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Welcome to ORASCAN CBCT

ORASCAN CBCT is western Maharashtra’s most advanced imaging centre for the face, teeth and jaws. At ORASCAN, we utilize the latest state of the art equipment available, which permits the lowest radiation dose possible, while producing the clearest, highest detailed images for you. Our imaging centre uses modern sterilization techniques, and the procedures are fast and painless. ORASCAN - THE first direct digital dental imaging center in WESTERN MAHARASHTRA is in KOLHAPUR.

Our services include Cone Beam CT, digital photography with intraoral close-ups, panoramic projection x-rays, cephaolgrams, tomography and other standard medical, dental and orthodontic radiographic services.

By adding ORASCAN CBCT to your practice, you gain a full imaging laboratory without giving up any office space. For the best service, our facility utilizes a streamline layout for the fastest processing of patients in an open, relaxing atmosphere. A call to ORASCAN today puts you in command of the best imaging equipment and a friendly, knowledgeable staff including a licensed ORAL radiologist.

About Us

3-Dimensional Imaging is revolutionizing dentistry. It is improving diagnosis and treatment in oral surgery, implant dentistry, orthodontics, and endondontics. Computed Tomography (CT) is not new, but with the development of CBCT units now available, these images can be produced with significantly less radiation exposure (upto 98% less) compared to medical CT, shorter scan times (10-15 seconds in the office), and lower cost.

The CBCT provides the dentists with a road map of sorts to plan surgical treatment. With the ability to identify vital anatomic structures such as nerves and blood vessels, with CBCT the dentist will be able to plan the best possible treatment while decreasing the risk of complications.

The software programs available now, also allow for 3-D reconstructions that are difficult to obtain and manipulate with a medical CT. We have the CARESTREAM CS9300 SELECT - a Superior large field of view CBCT in our centre. This is the first of its kind in Western Maharashtra and North Karnataka.

We are seeing a shift in implant dentistry as CBCT is incorporated. It is rapidly becoming the standard of care in implant dentistry. This is due in part to the ability to identify potential problems due to bone volume, or the location of the maxillary sinus or inferior alveolar nerve. With the ability to take direct measurements off of CBCT images, this far exceeds what can be done with panoramic x-rays or periapical films.

Before you have a dental implant placed, you should ask your surgeon or dentist to have a CBCT. The benefit of the scan will far exceed the cost.

Equipment - CARESTREAM CS9300

MULTIPLE FIELDS OF VIEW

With the CS 9300, we have selectable fields of views like 5 x 5cm, 10 x 5cm, 8 x 8cm and 10 x10cm. This gives us greater flexibility and the ability to collimate the field of view based on our patients’ diagnostic needs.

MULTI-MODALITY

The all-in-one CS 9300 is the most versatile multi-modality imaging system from Carestream Dental. In addition to its exceptional 3D imaging capabilities, it offers 2D digital panoramic imaging with variable focal trough technology—delivering crystal-clear images every time it’s used. It can even be upgraded to include one-shot cephalometric imaging. For practitioners who have been waiting to integrate cone beam computed tomography into their practice, the CS 9300 is the perfect option, giving you the most capabilities available in one compact, all-in-one system.

SUPERB IMAGE QUALITY

With image resolution up to 90 μm, the CS 9300 delivers a superb level of detail, allowing you to collect valuable diagnostic information for a range of clinical applications, including focused-field, single jaw, dual jaw, single and double TMJ, dual jaw, sinus and maxillofacial examinations.

