Eugene Antenucci, DDS, FAGD

	The advantages of implementing and using 3D cone beam imaging technology in dental practice are undeniable, and these benefits have led to the technology’s fast-paced advance into both everyday general dentistry as well as into specialty dental practice. This is despite the higher entry costs in terms of both financial and educational / training investments by a profession that is not known for investing in technologies that do not benefit patients and bring a significant return on investment.


	The decision to invest in a Cone Beam Volumetric Tomography (CBVT) 3D system is not a simple process. Both general dentists and specialists alike cannot approach the technology’s purchase in the same manner as they would if they were investing in an intraoral camera system or a 2D digital radiography system, particularly because when compared with all other advanced technologies in use in dentistry today, cone beam imaging ranks among the most technologically complex and the most expensive. However, this has not stopped or slowed the introduction of numerous CBVT devices in the dental marketplace since they were first introduced nearly 10 years ago.

	The devices range from full-volume large field-of-view systems, to supine systems, to small volume small field-of-view systems. In addition, systems such as Planmeca’s ProMax 3D Max are hybrid, allowing for a variety of studies including traditional digital panoramic and cephalometric imaging, along with 3D CBVT images and 3D photos and features a tomography system. The versatility of hybrid systems allow for study volume sizes that are selectable to meet diagnostic needs without excess radiation outside the area of interest.


	The starting point for integrating CBVT in practice is to have a clear vision of how the technology will be used. List the range of possible applications in your practice:

	Diagnosis of pathology
	Image transmission for pathology consultation
	Implant treatment planning
	Fabrication of surgical guides
	Fabrication of sterolithographic models
	Assessing the position of impacted teeth
	Evaluating Temporomandibular structures
	Evaluating airway patency
	Orthodontic treatment planning
	Endodontic assessments
	Periodontal assessments
	Panographic radiographs

	Once listed, evaluate the number of times you would potentially make use of anything on the list over the course of a month. Lease payments on a device can range between $1,900 and $3,600 monthly, depending on the features of the particular device. Scan fees can range between $350 and $600, but in actuality the fee is completely under your control.

	At a fee structure of $375 per scan with a lease payment on a device of $3,200 per month, the number of scans needed to “break-even” from a pure dollar standpoint would be in the range of 8-10 scans, or 2-3 weekly. In actuality, numerous intangibles increase the return on investment.

	For example, implant patients are kept “in-house” for the entire procedure, with minimized chances of “disappearing” during the process. The scan results are immediate, and the educational benefits are enormous.

	It also is important to accurately assess the ergonomics-what is the footprint of the device, what are the building code requirements (if any), and how will the device be integrated with existing office computer hardware and software.


	Training for doctors and staff members also is an important factor. This training begins with a thorough knowledge of the device itself-its own particular features and controls, and progresses to a thorough understanding of how to properly take the prescribed images-how to properly position the patient and use the correct settings.

	Training also is required for the software that will be used to read, manipulate and transmit the images that are acquired. Doctors also must pursue continuing education in methodology for segmenting images and in recognizing all pertinent information visible in a given field of view.

	Integration requires a commitment by the entire staff to understand the practice’s need for CBVT, and how the technology will further benefit the practice’s ability to deliver the highest quality of care. This means hygienists, assistants, reception staff and doctors must all have ongoing training at dedicated CBVT training sessions as well as at staff meetings.


	There are many devices available in the marketplace, with a wide range of costs, and making a selection is often a difficult process. Price alone cannot be the determining factor. The most important questions to consider are:

	Does the device allow for a range of image volumes from small to large to minimize patient radiation exposure while also delivering the highest quality image?

	Are images relatively simple to acquire with a consistently high level of quality?

	Can the device deliver 2D as well as 3D images?

	Does the device use the latest technology in acquiring the images (flat panel instead of image intensifiers)?

	Will the device’s footprint fit within the office’s physical setting?
	 

Articles

 The advantages of implementing and using 3D cone beam imaging technology in dental practice are undeniable, and these benefits have led to the technology’s fast-paced advance into both everyday general dentistry as well as into specialty dental practice. This is despite the higher entry costs in terms of both financial and educational / training investments by a profession that is not known for investing in technologies that do not benefit patients and bring a significant return on investment.