Office-Based Cone Beam CT

It is becoming increasingly common to find dental offices that have all the latest and greatest technological innovations. Even general dentists may practice dentistry with new tools and their associated software. One of these improvements is the inclusion of the office-based cone beam computed tomography (CBCT). As a 3-dimensional radiological study, it offers better visualization of the teeth than the two-dimensional intraoral and panoramic radiological exams. In addition to the normal radiological studies, CBCT information can be stored in the patient’s electronic health record (EHR) and can be available when necessary for reviewing for patient care.

“Even with high-quality digital panoramic and intraoral imaging, the third dimension of dental imaging was an educated guess based on experience, technique, and “rules” that I often found to give inconsistent results. As office-based procedures have become more sophisticated and expectations have risen for highly successful outcomes, immediate and accurate information has become essential for treating our patients” (2008).

Not every dental practice will need to invest in a CBCT. It is an expensive and extensive acquisition. Understanding your patient profile may help in the decision to provide this 3D imaging service. It may be more cost-effective to outsource the service as well as the interpreting radiologists. Additionally, offices need to determine whether their practice locations can accommodate the hardware and software. Other things to consider include having the correct electrical outlets, and any regulations regarding radiation exposure need to be reviewed. And if the practice intends to network from the office, it is important to make sure you have a high level of Internet connection.

“Like any other large capital acquisition, it needs to benefit your patients and be affordable, either by generating income or by providing such significant information that it becomes essential to patient care. Although specialty practices lent themselves best as candidates for using the information in a CBCT, general practices can also benefit greatly, especially if they perform expanded function procedures” (2008).

CBCT has shown promise in periodontal monitoring. Complex patients with extensive medical histories may benefit from CBCT to help improve oral health and promote better dental care by documenting periodontal progress in the EHR. Diabetic patients prone to infections around the teeth and gums could greatly benefit from CBCT studies to improve dental concerns and ultimately their quality of care.

“Most [CBCT] software includes tools for evaluating and monitoring bone density, which may help assess the effectiveness of treatment, predict the results of treatment, or identify areas of future concern” (2008).

By documenting progressive care in the EHR, dental professionals will have access to monitoring current and future dental care. The patient record can be electronically communicated with other specialists if and when needed immediately.

Lessons learned:

• CBCT can be a good investment decision depending on the needs of the practice.
• Research the type of CBCT to determine best fit.
• CBCT offers better visualization of teeth and gum.
• CBCT software can be integrated with the practice management software and EHR.
• CBCT can be stand alone or networked; practice should determine best fit.

Thomas, S. L. DDS, MS. (2008). Application of cone-beam CT in the office setting. Dent Clin N Am 52; 753–759.