INTELLIGENT DOSE MANAGEMENT

The CS 9300 gives practitioners a new degree of control when it comes to limiting radiation exposure for patients. The system uses cone beam computed tomography for image capture, which delivers lower radiation dosage than conventional CT units. To further limit radiation exposure, the system also allows users to collimate the imaging area based on their clinical needs. And, depending on the field of view you select, images are taken in as little as 12 seconds, once again limiting exposure time and reducing the risk of blurred images. The CS 9300 even lets you use preview image “scout” technology to evaluate patient positioning before 3D acquisition. This combination of speed, image quality, and precise placement dramatically reduces the need for retakes. Meanwhile, the optional cephalometric modality features one-shot technology to capture images in less than a second. When combined, these features make the CS 9300 the ideal system for practitioners in terms of both capabilities and radiation dose, adhering to the ALARA Principle (the “As Low as Reasonably Achievable” radiation standard that recommends taking any necessary precautions to minimise radiation exposure for patients).

EASY CASE REVIEW AND PLANNING

Our industry-leading imaging software has been designed by clinicians, for clinicians. The CS 9300 comes pre-installed with Carestream Dental’s innovative CS 3D imaging software. This complimentary feature not only facilitates a number of functions to enhance treatment planning, but also delivers fast, accurate results for better patient communication. View images slice-by-slice in axial, coronal, sagittal, cross-sectional, and oblique views to enhance diagnostic interpretation. The software includes two sophisticated implant planning features, allowing you to select from a comprehensive library of implant manufacturers or create your own custom implant sizes. It also shows visual representation of the long axis, the restorative space, and allows planning for customised abutments. And, there’s even a robust TMJ analysis feature

CBCT Benefits & Applications For Doctors

  1. We can export CBCT in DICOM format for 3rd party software viewers.
  2. We have a free interactive viewer per your request for our CBCT scans.
  3. A copy of the images will be on a CD and are in either PDF or JPEG format for easy management.
  4. PDF documents can be printed on your printer 1:1. (make sure your settings are correct)
  5. Images can be printed on 12 bit grey scale medical grade paper or film.

DID YOU KNOW?

  1. Images generated from the CBCT scanner are of highest diagnostic value.
  2. Your patients receive the lowest possible x-ray dose from this scan.
  3. Our staff is highly trained and possess the skills needed for this advanced technology
  4. Digital scans can be duplicated as needed
  5. An infinite number of views can be generated from CT scan

CBCT vs Everything Else

CBCT versus Dental X-ray

Cone beam images provide an undistorted or accurate dimensional views of the jaws. Panoramic images, by contrast, are both magnified and distorted. Magnification by itself is not a problem, as long as one knows or can calculate the magnification factor. Distortion, on the other hand, is the unequal magnification of different parts of the same image. (see Figure below). Due to distortion panoramic images are notoriously unreliable to use for making measurements.

In addition, while CT images can provide cross-sectional (bucco-lingual), axial, coronal, sagittal, and panoramic views, a panoramic film provides an image of only one dimension, namely a mesio-distal or antero-posterior perspective. Further, in a panoramic image all the structures between the x-ray tube and the image detector are superimposed on one another. With CT it is possible to separate out the various structures, for example, the left condyle from the right one.

CBCT compared to Tomography

Unlike panoramic radiography, plain-film tomography, if performed with the appropriate equipment, does not result in distortion. Like panoramic radiography, however, it does result in magnification, the degree of which differs from manufacturer to manufacturer. Plain-film tomography provides direct (as opposed to reconstructed) cross-sectional, sagittal and coronal views. The disadvantage of plain-film tomography is that it requires much more chair time than CT. It can thus be especially difficult to do on patients who are unable to sit or hold still for a period of time. Cone beam CT, on the other hand, can be performed within a 10-40 second range, depending on the region being imaged and on the desired quality of the image. Cone beam CT also provides stronger indication of bone quality.

