How 3D CBCT has impacted my practice
I practice as a general dentist in Jonesboro, AR. My area is not very heavy in specialists, and it is difficult for a patient to be seen in a timely manner. I believe being able to manage more difficult procedures provides value to my community and patients. There are times when a patient is confronted with the option of waiting 2 or 3 months to see an endodontist they would “rather have the tooth extracted”.
Diagnostics and Planning are Easier.
Having a 3D Picture of the patient’s dentition is a huge adjunct to traditional testing. I'm not spending as much time cold testing, percussion testing or palpation testing. If I am performing endo testing, its mostly to verify what I already know from the image. Periapical radiolucencies are much more obvious on a CBCT image versus a periapical radiograph. I am also able to visualize the position of restorations in relation to the nerve chamber and pulp horns. A lot of times fractures can be seen and can let you know if the tooth is restorable before "prepping and seeing how far the crack goes" and wasting that time only to have to extract the tooth. Being a 3 operatory clinic, any information I can get to make a procedure more efficient and have less surprises will benefit my business greatly.
Root Canals aren’t intimidating.
Preoperative 3-dimensional imaging has enhanced the efficiency of my root canal treatment. It allows me to see the exact anatomy and any challenges I may be faced with before I touch the tooth. I know my access shape and how deep I'll need to prep to reach the nerve. I'll have a map of the orifices with precise measurements to know exactly where I should be looking for canals. I'll know how many canals exist including MB2. Working length can be determined based off the image too. During treatment, I verify the lengths with an apex locator to have very predictable instrumentation. For many dentists, endo is anxiety inducing. CBCT imaging is an absolute benefit to peace of mind for endo as a general dentist.
Surgical Extractions are more predictable.
Knowing the position of roots prior to extractions lets me be much more confident and conservative in removal. I can plan for the difficult extractions and manage those cases accordingly. Two of the major risks of extractions are involvement of the maxillary sinus and inferior alveolar nerve. When evaluating and planning an extraction, I know just how the roots interact with the sinus and if there is direct involvement. I have become more comfortable in 3rd molar extraction cases when I know exactly where the roots are relative to the inferior alveolar nerve.
Implants play a better role in tooth replacement.
Three-dimensional imaging is critical for placing implants. There are tons of information on this subject available already. For my practice it has really influenced my treatment planning for tooth replacement. Having confidence in implant surgery and treatment planning in favor of single tooth implants versus a bridge is a huge value for patients. My goal is conservation of tooth structure, and this has allowed me to do that.
Conclusion
There are many more ways to utilize 3D imaging in general practice than I have described. It has been one of the most influential additions to my practice. I am always looking at ways to improve my quality of treatment and I have yet to regret the investment of new technology.