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Better Patient Care Starts with Better Imaging

Issue: Winter 2014
Andrew E. Swenda Jr., DMD

The goal of my dental practice is to listen to my patients and to provide unique, caring, comfortable, and clinically appropriate dentistry for each individual. Dentistry is our passion, and positively changing people’s lives is our joy! Digital dental x-rays and imaging, both intra-oral X-ray and cone beam 3D, as well as digitized models, have played a large part in achieving our objectives.

In 2010, I made the decision to transform my dental practice into a digital, chartless office. I chose to implement the Dentrix® practice management program as my best option. My next step was finding a digital imaging system that seamlessly integrated with Dentrix and also had great images. We tested a number of intra-oral systems, and I tried all of the sensors in my own mouth. At the end of the search, we chose DEXIS®. I liked the fact that we could use a single-size sensor instead of having to handle an assortment of sensors and holders in different sizes. And, when the unique shape of the sensor felt the most comfortable to me, I knew it would be comfortable for my patients. We’ve found the sensor to be very durable—we have used one sensor for three operatories every day for almost four years. The direct USB is a very convenient attribute—we just plug it directly into the computer and take clear images that immediately show up on the monitor, ready for the patient and me to review together. Besides the exceptional image quality that helps me in diagnosis, patients are impressed that we are able to lower the radiation dose with DEXIS—that really makes a difference to them.

We tested a number of intra-oral systems, and I tried all of the sensors in my own mouth. At the end of the search, we chose DEXIS®.

DEXIS also offers helpful image management and enhancement tools. I think one of the best aspects of software is the ability to easily pull up images for different dates on the same screen and to compare these enlarged radiographs for education. For example, a patient returned to my office a year after her last appointment. During that time, she developed a large lesion as a result of external resorption. The patient asked, “How could that be? I was just here a year ago.” It was wonderful to be able to bring up the image from a year ago and compare it side-by-side to the current image. It was obvious to both of us that during the course of the year, this amount of disease had occurred. We spend a lot of time on patient education at this practice. People make better choices when they can visualize what the problem is in their body. DEXIS digital imaging allows us to do that.

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Full 3D information with more control over scan dose and size

Besides my 2D imaging system, I recently invested in a CBCT for my office. I am not new to this modality. In fact, I have used CT scanning for implant planning since the early 1990s when I had to send patients to a local hospital for the scan. Then, in 2006, I incorporated in-office CBCT imaging by sharing my first i-CAT® cone beam 3D system with an orthodontist. The unit was located in his office a few buildings away from my practice. We had to drive the patients there for the scan, but the amount of detail we received from the scans for certain procedures was well worth the trip. However, it was frustrating not to have the convenience of this imaging method right in my office.

Over the years, I kept researching CBCTs, and was happy to note that some companies were evolving with lowered radiation levels. During my research, I explored several different brands of units. The sales people all ended up saying, “This is how we compare to i-CAT.” Everyone seemed to know who’s the ‘top dog’—even the dental lab that I use for implant planning!

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Quick and easy image comparison for patient education

Across the board, they noted that i-CAT provided the best, most consistent images, so, I decided to invest in an i-CAT® FLX. For implant patients, it is incredible to have the ability to incorporate a scan of the patient’s edentulous area, and then
use my digital impression system to decide exactly where to place the implant in relationship to the other teeth without taking traditional impressions. I can also generate surgical guides using the CBCT data.

i-CAT helps my referring clinicians and me plan more exactly. One recent case that I shared with a periodontist involved an 18-year-old female who needed crown-lengthening surgery in the anterior. We took an i-CAT FLX scan and intra-oral 3D images of the dental models and superimposed the dental model over the scan to actually show the surgeon the soft tissue and hard tissue. With this information, he stated that he could make better decisions about whether to remove osseous structure or do a gingivectomy. This kind of planning with my colleagues is amazing.

In my opinion, what sets i-CAT FLX apart from the competition is its flexibility and control over radiation dose and scan size. For my younger patients who have been referred by other doctors to evaluate the airway, I have the control with my i-CAT to check their anatomy without exposing them to excess radiation. Since I find it helpful to check the patient’s airway opening with the appliance in place, I can take a QuickScan+ and know that I have full 3D information with less exposure than a 2D pan.

Sleep dentistry is another big aspect of my practice. My imaging protocol typically includes using a 3D scan to check temporomandibular joints to assess any pre-existing disease. Sleep appliances advance the mandible, and this can result in pain for some of these patients. I want to know those details and educate them to the possible issues. Scans are also taken on pain and TMJ patients, as indicated, and can also be helpful in restorative cases and Invisalign® procedures.

I believe that digital imaging, when used responsibly, can help clinicians to become better diagnosticians and patient educators.

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I believe that digital imaging, when used responsibly, can help clinicians to become better diagnosticians and patient educators. This improved diagnosis and subsequent treatment can lead to improved dental care, more compliance, and treatment plan acceptance. While I can’t change my patients’ whole world, I can strive to change a part of it for the better when I alleviate the pain of TMD or help them get a good night’s sleep with a new appliance. Knowing that I can offer that level of care helps me to sleep better at night, too.