CBCT versus MDCT

  • Cost of equipment is approximately 3-5 times less than traditional Medical CT
  • The equipment is substantially lighter and smaller.
  • Cone beam CTs have better spatial resolution (i.e. smaller pixels)
  • No special electrical requirements needed
  • No floor strengthening required
  • The room does not need to be cooled
  • Very easy to operate and to maintain; little technician training is required
  • Some cone beam manufacturers and vendors are dedicated to the dental market. This makes for a greater appreciation of the dentist ’s needs
  • In the majority of cone beam CTs the patient is seated, as compared with lying down in a medical CT unit. This, together with the open design of the cone beam CTs virtually eliminates claustrophobia and greatly enhances patient comfort and acceptance. The upright position is also thought by many to provide a more realistic picture of condylar positions during a TMJ examination
  • The lower cost of the machine may be passed on to the patient in the form of lower fees
  • Both jaws can be imaged at the same time (depending on the specific cone beam machine)
  • Radiation dose is considerably less than with a medical CT.

Limitation of CBCT compared to regular MDCT

Lower contrast resolution which means less discrimination between different tissue types (i.e. bone, teeth and soft tissue)

Sample MDCT axial image to compare with Conebeam for contrast resolution
Sample Conebeam axial image to compare with MDCT for contrast resolution

3D Color Plot Comparison

Images show a color plot comparing two maxilla 3D reconstructions of the same patient rendered from a conebeam CT and a regular MDCT scanner.

Parameter/scanner Newtom 3G GE light speed ultra
Slice Thickness 0.5 mm 1.0 mm
Pixel size 0.25 mm 0.293 mm
Total number of image 60 28
3D processing time 60 min 25 min

  • The same experienced imaging processor used best 3D outcome judgments on both models.

Both models were registered together using 4 distinct anatomical structures. A color plot of the deviation between both models is then calculated using the MDCT 3D as the reference model and the CBCT 3D as the test model. Shortest distance was used as the deviation measurement algorithm. Units in Millimeters.

3D & Stereolithography

Stereolithography Models

Stereolithography is one of a set of engineering technologies called Rapid Prototyping. Rapid prototyping allows the fabrication of physical replicas of 3D computer generated models in a layered approach. After the generation of a 3D rendition, software slices the file from top to bottom and then the slice data is sent to a machine that fabricates the part slice by slice. The technology is mainly used for engineering purposes for the quick fabrication of design parts for physical analyses, form, fit and functional testing before full scale fabrication. The slice by slice fabrication technique found a strong marriage with the Computed Tomography data for fabrication of anatomic structures (Biomodels)

Stereolithography in specific fabricates parts from a vat of photo-curing polymer using a computer guided UV laser. The UV laser moves scans the curing polymer, fusing the selected layer onto a platform. The platform then shifts down the thickness of one slice and the laser sweeps the second layer. Thenprocess is repeated many times until the part is built from bottom to top. Slice thickness vary from 0.15mm-0.05mm (higher slice resolution than CT, which varies from 0.1mm-3mm). The most commonly used resins in medical applications is the stereocol resin, which is medical grade resin that is FDA class VI approved for sterilization and use in the operating room.

Stereolithogrpahy operation



Acquiring Stereolithography Models

Specializes in the production of physical solid models from data generated from MRI, CT and Conebeam scans. BMI Biomodels are accurate, tactile, three-dimensional representations of patient anatomy. Send the data to BMI on CD or using their FTP server to fabricate a custom Biomodel for you.

Download their CT scanning protocol

Allows you to import Conebeam data, perform image segmentation, 3D rendering and interface with Rapid Prototyping technologies including Stereolithography.

Dental Implant Planning

Guided surgery can be used to position implants precisely into predetermined positions using a guided surgery kit. Our planning team will use software’s to optimally plan implant positions for your patient with respect to the radiographic stent and the patient's bone.

Screenshots of the planning will be emailed back for approval before a guide is ordered. To do this we need original scan data for your patient with a radiographic prosthesis/stent in place and similar data for the stent on its own. If the scan has taken place, or is to take place at our Orascan CBCT Imaging centre, then we will have this data on file. It is essential that these scans are obtained with the patient in the planned occlusion, with stent and "bite" fully seated.

