A New Vision
Distributor reps have an opportunity to expose dentists to 3D imaging technology.
By Laura Thill
In 1519, Ferdinand Magellan set out to prove to the Queen of Spain that the world wasn’t flat. Today, almost 500 years later, distributor reps are sending a similar message to their dental customers. The same scanning technology used in hospitals, which permits doctors to slice through images and rotate them to produce anatomically detailed pictures, is making its way into dental practices.
"We’re moving from a two-dimensional to a three-dimensional world," says John Smithson, director of marketing imaging products, Sirona Dental Systems, LLC (Charlotte, N.C.). "We’re not launching a new product, but a new way of looking at things."
Newly designed for the dental industry, three-dimensional cone beam volumetric tomography (CBVT) combines 3D and digital technology, such that one cone beam scan exposes the patient to the same dose of radiation as three panoramic scans. But, one 3D volumetric image can provide more information than a panoramic view.
From 2D to 3D
Over the last 35 years, few patients have left the dentist’s chair without gagging on a pair of intra-oral bitewings - two-dimensional periapical intraoral X-rays of one or two teeth. Sixteen films later, patient and doctor would have a full-mouth series. "Thirty years ago, this was the most common way to chart the entire mouth," says Steve White, senior vice president sales and marketing, J. Morita USA (Irvine, Calif.). "But, it [can be] difficult for the dentist to educate patients using the full-mouth series, and the patient is exposed to 16 doses of radiation."
In the ’70s, panoramic X-rays became popular. Like pariapical X-rays, panoramic images are 2D. But, the X-ray unit would produce a single film of the entire upper and lower jaw. The whole process took less time than pariapicals, providing the patient with a healthier, more comfortable experience. The downside, however, was that the broader panoramic view came with less clarity than pariapicals. "So, dentists could take a panoramic view and later zero in on a problem area using pariapical [technology]," says White.
As dentistry became more sophisticated, however, and implantology became more routine, oral surgeons and dentists required more sophisticated imaging techniques. "They needed to plot where to place multiple implants," says White. For instance, they needed to know that there was enough room to place implants while ensuring the foundation was sound. Dentists used to send these patients to the hospital for a CT scan," he continues. "But, this could cost $800 to $1,000, and they exposed an entire clinical area for [one view of] the mouth."
Over the past 12 years or so, researchers have explored the possibility of tailoring cone beam and 3D imaging for the dental industry, notes White. And for the last four or five years, in fact, this technology has been available to dentists. As with any new technology, the 3D cone beam is not cheap. The systems, which generally stand about two feet wider than standard X-ray units, cost between $150,000 and $300,000. But, a 14-second scan yields "slices" of images between 150 and 300 microns thick, according to Smithson. "[The dentist] can look at detail in and around the tooth and see periapical lesions, [enabling him or her] to see how to treat the tooth." Depending on the clinical situation, it can take between 30 seconds and 30 minutes for the dentist to reconstruct the image, he adds. But, the patient is exposed to between 20 and 50 times less radiation, and the end-result is a panoramic-style volumetric image.
Clinical applications
One of the greatest challenges in applying 3D cone beam imaging technology to dentistry has been to balance the field of view with the degree of clarity. If the user takes a smaller field of view, he or she could attain better clarity, according to White. Conversely, a larger field of view typically yields less clarity, he adds. In addition, there is some variance from one manufacturer’s system to the next, he notes. One system might provide better diagnostic capability while another offers a good view of the patient’s total arch. So, distributor reps need to know how their customers intend to use the technology.
Presently, practitioners use 3D cone beam imaging primarily to plot exact locations of implants, says White. But, the clinical and diagnostic capabilities of 3D cone beam are broader than that, particularly as the technology continues to improve. From endodontics and periodontics to orthodontics, in the coming years dentists are expected to use 3D cone beam to diagnose a wide range of conditions, including the following:
- Lesions
- Root fractures
- Temporomandibulor disorders, which can cause chronic facial pain
- Sinus blockage and/or airway analysis
- Impacted teeth.
Three-dimensional cone beam provides better pictures with better diagnostic capability, White points out. "It enables dentists to see their area of interest from all angles and [get a better idea] of what the problem is," he says. "It comes down to the field of view vs. the quality of the image. As the technology improves, practitioners and specialists will be able to apply 3D cone beam to all aspects of dentistry diagnostics." Not to mention, improved diagnostic capability permits more precise treatment, which reduces the length of the procedure for the patient,
he adds. And, especially with regard to positioning implants, greater accuracy helps ensure a better fitting product as well.
Sales
Of the 300 to 400 CBVT units sold each year, about 80 percent are purchased by specialists and 20 percent by dental practices, according to Smithson. Depending on how the technology is used, the return on investment may vary. "It depends on what [dentists] are doing," he says. "If they are sending their patients out for
CT scans, the system pays for itself very quickly." However, if 3D cone beam imaging is used for implantology, payments may vary from one insurance company to the next, and the practitioner might not recover his or her investment as quickly.
For now, the return is that dentists have the potential to achieve higher levels of diagnosis and set themselves apart from their competition, White points out. In fact, 3D cone beam technology makes a practice more attractive, helps practitioners perform better and faster dentistry and makes a practice more attractive to a buyer, adds Smithson. White agrees: "We are seeing more dentists who are retiring than
those who are graduating [from dental school]," he says. "It’s a buyer’s market. Retiring dentists looking to get the highest dollar amount for their practice need to stay current with this technology. It can only make a practice more appealing."
White is confident that as 3D cone beam technology is mainstreamed, even if the cost doesn’t drop substantially, dentists will get much more capacity for their money. Getting the technology mainstreamed, however, may be one of the biggest challenges for distributor reps. "Distributor reps need a better working knowledge of this technology," he says. "They need to be aware of the different uses for 3D cone beam and know what different manufacturers offer."
"I think that in the next 10 years, digital panorama
with 3D imaging of the field of interest, will become a standard of care," he continues. "So, everyone is a prospective customer.
"This is the closest thing we have in dentistry next to hospital 3D imagers. A three-dimensional [picture] removes so much question and unknown from the diagnosis." [FI]
|
|
|
