software will be updated and if these updates are free or not.
Another question worth asking is if the equipment is self-calibrating. If not, how often does the machine need to be calibrated? What happens if it is not calibrated? What is the cost of these calibrations? There is no way to know the true cost of 3D imaging equipment without asking these questions first. Some companies charge practices an annual operating fee for maintaining equipment.
In addition to expenses, practitioners should also consider that these are complicated machines, which makes the level of customer support another important factor in selecting 3D imaging equipment. Ideally, the company will always be available to quickly accept support requests, log on to the practitioner’s computer, and make any necessary changes.
Voxel Size
One of the terms you will often hear associated with 3D imaging is “voxel size.” A voxel, which is named after a contraction of “vox” for volume and “el” for element, is similar to a pixel. The higher the voxel size of a 3D image, the higher the “noise” and lower the resolution of that 3D image.
In 2012, the Journal of DentoMaxilloFacial Radiology performed an extensive study of the different 3D imaging systems available at that time.5 These researchers came to the conclusion that there was no appreciable difference in quality between 200 µm and 300 µm images.
2D and 3D Technology
There are two kinds of 3D imaging equipment: those that have both a 2D sensor and a 3D sensor, and those that only have a 3D sensor and can reconstruct panoramic 2D images from a 3D scan. It is best to have both 3D and 2D sensors, rather than reconstructing a 2D panoramic image from a 3D scan. A separate 2D sensor is required for high-quality panoramic images.
With a separate 2D sensor, practitioners can take partial mouth x-rays. This is helpful with patients that have trouble with gagging during bitewing x-rays.
The field of view is also very important. Many patients are concerned about radiation, so the equipment purchased has to be versatile in terms of the field of view in order to address these concerns and keep patients feeling safe.
Being able to take a 3D image of a small area when that is all that’s needed produces much less radiation than taking a 3D image of the full arch. But it’s also necessary to have the capability to take a 3D image of a full arch. With a full arch image, a practitioner can manufacture a surgical guide if their machine is able to take a 3D image of the whole upper or lower jaw.
Certain models of 3D imaging equipment provide additional capabilities (eg, having the ability to trace jaw movements and show the patient’s airways). Equipment with additional capabilities is more expensive, but it can provide significant value by enabling practices to offer unique services and stand out from the competition.
Conclusion
3D dental imaging equipment has become both more affordable and more advanced in the last 5 years. Once considered a luxury and used mostly in dental surgery-oriented practices, today it’s becoming an integral part of any multispecialty and many general dentistry practices. It’s a great return on investment, which will quickly pay for itself by increasing the quality of diagnosis and treatment, and allowing practitioners to safely perform many advanced dental procedures. While it’s important to select the right make and model as well as good support options, even less expensive scanners will provide a tremendous improvement over traditional radiography and 2D panoramic equipment.
References
1. Niyas FM. Use of CBCT As A Diagnostic Aid in the Treatment Planning for Implants in Mandibular Premolars Among South Indian Population. J Pharm Sci Res. 2015;7(7):492-496.
2. Orentlicher G, Abboud M. Guided surgery for implant therapy. Oral Maxillofac Surg Clin North Am. 2011;23(2):239-256, v-vi.
3. Kajan ZD, Taromsari M. Value of cone beam CT in detection of dental root fractures. Dentomaxillofac Radiol. 2012;41(1):3-10.
4. Dental Cone Bean Imaging. http://www.dentalcompare.com/Dental-Digital-Imaging-Dental-Imaging/4851-Dental-Cone-Beam-Imaging-Cone-Beam-3D/. Accessed August 20, 2016.
5. Maret D, Telmon N, Peters OA, et al. Effect of voxel size on the accuracy of 3D reconstructions with cone beam CT. Dentomaxillofac Radiol. 2012; 41(8):649-655.
About the Author
Olga Malkin, DMD
Private Practice
New York, New York