We need to know the optimal number of fixtures that you would like to use, with an indication to the extent and form of the planed prosthesis. If you have a strong opinion as to where the fixtures should be placed please let us know. Please also share views on fixture angulation and abutment selection. We will also need to know which implant system you would like to use. Once planning has been completed you will be sent a surgical and laboratory specification and a viewing file of the planning for your approval. You will be asked to confirm that you have been trained in implant surgery and in guided surgery, and that you have approved the final planning.

Cosmetic factors are not always easy to assess from scans and planning alone. It is therefore important that the surgeon and prosthodontist who are carrying out the treatment fully appreciate and react to cosmetic aspects of the precise implant emergence and position in aesthetically sensitive cases - for example it may be inappropriate to produce a definitive bridge or crown unit on the basis of computer planning alone. Allow 5 working days for planning, and 10 working days for manufacture of the guide.

SURGICAL TEMPLATE

Translating the virtual or physical plan from the virtual or physical model, to the operative field, is facilitated by a cutting or drilling template or guide.

These are available in a range of materials from our in-house laboratory, but we are also pleased to liase with your own laboratory service.

Our templates and guides are used wherever bone is prepared or manipulated. Guides may be used to precisely position pre-bent fixation plates or craniofacial or orthopaedic implants

Surgical accuracy may be measured by our scientific team using a variety of software techniques.

Pediatric Dental Radiology

What is Pediatric Dental Radiology?

There are many different types of x-ray images (pictures) that can be taken of children in the dental office to assist in diagnosis. These include the panoramic and orthodontic (cephalometric) extraoral images, intraoral images such as bitewings and periapicals (little films that go inside the mouth) and cone beam computed tomography (CBCT). All of these dental images use ionizing radiation (x-rays), and therefore parents may be concerned about the increased cancer risk (because of the x-rays) to their children. The following provides information on the risks of dental images in relation to their benefits.

What is X-ray?

X-rays are invisible beams of ionizing radiation. X-rays that are directed to the body do not pass through without changes but are absorbed differently by various tissues of the body. Once they pass through a body part, they are captured by the film and produce images in tones of gray showing calcified stuctures such as the jaw bones, teeth, and other bony structures. The use of x-rays to create dental images is not painful but during the procedure, the child must stay still or else the image may be fuzzy. In some circumstances, parents may be asked to help keep their children still while dental images are taken. Depending on the area of the jaw imaged and the type of dental image, a lead body apron or thyroid shield may be used to reduce radiation exposure to other body areas not being imaged.

What is a panoramic film?

Panoramic films belong to the extraoral category of dental x-rays because the film is outside the mouth. The panoramic film provides to the dentist a good view of the maxilla and mandible as well as the whole dentition. Panoramic films also provide a partial view of the temporo-mandibular joint. One of the major advantages of the panoramic films is the short time required to acquire the image. Panoramic films are widely used by dentist because it provides a comprehensive “panoramic” view of the maxilla and mandible. It is commonly used for evaluation of the wisdom teeth or for the evaluation of potential fractures in trauma cases.

What is a periapical film?

Periapical films belong to the intraoral category of dental x-rays because the film is inside the mouth. The name “periapical “means that this film is designed to evaluate the root and crown of the teeth. The dentist usually takes periapicals of the back and anterior teeth.

What is a bitewing film?

The name “bitewing” refers to a little tab of paper or plastic situated in the center of the x-ray film, which when bite on, allows the film to hover so that it captures an even amount of the maxillary and mandibular teeth. Bitewings are designed to evaluate the crowns and the most superior part of the bone around the teeth. They do not provide information of the roots of the teeth. Dentist usually uses bitewings for evaluation of the area in-between teeth looking for caries. The Indian Dental Association (IDA) recommends bitewings for children (until the eruption of the first permanent molars) only if the spaces between teeth cannot visualized in the clinical exam. For children with high risk of decay, the recommendation is to take bitewings every 6 to 12 months (if the spaces between teeth cannot be visualized in the clinical exam). For children with low risk of decay, the recommendation is every 12 to 24 months. The clinical judgment of the dentist is at the end, the most important criteria.

