January 3, 2011

Cone Beam CT Dentistry has Arrived!

I have been looking seriously at CBCT machines for over 3 years, and am glad the prices have come down substantially from where they were when they first appeared on the market in 2001.  We’ve been getting along alright with an old Planmeca® digital panorex machine for the past decade, but the old girl is ready to be replaced.  My dental rep, Ken Bess, from Atlanta Dental seems to think I can donate it to some university program somewhere around the southeast for a good tax write-off verses putting it on eBay and taking the risk of a low bidder winning.


I’ve been flown to Chicago to see the Planmeca® CBCT’s, and gone to Las Vegas to listen to Dr. James Mah‘s Gendex® sponsored lecture.  I’ve been to the Florida National Dental Conference and the recent ADA Annual Conference in Orlando and looked at all of them.  I know of an i-CAT® user right here in the Fort Myers area who can’t use his machine in his main office because it was recently classified as a medical CT, which has to have a special lead-lined room, a door, a leaded glass window and plenty of space for the hefty machinery.  I’ve had a Suni® rep show up in the office, and claim a lot of hoopla about his product, and Kodak® tell me they have the lowest radiation levels on the market today.  I’ve read the NY Times article on the evils of CBCT’s invading the dental market place, and the pros of how there is no more radiation given to the body with a CBCT than an airplane flight from NYC to LA.  I believe I have just about heard it all, and don’t really know if I believe every salesmen trying to get their commissions boosted at my expense.  One thing I still can’t figure out is how every CBCT manufacturer can claim that their machine has the least amount of radiation?

The simple answer to this is that there is no standard for measuring the radiation from a dental CBCT, although they are trying.  The law of inverse squares can be manipulated many ways when it comes to measuring x-rays from a radiation source.

We’ve been relying on our panorex with measuring balls, and periapicals for years now, but recently we have switched to a portable NewTom® CBCT that arrives by van to our parking lot every Wednesday.  The patients have been accepting of this procedure once they realize the benefits, and it sure has been nice to see the “whole” picture with a great deal of accuracy, but it is in my opinion still too expensive.   Not having the images on demand also crimps my style.  When it comes to getting information about a case, I am definitely in the “here and now” mentality, and do not want to wait until the van shows up.

Then there is the service, and warranty agreements you have to consider.  Is your manufacturing company big enough to last as long as you need them?  Is this the right size sensor you need for every case? If I have a large sensor, does this mean every scan is the largest dose of radiation?  Do you have to stitch your small scans together for an entire arch shot?  Will the surgical guide companies accept a stitched scan for a large guide? Will the manufacturer drop support for your product over time?  Will they slash the price or come out with a newer/better machine weeks after you purchase it?  Why do you think I was “looking” for the last 3 years?  I am glad the US Congress finally got their act together, and prevented the tax increase scheduled to take affect in 2011.  Can you tell my political party affiliation by the wording in that last sentence?  And of course I used the 179 tax code to get the maximum reduction in purchase price.

All of these factors need to be played out in your mind before you purchase any piece of equipment in this economic environment (or any economic environment for that matter). This is why we purchased the Vatech PaX-Duo3D Cone Beam CT.

PaX-Duo3D Features:

  • Vatech & E-Woo are leaders in the world for CBCT
  • Auto-Switching between Panoramic & CBCT sensors
  • Adaptive Layer Control which eliminates blurred images of the incisors and molars in a panoramic view
  • Reliable data communication and storage
  • Automatic Optimization process of images
  • EzRecon technology for fast reconstruction time
  • Cost effective: It not only has both a panoramic and CBCT sensor, but you can shoot two different sized CBCT with the same sensor. FOV 12X8.5cm for entire arch and FOV 5X5cm for single sites wether it be endodontics or implant placement. (FOV=Field of View)
  • Small voxel size (0.08 to 0.30) This way I can take a large volume FOV 12X8.5 at 0.20-0.30 voxels, and for really fine detailed FOV 5X5 shots I can use 0.08 voxels.  This is the part that really sold me on this particular CBCT machine.
  • Low radiation levels
  • No scout shots need for patient alignment
  • They are a true DICOM file that can be transferred to any other CBCT reader software.  Not a proprietary file like most of the other CBCTs that will only work in their own reader software.  Important!
  • User-friendly software
  • Easy for staff to learn
  • 3 days of staff/doctors training (Panoramic, CBCT and Doctors advanced training)
  • Bone density profiling
  • Mandibular Canal manager with alarms and auto-draw mode (although I’m not going to trust “Auto-draw” completely, if you know what I mean)
  • Implant placement simulation of any brand implant system
  • Various view modes such as cross-esectional, oblique and 3D zoom views. (I like the mode where you can line up a single rooted tooth and spin it like a top to like for cracks/canals/other pathologies)
  • Ez3D CD publishing that includes STL Exporting, raw DICOM data, Free simple view (which is pretty much the entire regular viewer), and EzReport for my referring doctors.
  • And because I bought it before the end of 2010, I received an extended 5 year warranty (a $3,000 value), that included parts, tech support and upgrades in software. (Normally included  in the purchase is a 2 year warranty with additional $1,000 per year after that). But Wait! Instead of the standard license for the aquisition computer and 1 other networked computer (1+1N), we got a free upgrade to (1+5N) which means I can look at the same case or different cases in 5 separate operatories and the aquisition computer at the same time, a $12,000 value.  But Wait!  My Atlanta rep threw in an iPad 64 gig for the office to show cases to our patients just to get the sale before the end of the year (Thanks Ken)!
  • Atlanta Dental installation and technical support (Thanks Wayne and Rick).
  • I know, I know, it’s going to be cheaper next year, oh well, I’ve jumped in now, and am loving it!

I know this sounds like a crummy commercial, but I know good and well that there are others just like me who are wanting to take the plunge into the CBCT waters, and have many of the same questions I had to work out in my mind before purchasing this machine.  They may decide to get a different machine to suit their own purposes, and that is great, as long as they are as happy with their decision as I am with mine.

Good Luck!