Wednesday, August 28, 2013

Do We Really Need a Cone Beam Scan?

A recently published article discussed the widespread acceptance of dental implants, and the pressure upon general dentists to provide these dental services to their patients.  CBCT is marketed as the solution to remove the barriers that stop many general dentists from placing implants in their practice.  The article then went on to discuss the reasons why CBCT is often overused and its popularity is fueled by misinformation regarding its necessity, safety and efficacy.  While this argument was made regarding use of CBCT for placement of dental implants, the same argument could be made against the use of CBCT in endodontics.

Some of the points argued against the use of CBCT are as follows:
  • Risks of ionizing radiation include cancer, burns & other injuries
  • Dentists can order CT scans at any frequency with no regard to patient's prior radiation exposure
  • Dental offices with CBCT are seven times more likely to prescribe a CBCT scan compared to those offices without CBCT
  • CBCT scans are too expensive for the average patient
  • Poor ROI (return on investment) for a small dental practice with CBCT
  • CBCT scanner require additional office space
  • CT may soon require additional registration and documentation
While each of these points of argument may have some validity, the counter argument would be:
  • Not all CBCT scans are the same (click here).  Focused field, low dose radiation scans are available which limits the amount of radiation.  CBCT is a fraction of the radiation compared with conventional medical CT's.
  • CBCT can prevent a host of complications that can cause short and long term problems
  • CBCT can reduce the cost of treatment by preventing complications and the need for treatment revision
  • Dentists without access or experience with CBCT are less likely to understand and appreciate all the potential applications/benefits of 3D imaging
  • Dentists are expected everyday to put their patient's best interest first over any financial benefit.
In my opinion, in regards to endodontics, CBCT will be required to provide the highest levels of care.  Just as a microscope improves the quality of care, CBCT improves the imaging providing a higher level of endodontic care.

I think the only way to appreciate the benefit of 3D imaging over traditional 2D imaging is to see it.

The following videos are an attempt to show how CBCT imaging provides valuable information that improves diagnosis and treatment in endodontics.  The videos are made with a screen capture software. I did notice that the video recording of the screen is a little jumpy. Hopefully you'll get the idea...