What is Cone Beam Computed Tomography (CBCT)?

Over the past 10 years, cone beam computed tomography (CBCT) has become increasingly available for use in dental offices. CBCT produces images similar to computed tomography (CT) used in medicine except that CBCT may expose a child to less radiation dose. In CBCT an x-ray device rotates around the head to create many individual pictures of the child's jaw and teeth, and these individual images are used to build a virtual three-dimensional (3D) representation (main advantage of CBCT vs. other dental radiographs). This virtual image may contain diagnostically important information that is not present in other dental images such as bitewing or panoramic image. However, taking a CBCT image results in more radiation dose to the child than other commonly used dental images.

Preinstalled Scanner Software

Scanner Pre-installed Software

All Conebeam scanners come with preinstalled software for image manipulation, for added image functionality. Such imaging tools include:

  • Multi Planner Reformats MPR,
  • 3D volume data is usually acquired in the axial plane of the patient (top to bottom slices). MPR creates sagital, coronal and transverse images from those axial images (basically front view and side view slices). The display of the images in such formats allows the effective visualization of section to section change in the scanned structure. MPR images are available in all pre-installed Conebeam scanner software. The software also allows you to take measurements on the slices and measure Hounsfield values.

Sample MPR from Conebeam data

  • Panoramics, Conebeam
  • images could be used to generate accurate 3D panoramic slices along a specified curve either using pre-installed software that comes with the Conebeam machine or 3rd party software. Panoramic images generated from Conebeam scanners are more accurate than conventional panoramic images for 2 main reasons:

  1. No tissue superimposition
  2. No image distortion, ie 1 to 1 scale images for accurate measurements

Sample panoramic slice created from Conebeam data. Note very rare case of impacted second molar

Sample Cross sectional slices through panoramic images displayed earlier (note impacted Tooth)

  • Maximum Intensity
  • Projections (MIP), MIP algorithm evaluates each Conebeam voxel along a ray through the viewer’s line of site and the maximum voxel value is selected as the pixel to be displayed in the resulting image. Such representation allows the viewer to appreciate the depth of the rendering.

Sample Conebeam MIP

  • Visualization of Mandibular canal:
  • 3D Volume Rendering, This technique
  • renders the entire volume of Conebeam data, by summing up the value of each voxel along the viewer’s line of sight through the complete data set. The process is done repeatedly to determine the pixel value to be displayed in the resulting image. 3D volume renderings allows:

  • Realistic visualization of 3D volume data
  • Characterization of disease
  • Appreciation of anatomic relationships

I-Cat 3DVR software Sample Bone 3D Volume Rendering of Conebeam Data set


Newtom software 3D volume renderings

Registration for Software Training

Patient Referral Form

What is CBCT?

To better explain what Cone Beam CT ( CBCT ) is, we should first explain what regular CT is:

Computed tomography (CT) imaging, also referred to as a computed axial tomography (CAT) scan, involves the use of rotating x-ray equipment, combined with a digital computer, to obtain images of the body. Using CT imaging, cross sectional images of body organs and tissues can be produced. Though there are many other imaging techniques, CT imaging has the unique ability to offer clear images of different types of tissue. CT imaging can provide views of soft tissue, bone, muscle, and blood vessels, without sacrificing clarity. Other imaging techniques are much more limited in the types of images they can provide.

To understand the difference between CT imaging and other techniques, consider an x-ray of the head. Using basic x-ray techniques, the bone structures of the skull can be viewed. With magnetic resonance imaging (MRI), blood vessels and soft tissue can be viewed, but clear, detailed images of bony structures cannot be obtained. On the other hand, x-ray angiography can provide a look at the blood vessels of the head, but not soft tissue. CT imaging of the head can provide clear images not only of soft tissue, but also of bones and blood vessels.

