Monday, May 21, 2012
When Dental Cone Beam Imaging was first introduced to the dental market, the most obvious use of the machine was for placing implants. Personally, I would never attempt to place an implant without it considering the distortion and lack of landmarks that you might find in a typical panoramic X-ray.
What our office has found, however, is that we are much better at diagnosing problems that previously left us scratching our heads. It may be why focused field Cone Beam system, such as Suni3D Cone Beam Panoramic System, are finding their way into many endodontic offices. Take for example this case from yesterday:
The patient was in for a routine cleaning. She said that there was an area on the tongue side of her right lower first molar that had been bothering her. It had recently flared up, but calmed back down again. Using a periodontal probe, I couldn’t detect anything deeper than a 3mm pocket around the tooth. A PA xray showed a PFM crown with no decay, and no periapical radiolucency.
There was a question of whether there was a bit of a defect on the mesial root, but it wasn’t very well defined on the X-ray. We took a cone beam scan using our Galileos from Sirona, and it immediately showed us what we were dealing with.
Most likely there was a vertical fracture in the root, and despite good hygiene, the long vertical attachment of the gingiva would occasionally unzip. This could explain why we didn’t see probing depths longer than 3mm at the time of the exam. If it does have a vertical fracture, there may not be much we can do in the long run. But by detecting this in earlier stages, it at least gives us a chance to treat the defect instead of jumping right to an extraction.
Is it practical then to buy an expensive cone beam machine simply to catch the occasional periodontal defect? It definitely is one of the most important diagnostic tools we have seen in a few decades, and there is no question it will be part of the future of the dental profession. Perhaps more offices could do what we did: We went in on the machine with another office to split the charge. It dropped the price in half, and there is rarely a time in which we both need a 3-D scan at the same time. Also, if you are a general practitioner or an endodontist, many of the focused field machines are much cheaper today. Either way, this is one piece of equipment that won’t end up getting dusty in a corner somewhere.