Shopping for a new cone-beam CT is not as easy as it sounds, unless of course, coughing up hundreds of thousands for a less-than-ideal product is no skin off your teeth. Otherwise, it pays to carry out extensive pre-purchase research, visit dental trade shows, and test-operate as many different types of machines as possible. More importantly, you should make a list of all your product needs and – regardless of what the showroom manager tells you or how glossy the brochure images look – stick to them!
These words of advice could well be inferred from Dr Harris Schlen’s testimony of his own CBCT-buying experience. The fact that he is the proud owner of a Planmeca ProMax 3D Mid provides tacit evidence of his resolve to secure the best possible investment for his practice.
Dr Harris Schlen owns a private dental practice located in St. Vincent’s Hospital in Melbourne. Besides serving as a general practice, Schlen Dental provides consultation to private and public hospitals in the St. Vincent area as well as those in surrounding suburbs, attending to the special needs of medical patients that require dental treatment. Due to his unique vocation, Dr Schlen has had first hand experience utilizing advanced pathology and radiology services available on the market.
Years of referring patients for third party CT scans and resulting inconsistencies in image quality finally prompted him to consider acquiring a CBCT for his own practice. The fluctuating outputs, coupled with the inherent limitations of proprietary viewer software in interpreting them, had been pushing the issue for some time. Dr Schlen’s evaluation of these patient referral schemes stems from personal experience, having utilised the full range from dental packages on medical CTs to more dental-specific CBCT services. He laments:
“We tried referring to various providers utilizing multiple types of equipment, and soon found which were the most reliable but we never consistently achieved the results we were looking for.”
Armed with a basic knowledge of CBCTs and a wish list, Harris began seeking out major suppliers of digital radiography equipment.
Planmeca Outshines Competition
On more than one occasion, Dr Schlen lets on, the purchasing team had “met with sarcasm and derision” as they spelt out their requirements to product vendors. Unfazed by tactless salespersons, Dr Schlen then ventured overseas in search of that elusive all-in-one radiography solution.
“We determined that we needed the CBCT to produce the exact outcomes that we wanted but we didn’t want another compromise that would leave us with a major financial commitment and still not able to achieve the outcomes that we were looking for.”
The team’s stoic insistence finally paid dividends in the form of what manufacturer Planmeca dubs the “intelligent X-ray unit”. Planmeca ProMax 3D Mid is the all-in-one CBVT (Cone Beam Volumetric Tomography) unit including 3D imaging, digital panoramic, digital cephalometric and 3D photo – yes, all in the same unit. It purportedly meets every known requirement in maxillofacial imaging.
As a vindication of sorts, Dr Schlen proclaims that since buying the digital X-ray machine some 10 months ago, it has consistently been delivering the goods – doing exactly what some of its competitors said couldn’t be done. The Melbourne practitioner spurns his detractors further, with his take on making a shrewd CBCT purchase:
“All the images that you see on a CT brochure look magnificent. However, what they don’t tell you is the relationship between radiation dosage and image quality. You need to be able to produce consistently good images while administering the lowest possible dosage of radiation to patients.”
Dr Schlen was referring to the product’s advanced feature that allows adjustable volume sizes and resolution modes. The unit provides volume sizes for every clinical application with possibility to adjust volume position according to acquired scout images. The 3D image volume range covers everything between single tooth to whole facial region. For every volume size, different resolution modes are available in high, normal and low dose resolutions.
Planmeca ProMax 3D Mid offers different imaging modes for different needs. For example. the low dose mode can be used in orthodontic studies whereas a special high definition program is developed for imaging of small size ear bones.
3D visualization covers every angle
Of course, the raison d’etre of any 3D X-ray unit is that it offers diagnostic views at angles that escape the sensory abilities of its traditional counterpart. While appreciative that the unit also offers a 2D sensor, Dr Schlen highlights the 3D feature that identifies and locates abnormalities from any conceivable angle.
“Many CBCT packages are designed with limited functionality aimed at measuring implant sites but with severe limitations on angles and perspective. The value of being able to look not only at pathology but also at implant planning from different perspectives cannot be overstated.
“We had grown accustomed to using medical CTs which enabled us to create views within the three dimensional volume from any angle, hence were happy to find that extended functionality in the Planmeca software. Further, implant placement is a major part of our practice so implant planning software with incorporated implant libraries was also high on our list of priorities.”
Another priority for Schlen Dental, as they started providing their own radiography service, was the ability to produce DVD reports for referring clinicians.
“With the Planmeca Romexis, we were able to produce DVDs with fully licenced viewer software that had all of the functionality of the workstation software, including the implant planning feature.”
Planmeca Romexis is a comprehensive software for acquiring, viewing and processing 2D and 3D images. It offers easy-to-use tools and supports workflows from high patient turnover 2D-imaging to advanced specialist 3D treatment planning.
“Romexis software is the best dental software available at present. We continue to work with Planmeca to get more out of the software. No matter how much you have, you always want more.”
Any supplier of a technological product worth their salt should also provide the necessary technical support for training, maintenance and repairs. As Dr Schlen puts it squarely, “When you are paying major dollars for equipment, and are dependent on its daily functioning, you can’t afford to have any downtime.”
To this end, the dentist is confident that Planmeca is backed by a history of reliability, whether in terms of staff training or resolving upforeseen technical hiccups.
He adds: “The agent must be able to deploy technicians quickly and efficiently in response to emergency cases like a breakdown. This is critical to our business and we’re thankful that the local Planmeca distributor, Henry Schein Halas, provides that backend support.”
Besides giving customers a peace of mind, flexibility and versatility were dominant attributes of the Finnish product. Planmeca ProMax 3D Mid complies with a multitude of diagnostic requirements: those of implantology, endodontics, periodontics, orthodontics, as well as dental and maxillofacial surgery, and TMJ analysis. It is also an excellent tool for diagnosing ear, maxillary sinus, and respiratory tract diseases.
“We purchased the unit not only for our own use but also to incorporate in a radiology service for the head and neck region that we provide to the hospitals that we support. We extend the same service to all the medical and dental professionals in our region.
“We use the unit for a wide variety of investigations. From a dental perspective, they include implant planning, investigating TMJ dysfunction, and identification of many different types of pathology. From a medical perspective, we use the unit to investigate airway and sinus pathology, and airway volume in sleep apnoea studies. We also have a Planmeca Dimax 4 2d sensor to take OPG’s and various 2D images, and a full range of Planmeca intra-oral pro sensors to take intra oral images.”
“Nothing even came close”
Noting how medical image reporting commonly lacks an understanding of dentistry, Schlen Dental endeavours to fill the gaping need. The Melbourne practice now employs three radiologists working with a team of dentists to provide a specialist radiology service with the advantage of a dental background to assist in the interpretation of images and implant planning.
“3D imaging is an essential tool for implant planning. Apart from the obvious advantages of being able to identify structures such as sinuses or the inferior alveolar nerve – which must be taken into account when determining the choice of implant size and positiion – it also gives the clinician the ability to plan the positioning of an implant before they commence surgery and anticipate difficulties before they arise.
“It is too late to be contending with unexpected issues or to be planning your choice of implant position once you have commenced your surgical procedure.”
Asked for how Promax 3D Mid had transformed his surgery, Dr Schlen evaluates: “Now we get the images that we want, the way we want them, when we want them.”
As for his CBCT-buying experience, it couldn’t have been more triumphant. Dr Schlen gladly reiterates, “Planmeca was the only unit that ticked all the boxes and in truth, we were lucky because nothing else even came close.”