CT imaging is commonly used for diagnostic purposes. In fact, it is a chief imaging method used in diagnosing a variety of cancers, including those affecting the lungs, pancreas, and liver. Using CT imaging, not only can physicians confirm that tumors exist, but they can also pinpoint their locations, accurately measure the size of tumors, and determine whether or not they’ve spread to neighboring tissues. In addition to the diagnosis of certain cancers, CT imaging is used for planning and administering radiation cancer treatments, as well as for planning certain types of surgeries. It is useful for guiding biopsies and a range of other procedures categorized as minimally invasive. Thanks to its ability to provide clear images of bone, muscle, and blood vessels, CT imaging is a valuable tool for the diagnosis and treatment of musculoskeletal disorders and injuries. It is often used to measure bone mineral density and to detect injuries to internal organs. CT imaging is even used for the diagnosis and treatment of certain vascular diseases that, undetected and untreated, have the potential to cause renal failure, stroke, or death.

So, what exactly is Cone Beam CT?

In layman's terms, CBCT is a compact, faster and safer version of the regular CT. Through the use of a cone shaped X-Ray beam, the size of the scanner, radiation dosage and time needed for scanning are all dramatically reduced. A typical CBCT scanner can fit easily into any dental ( or otherwise ) practice and is easily accessible by patients. The time needed for a full scan is typically under one minute and the radiation dosage is up to a hundred times less than that of a regular CT scanner.

Patient Benefits

Regular MDCT scanners are large-sized machines mostly available at hospital and major diagnostic scanning centers,while Cone Beam scanners are much smaller in size and mostly available at the clinicians’ office or at dedicated maxillofacial scanning centers.



Most of the CBCT scanners are square like machines with a chair. You will sit upright while a C-arm rotates around your head.Within the arm there is an X-ray source and detector (X-ray receiver),which will make one complete 360° rotation for each scan. While the arm is rotating, it is capturing multiple images of your head from different angles. These images are then reconstructed to create a 3D image of your internal anatomy. Some of the CBCT scanners have you lay down on a table that can move up or down, and slide into and out of the center of a hole, while a gantry makes the 360° rotation.


How does the CT scan help my Physician or Dentist?

It allows him/her to:

  • Visualize internal anatomy that can not be diagnosed externally
  • Plan treatment and surgery
  • Prepare necessary aids
  • Assess risk
  • Analyze the position and orientation of critical structures, like nerves, teeth roots, previous implants, the sinus and nose

Is it painful?

No, the CBCT scan process is completely painless.

Is it handicap-accessible?

The iCAT scanner from Imaging Sciences International is handicap Accessible

What are the Cone Beam scanners used for?

  • Oral surgery
  • Implant planning
  • Orthodontic planning & implant anchorage
  • Cephalometric analysis
  • TMJ analysis
  • Airway study (sleep apnea)
  • Jaw tumors
  • Impacted teeth
  • Periodontal diseases
  • Endodontic anomalies

How much does a scan Cost?

Cone Beam scans cost between $250-$600 depending on locality.

Why a CBCT scanner rather than a regular Medical CT scanner?

  • X-Ray Radiation exposure to the patient is up 10 times less than a regular CT scanner.
  • Much faster scan time. Scan on a CBCT takes between 10-40 sec, while on a regular CT scanner it takes a few minutes.
  • Cheaper, average price of a CBCT scan could be up to 50% less than a regular MDCT scan.

What are the benefits versus risks?

Benefits

  • Unlike regular x-rays CT scans can discriminate between many types of tissue including bone, teeth, nerves and soft tissue.
  • CT scans are noninvasive, and can eliminate the need for exploratory surgery in some cases.
  • CT can identify the effects of conditions such as infection and tumors.
  • A cost effective tool for imaging a wide range of clinical problems.

