The power of interactive 3D CBCT scans in implant dentistry is amazing!
It allows us to plan the surgery in advance. We can see things that we could never see with traditional x-rays. This man from Glendale, California was missing all of his teeth and wore regular dentures.
The 3D (CBCT) scan allows Dr. Amin and the patient to really appreciate the bone loss he had suffered due to missing his teeth for so long. A cone beam 3D scan exposes you to minimal radiation and maximizes safety.
Four dental implants were placed and an overdenture made for the bottom jaw. He has been thrilled. Even with his bone as thin as it looks, a bone graft was NOT needed due to planning with a 3D scan.
3D Cone-Beam Scan
There’s a good chance we will need to obtain one or more x-rays of your jaw, teeth or facial skeleton at some point during the diagnostic evaluation (or workup) of your condition or during treatment of your condition of bone loss or missing teeth.
Oftentimes, films (or copies of films) from your previous dentist can be utilized without the need for additional imaging; however, please be aware many times these film images are of inadequate orientation or quality (particularly when an image has been transferred to paper) and critical areas of anatomy cannot always be adequately discerned in order to make an informed decision (transferring radiographic data from electronic media to paper can result in significant loss of image resolution and clarity). In these cases a new image in our office is typically obtained.
Various types of films/images obtained for evaluation of bone loss conditions:
Peri apical (PA)-or dental peri apical films- (2-Dimensional) are commonly obtained in our office. These films provide high detail for very small anatomic regions (and are typically used to evaluate individual teeth or structures surrounding teeth).
(2-Dimensional)-essentially, a tomogram of the facial skeleton; this is the “workhorse” film within our implant specialty, as multiple anatomic regions can be evaluated in one film.
Cone-Beam 3D scans:
(2 and 3-Dimensional)- representing a new imaging modality, these scanners allow excellent visualization of facial bone anatomy but at significantly lower radiation dosages than medical-grade CT scanners. The amount of radiation imparted to the patient by some cone beam scanners is very similar to that imparted by a traditional panoramic film. As the voxel size with these scanners is quite small, the accuracy of these images is superior to medical-grade scanners (accuracy with a cone-beam 3D scan is within one tenth of a millimeter [0.1mm] while medical CT scanners are off by 0.5mm or more).
What type of image will I have during my appointment?
While individual problems are presented by each patient, most patients will benefit from a traditional panoramic (the exact type of image will be determined based upon your presenting clinical problem). Traditional panoramic films are used most often for obtaining screening views of the upper and lower jaw prior to performing wisdom tooth removal or for evaluation of other problems related to the jaws (including placement of dental implants). Panorex images allow obtaining of a large amount of clinical information for relatively low radiation dosage to the patient.
Problematic however: the Panorex is a 2 dimensional image while the jaws and facial skeleton are 3-diminsional structures. Therefore, the Panorex is unable to provide all the information sometimes required.
As a commonly encountered example, the anatomy of the inferior alveolar nerve (and its relation to the roots of the wisdom teeth) is an important consideration during the evaluation process of wisdom tooth surgery. Its relation to areas of the lower jaw in cases of dental implant planning are also critical. In addition, the evaluation of sinus anatomy (in relation to the upper jaw bone) is often less than ideal with a Panorex.
More specific detail of individual teeth has been obtained historically by use of periapical (dental) films. These, however, can be difficult to place in certain needed regions of the mouth and don’t provide all the information sometimes required.
A 3D scan is often beneficial in helping discern critical anatomy.
The Dilemma: Do I need a Panoramic, PA film or Cone-Beam 3D Scan (or some combination of these)?
Goal: It is the desire of our doctor to obtain the highest quality needed clinical/x-ray data in the safest manner (lowest radiation dose) and lowest cost to the patient. Having stated this, please understand the following factors:
Individual anatomy varies from person to person
The Cone beam scan is more expensive than screening panoramic view (total costs for a cone- beam scan are approximately $295, versus the panoramic view-costing approximately $140), but the cone beam scan provides a vastly larger amount of clinical data upon which to make clinical decisions.
Most patients will benefit from an initial screening panoramic film or PA. In situations where the anatomy suggested from this film is uncomplicated, this may be the only images required.
Some patients, based upon the information obtained from the panoramic or PA film, will then benefit from an additional cone beam scan in order to discern more detail.
Some patients should (or may choose to) proceed directly with a cone-beam scan (skip the Panoramic): i.e. implant patients, patients with complex facial skeletal problems, patients in whom a previous film has suggested close root/nerve anatomy or patients who simply choose to proceed directly to cone beam scan). Again, radiation dose with a cone beam scan is just slightly higher than a panoramic film.
Some patients may choose to proceed directly with a cone-beam scan and skip the Panorex film. Given the current capabilities and low dosage of cone beam technology, this is sometimes a reasonable option.
While we understand that these issues may sound somewhat complicated, we do feel it is important for those patients who have questions related to their unique imaging needs be aware of the issues involved in the decision-making process. Please don’t hesitate to discuss your individual situation with us!
Missing Several Teeth | Missing All Teeth -Full Mouth or One Jaw Implants
Implant Over-Dentures & Conventional Dentures | CT Scan | Dental Trauma