LESSONS FROM ENDODONTICS
in the shape of paddles that allow the rubber
dam to stay on while capturing an image and
not violating sterilization protocol.
I like the software features of the DEXIS
Imaging Suite. My Soredex 3-D CBCT imaging
is stored in the DEXIS software. When I view
the patient’s imaging in DEXIS, I can switch
between 2-D and 3-D images. In other words,
I don’t have to open up different software.
This type of workflow ease is essential in
streamlining the patient experience.
3-D technology allows for thorough treatment planning ( figure 3). While I do not take
a 3-D scan on every patient, 3-D images are
captured when we feel the benefit outweighs
the risk to the patient. Some examples of this
are a failing root canal, a presurgical consulta-
tion to determine an odontogenic or nonodon-togenic lesion, or if the source of the patient’s
chief complaint is not obvious on the 2-D ra-
diograph. Some other uses for CBC T are when
I sense complicated anatomy, resorption, per-
forations, or instrument failures.
The 3-D imaging software also allows me
to take measurements that I use in conjunc-
tion with my microscope to locate difficult
anatomy in a conservative manner. Also, I can
be more cautious when using a CBCT during
treatment planning. The technology helps me
confirm when not to treat certain “hopeless”
teeth. Before implementing 3-D imaging, I
would have had to open up the tooth or per-
form an irreversible procedure, only to dis-
cover that the tooth could not be saved.
It is interesting to note that when looking
at a preoperative image with CBCT, 62% of
clinicians change their treatment plans be-
cause they receive more information.
treatment changes when one has the full
knowledge to create a more thorough treatment plan.
gies, my investments continue to pay back
over the years in better diagnostics and more
efficient treatment methods. When patients
see these high-quality imaging methods and
realize their endodontist is investing in better
patient care, the reputation boost contributes
to your monetary return.
1. Ee J, Fayad MI, Johnson BR. Comparison of
endodontic diagnosis and treatment planning
decisions using cone-beam volumetric tomography
versus periapical radiography. J Endod.
2014; 40( 7):910-916.
DIWAKAR KINRA, DDS,
MS, received his dental
degree in 1999 from the
University of Michigan and his
master’s degree in
endodontics from the
University of Detroit-Mercy in
2004. Afterward, he began his
solo private practice limited to
endodontics in Flint, Michigan. Dr. Kinra is an adjunct
professor at the University of Detroit-Mercy
Department of Endodontics and Periodontics. He
lectures extensively on practice management and
Our patients benefit from seeing their images. I have a monitor on the footrest of the
patient’s chair that I use to show both 2-D and
3-D images. When patients see their images
in conjunction with my explanation, they understand the problem and why they need a
certain procedure. Case acceptance goes up
tremendously when patients are actively involved in their own health care.
Here is some advice before adding 3-D
technology to your office. Learning to use a
CBCT is not difficult, but check to make sure
that proper training is incorporated into the
cost of the machine. Look for a company that
has a good track record when it comes to
service and stands behind the product it sells.
There is a learning curve, so stick with it and
get help from mentors when needed. Also,
choose a brand within ALARA (as low as rea-
sonably achievable) radiation standards. If
you are uncomfortable with reading CBCT
images or suspect an anomaly, send the scan
to an oral radiologist.
Endodontists are notorious for being early
adopters of technology. I can’t believe that it
has been 12 years since I began using 2-D
digital radiography. As with my other technolo-
Figure 2: Detailed 2-D
radiographic image quality,
as seen in these images,
is imperative for diagnosis
3-D CBCT offers
views of the