Risks

As with all imaging modalities that use ionizing radiation, the use of CBCT does involve a consideration of risk to the patient. However, it has the benefit of providing useful information needed to assist in making a diagnosis and/or in facilitating treatment. When your doctor refers you for an x-ray examination, he has made the determination that the benefit outweighs the risk. Of course, it is ultimately up to you to decide whether to undergo the examination.Bear in mind that the risk of most x-ray examinations are much less than other risks we commonly accept in daily life.

How should I prepare for the scan?

No special preparation is needed for a CBCT scan of the head. You should wear comfortable, loose-fitting clothing for your CBCT exam. Anything that might interfere with imaging such as earrings, necklaces,piercing, hairpins or eyeglasses should be removed. The x-ray technician may ask you to also remove dentures or other appliances, but it is advisable to bring these along to the appointment as the technician may on occasion want to use them.

Patient's Perspective

Services & Advantages:

CBCT 3D imaging technology is far superior to conventional 2D dental imaging, as it enables practitioners to visualize all dental and facial structures in three dimensions and identify potential pathologic hard tissue lesions and other abnormalities. It also provides the most accurate diagnosis and treatment planning in general dentistry, periodontics, implant planning, oral maxillo-facial surgical cases, and orthodontics. It is crucial for your dentist to have the most accurate and complete information to properly plan your treatment. Unlike traditional x-rays, the Cone Beam CT image is a three dimensional computerized image that enables your dentist to very carefully and precisely diagnosis and plan your treatment. Safe and reliable 3-D cone beam imaging provides that information, with a host of additional advantages for both you and your dentist.

Advantages of 3-D Cone Beam imaging for patients

  1. No pre-scan preparation needed
  2. Your scan only takes 18 seconds, it's quick and painless!
  3. Significantly reduced radiation and greater accuracy than conventional medical CT machines
  4. 3-D images rather than "flat" dental pictures to visualize "inside" skull and jaw bone
  5. Infinite number of views created from one scan taken in seconds

How does the scan help my dentist?

It allows them to:

  1. Visualize internal anatomy that cannot be visualized externally.
  2. Plan treatment and surgery
  3. Prepare necessary aids
  4. Assess risk
  5. Analyse the orientation and position of critical structures like nerves, teeth and roots.
  6. Helps to ensure a faster, safer dental procedures.

Should I prepare myself for the scan?

No special preparation is required before a CBCT scan. Anything that may interfere with the imaging such as earrings, eye-glasses, hair pins or piercings should be removed. This interference takes the form of a ‘scatter’ which distorts the image in the immediate surrounding area.

The technician may ask you to remove dentures or other appliances, but it is advisable to bring these along for your appointment, as the technician may want to incorporate these into your scan.

What should I expect at my appointment?

The scan is acquired by simply positioning you in an upright position while the machine spins 360 degrees around your head. Unlike many other technologies, this procedure is safe, non-invasive and requires about 98% less radiation than the medical spiral CT.

On arrival, our staff will spend about two minutes explaining the acquisition process. The scan will take about 20 seconds. If you wish, you can also review you 3D scans on our computer screens. Our appointments average about 20 minutes from start to end.

Here you'll find the most important information that you need before you visit our Orascan CBCT Imaging Center.

Referral:

You may be referred to our centre by your family dentist, a dental specialist, or a physician. The focus at our Orascan CBCT Imaging Center is the doctor-patient relationship with a commitment to delivering the highest quality clinical practice. The partners who staff the service reflect this focus.

Technology:

This professional expertise is supported by state-of-the-art technology. The Orascan CBCT Imaging Center just recently became one of the first clinics in the Western Maharashtra to install the Carestream 9300 Cone Beam CT scanner. Carestream may not be a commonly known name, but it is the successor to the Kodak Medical Imaging group which has over 100 years of expertise in the field. The 9300 offers the same diagnostic capabilities as traditional CT imaging, at the same time reducing patient exposure to a level no greater than your typical annual dental exam with plain speed film.

