Does 3-D Imaging Belong In Your Practice?

Dr. Greg Grillo
Dentist and Contributing Author

The evolution of medical technology continues to drive the rapid improvement of healthcare quality and delivery. Providers have historically faced limits around diagnosis and treatment due to the complex anatomical structures built into the human body. For example, dentists share the struggle of reading multi-dimensional layers compressed into a single layer x-ray with their medical colleagues.

It doesn’t need to be that way anymore. 3D dental imaging brings a broad new perspective to dentistry and enhances our ability to uncover chronic disease, plan precise treatment, and offer more to our patients. If we reflect on the evolution of medical treatment, we start to grasp the value of this technology in our practices.

Before the twentieth-century, diagnosis often involved intrusively cutting open a patient’s body to uncover hidden ailments. In 1895, Roentgen’s work stumbled onto x-ray analysis and a whole new world opened up in medicine. Checking for bone fractures and internal abnormalities could be done before a surgeon’s knife went to work. The invention of Computed Tomography (CT) scans in the 1970s widened the application of x-ray with more benefits and fewer disadvantages.

Cone beam Computed Tomography (CBCT) evolved from CT technology, and it works by generating divergent x-ray beams in the shape of a cone. Although this technology first appeared in the European market in 1996, it took time before it began early adoption in the Australia and New Zealand. Many patients are still oblivious to the benefits of CBCT today.

When your patients visit your clinic, they expect to see traditional equipment needed to carry out proper dental diagnosis and treatment. Recently, progressive healthcare institutions have acquired CBCT to improve the delivery of healthcare to patients who expect exceptional service. Although a relatively new technology, CBCT has garnered a lot of attention from dentists. CBCT quickly renders a 3D image of the patient’s dentition and surrounding structures, areas that would otherwise be viewed with flat, ‘common’ x-rays. This remarkable information allows identification of abnormalities from every visual perspective.


CBCT offers a range of benefits that we’re only starting to appreciate in our profession. This advanced technology provides the following advantages:

1.  Limitation of Radiation:

CBCT scanners restrict the radiation to a specific zone under assessment with less radiation scatter. The patient’s overall exposure to radiation decreases due to the beam’s limitation and focus.

2.  Short Duration For Scanning:

In about ten seconds, a CBCT machine produces an image of the scanned area that’s ready for assessment after a brief period of processing. Fortunately, imaging distortions due to the patient’s natural movements aren’t as noticeable as they are with conventional X-rays.

3.  Evaluation of Bone Quality:

Before CBCT technology, conventional X-rays were used to try and evaluate bone mineral density. CBCT’s ability to reproduce detailed anatomy gives unprecedented insight into the progression of periodontal disease and helps with precise implant placement decisions.

4.  User-friendly:

It’s not complicated to use a CBCT machine. A professional trained to take panoramic x-rays can easily adapt to capturing images, and the patient can’t tell the difference. But they sure can see it. Deciphering the data takes a little training, but your background and education prepare you for it.

5.  Interactive Display:

With 3D dental imaging, many slices and angles take you into the body. Better yet, virtual implants can be inserted into the scans and analyzed for perfect placement.

6.  Non-intrusive:

CBCT scans a region without invasive or uncomfortable procedures. If a patient can stand still for a few seconds, a stunning image emerges.

7.  Minimal Radiation Exposure:

A CBCT scan produces a similar amount of radiation as a Full Mouth Series of films. But it does it in a fraction of the time, with less scatter, and with superior results.

8.  Diagnostic Accuracy:

While conventional x-rays limit visualization of anatomy to compressed single layer images, CBCT uncovers pathology which just can’t be seen any other way. TMJ structure, infections, airway analysis, periapical lesions, and even dental caries show up in unprecedented detail.

Do I REALLY Need It?

source: https://commons.wikimedia.org/wiki/File:CBCT_image_03.png

In dentistry, CBCT is still considered a relatively new technology.  But its rapidly becoming the standard of care for implant planning and placement and other oral surgeries, such as wisdom tooth removal. Just a few years ago, this technology could cost a practice $200,000, a price tag few could afford. Advancements in hardware and software, coupled with numerous global manufacturers offering CBCT units, continue to drive ownership costs down.

If you plan to place implants surgically, CBCT belongs in your practice.  In today’s world, placing implants without a 3D scan puts you on thin ice and increases your stress.  At the same time, better visualization of root canal anatomy makes endodontic treatment more predictable.  Relationships between impacted third molars and the Inferior Alveolar Nerve quickly help you determine the risk/benefit ratio of surgical procedures.  The list of benefits grows as you make CBCT part of daily practice life.

Dentists who put CBCT into action soon discover how much they’ve been missing in their patients.  Every CBCT practitioner routinely finds chronic, asymptomatic periapical lesions that represent a dangerous bacterial population residing in the jaw.  This new insight ends up in more treatment and healthier patients.

Each practice needs to create a roadmap for wisely implementing new technologies, and CBCT deserves a close look.  If not now, keep it on the list and watch for manufacturer specials that pop up, especially around the end of the year.   Your patients will thank you for it, and you’ll wonder how you practiced without it!


Dr. Greg Grillo is a 1995 University of Washington School of Dentistry graduate practicing in North Central Washington.

He balances clinical practice with a role as the Content Director for Legwork, a rapidly growing dental software company.

Dr. Grillo purchased his current practice in 2001 after four years as a U.S. Navy Dental Officer and proceeded to quadruple the practice by every productive measure. He’s now the senior partner of Grillo Robeck Dental, an innovative practice blending technology with exceptional staffing to provide relationship-based healthcare.


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