Dr. Justin Moody is a giant in the field of implant education. His education center, Implant Pathway, has taught hundreds of general dentists about implant surgery, grafting, platelet-rich fibrin (PRF), and much more. It’s one of the best ways for dentists to become competent with surgical implant placement. I wanted to talk to him about cone-beam computed tomography (CBCT) as I ponder adding it to my practice.
Dr. Joshua Austin: I have been recently considering adding CBCT to my practice. I know that you’re a big advocate; can you tell me a little about your history with CBCT in your clinical practice?
Dr. Justin Moody: I bought the first one in Nebraska in 2005, an i-CAT Classic, at the time it was $250,000 and no one knew much about CBCT. It changed the way I practiced implant dentistry; knowing all the information is vital to treatment planning and patient safety. Over the years I have owned many offices and have used brands such as i-CAT, Carestream, Planmeca, and most recently, the Acteon Prime.
Related reading:
- 7 unexpected benefits of CBCT (the 6th one might surprise you)
- Digital implant planning with prefabricated immediate provisional: A digital workflow example
- Transforming patients and practices through a seamless digital workflow
JA: Wow, you’ve been in the CBCT game for a minute! I think it’s fair to say you’re a clinical expert when it comes to applying CBCT use to everyday treatment. How on earth do I even begin to find the right CBCT machine for me and my practice?
JM: First I think we can safely say that image quality is pretty much the same across the board. If a patient has a lot of metal in their mouth, the scan isn’t going to look good. So, it comes down to three things: what you’re planning to use it for, its key features, and price.
JA: I think it makes sense to think about what kinds of procedures I plan to utilize CBCT for. What if I want to grow out the airway and ortho side of my practice?
JM: If you do a lot of airway or ortho and need a lateral ceph image, you will need to get one of the larger field-of-view machines, and this will cost more. i-CAT is a great full-volume machine. It’s expensive, but worth it if you’re looking for a full-featured, full-volume CBCT.
JA: Good choice. What if implants are driving my decision to add CBCT?
JM: If your need is for implants, comprehensive planning, and a pano, then a 10x12 cm view is more than adequate.
JA: That feels like a great option for a lot of general dentists. I know the endodontist I refer to has a CBCT. Are endo offices buying those kinds of CBCTs, or is there another choice for them?
JM: Endodontists can go smaller and more collimated to reduce radiation and get more clarity.
JA: That makes sense. No need for a full-volume when they focus on specific teeth. Obviously, every CBCT gathers an image, but what are some other features I should be looking for when purchasing?
JM: The first thing I look at is, what does the software do? For me, I ask if the software can treatment-plan implants with minimal clicks, and if I can design and export a surgical guide without using a third-party service or software. That’s huge for me and my practice with implants. That may not be as important for others, but I would guess that most people with a CBCT in their practice do something related to implants as well, so this would be a great help to them.
JA: Absolutely. Even if one doesn’t place implants, I can see how CBCT would change the game, even in just treatment planning. Okay, so the elephant in the room with any technology is cost. What am I looking at price wise?
JM: All over the board, but I use the Acteon Prime (10x12 sensor). It’s got great software, an exports guide, and model STL straight to my SprintRay, and it’s under $50,000. You can also purchase it and have it installed and serviced by Schein, Patterson, Benco, and Burkhart.
JA: That isn’t as much as I thought, honestly. I mean, that’s basically just double what I paid for my digital pano. And it’s way more than double the functionality and production! How do you feel about having an oral radiologist read your scans? Should I be worried about missing something? I don’t have a ton of experience with reading a CBCT for weird pathology.
JM: We only have an oral radiologist read scans that we think have items of interest. To my knowledge, we aren’t responsible for all the data. This has been a talking point, but there’s no consensus on this. Obviously, do what is comfortable for you, but I don’t worry about it at all.
JA: Thank you so much, Dr. Moody! You’ve given me some great information to make the right decision for me and my practice.
Editor's note: This article appeared in the July 2022 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.
