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 ENTAL
CAT SCANS are becoming endo friendly! New technology and software are allowing
a virtual 3-D view of the roots and surrounding bone. Better diagnosis
makes better treatment. Dr. Alan Winter, a New York periodontist whom many
of you know, describes it in detail below.
—Allan S. Deutsch
THE NEWTOM® 9000 is not a GPS guided missile system, but it does have
pinpoint accuracy. NewTom is an abbreviation for new tomography,
a technology with great promise. Until now, computed tomography (CT)
imaging, also known as CAT (computed axial tomography) scanning, has been
ordered primarily by dentists who place implants, and in certain diagnostic
situations where 3-D imaging helps formulate a diagnosis. Dental
CT scans reformat a series of spiral images into recognizable dental structures.
The result is a series of transaxial and axial views that enable us to
locate the mandibular nerve, observe the size and shape of the maxillary
sinus, determine whether a cyst has broken through the cortical plate,
note the dimensions and placement of atrophic ridges, and do so much more
as well.
What does the NewTom 9000 offer beyond all that?
Plenty.
Accuracy
The first thing that impresses us is NewTom’s accuracy. Although
dental CT scans provide detailed information, dimensions can be off by
as much as 1.5 mm. That may not seem to be much, but when there is
only 10 mm above the mandibular nerve, technical errors on the magnitude
of 1.5 mm cannot be overlooked. Why does the error occur? Dental
CT scans take a series of parallel spirals and convert them into specific
images by sophisticated algorithms. The computer compensates for
the small gaps between the spirals, but these gaps accumulate into a margin
of error. The manner in which a technician places the patient’s head
also contributes to the error.
The NewTom differs from a traditional dental CT
scan in the way it captures an image; it does so by cone beam volumetric
tomography. The X-ray tube revolves around the patient’s head in
a single spiral, capturing a volume with each of the 360 degrees it rotates.
Added together, the volumetric cone images are reformatted without any
discernible error. In fact, the NewTom is accurate to 0.1 mm.
Reduced Radiation
Accuracy is good, but what else separates the NewTom from a traditional
dental CT scan? In two words, less radiation. While a dental
CT scan takes ten minutes of working time and exposes the patient to two
minutes of radiation, the NewTom scan takes 70 seconds and exposes the
patient to 17 seconds of low-dose radiation. The radiation from a
NewTom scan is comparable to the radiation from a single Panorex, while
a dental CT scan is roughly equivalent to 6?8 times that amount, depending
on bone density.
More Information
Another difference is that a dental CT scan shows only what is prescribed:
either the mandible or maxilla. If a patient needs both a maxillary
and mandibular CT scan for implants, the total radiation is equivalent
to about 15 Panorexes. The NewTom, however, takes both the maxilla
and mandible with a radiation dose equivalent to that of a single Panorex.
In addition to both jaws, the NewTom scan displays both TMJs and the sinuses,
as well. Another advantage of the NewTom is that the fees are much
less for much more information.
Tomographic Images and Endodontics
Okay, so we’re talking about greater accuracy, more information, less radiation,
quicker scans, but why would endodontists be interested in dental tomographic
images? The answer is evident once you see what this machine is capable
of doing. For example, consider the following:
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An axial cut on the NewTom easily identifies a second hidden canal in the
MB root of a maxillary first molar. Actually, the axial cuts of the
NewTom cut through each root, millimeter by millimeter, depicting every
canal of every root of every tooth.
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Transaxial cuts reveal hidden roots or untreated roots that require endodontic
treatment.
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Coronal cuts are so specific that they can separate the MB from the DB
root of a maxillary molar, permitting an accurate diagnosis of which root
has periapical pathology and which doesn’t. Extrapolate this to the
next step, and the NewTom distinguishes between sinus and dental infections.
You can see why we are so excited about the NewTom.
It gives more information about the teeth, the root canals, condyles, mixed
dentitions, impacted teeth, and supernumeraries than conventional CT imaging
does, and it helps detect and diagnosis pathology with greater accuracy
than anything else currently out there. It won’t solve every problem
for us, but in an age that demands greater precision and predictable results,
the NewTom brings us one step closer to the elusive gold ring of 100 percent
detection and diagnosis that we all strive to grab.
For those needing one more reason to try this technology,
the NewTom 9000 can produce studies in both NewTom and SimPlant¨ formats.
Implant studies can be ordered along with views of the TMJ; chronic pain
sufferers can get specific pictures along with detailed panoramic cuts;
and patient studies are always on file for future review.
If the NewTom interests you as much as it has captivated
us, call me at APW Dental Services, PC, (212) 838-8302, and request a descriptive
brochure. Not only do we have the first NewTom 9000 in New York City
at APW, but we have the only one on the East Coast. We are located
in a historic townhouse at 34 East 62nd Street, and we would be pleased
to have you visit our office or arrange for a personal in-office demonstration.
Dr. Herbert Frommer, director of radiology at NYU Dental Center and the
only board-certified oral and maxillofacial radiologist in New York City,
reads every scan for pathology including the structures of both jaws, the
sinuses, airway space, and temporomandibular joints. APW is a radiology
lab run by dentists for dentists.
May-June 2003
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