Partnership with your Doctor:

Please note that we respect the relationship you have with your doctor or dentist. Your contact will be with our office staff.

It is the desire of all those involved with Orascan CBCT Imaging Center to provide you with the state-of-the-art dental imaging and patient safety combined with the highest professional quality interpretation at a cost-effective price.

What are the benefits versus risks?

Benefits

  • Unlike regular x-rays CT scans can discriminate between many types of tissue including bone, teeth, nerves and soft tissue.
  • CT scans are noninvasive, and can eliminate the need for exploratory surgery in some cases.
  • CT can identify the effects of conditions such as infection and tumors.
  • A cost effective tool for imaging a wide range of clinical problems.

Risks

As with all imaging modalities that use ionizing radiation, the use of CBCT does involve a consideration of risk to the patient. However, it has the benefit of providing useful information needed to assist in making a diagnosis and/or in facilitating treatment. When your doctor refers you for an x-ray examination, he has made the determination that the benefit outweighs the risk. Of course, it is ultimately up to you to decide whether to undergo the examination.Bear in mind that the risk of most x-ray examinations are much less than other risks we commonly accept in daily life.

Various Diagnostic Services offered at the Orascan CBCT Imaging Centre

  1. Implant studies to provide a high resolution, 3-D view of critical anatomy and bone structure and density to optimize implant placement.
  2. Oral surgery studies to provide precise tooth position and proximity to vital structures, such as the nerve canal, sinus walls, and cortical borders. For any pathology in the maxilla or the mandible, accurate bone measurement and effect of the lesion on critical anatomical structures like the inferior alveolar canal, cortical bone, and sinus will be provided.
  3. TMJ studies will include coronal, sagittal, and axial views of the TMJ. 3-D views of condyles and surrounding structures will also be provided.
  4. Orthodontic diagnosis and treatment studies will provide the multiple projections needed to accurately evaluate the relationships of the teeth and the jaws. Accurate 3-D views of impacted supernumerary or impacted teeth in relationship to other anatomical structures will also be provided.
  5. Sinus and airway studies will help identify airway problems and polyps. Axial, sagittal, and coronal views of the airway will be provided.

Dental Implant Planning

The Guided Surgery Concept is an amalgamation of exciting, innovative techniques in implant dentistry, imaging, and laboratory technology.

The approach is to:

  • Plan surgery using 3D software to interpret the CT scan and create a "virtual model" of the jaw. Simulate implant placement on the computer in the 3D "model".
  • Use this information to create a custom made Drill Guide. Once again the software interprets the 3D computer model and implant positioning information, to produce a computerised specification for this physical Guide.
  • The Guide is produced using 3D printer technology. It is fitted in the mouth, and implant surgery takes place using the guide to precisely align the drills and implants. Because the implants are inserted precisely into predetermined positions there is no necessity to raise gum "flaps" in order to see directly what is being done to the jaw. This means that pain, swelling and bruising are all minimised.
  • In most cases, the fact that your surgeon has already decided precisely where the implants are to be placed means that temporary or the definitive bridgework can be made before the surgery even takes place. This means that it is often possible to fit bridgework within an hour of starting the procedure - Immediate smile or Teeth-in-an-hour.
  • The very great advantage of these techniques is that treatment is minimally invasive. This means that even when there is little bone available and it is a struggle to find sufficient support for bridgework, the implants can be placed with little impact on the patient. There is usually no need for cutting with a scalpel, or stitches, (and therefore no need to have stitches removed).

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Applications

Endodontics

Endodontic Indications for CBCT

  • Differentiation of pathosis from normal anatomy

  • Relationship with important anatomical structure

  • Management of aberrant anatomy (ie: dens, c-shapes)

  • External & Internal resorption

  • Root perforations

  • Accessory/ missed canal identification

  • Management of fractured instruments

  • Aiding surgical planning

  • Retreatments

  • Traumatic injuries

  • Intra-operative (ie: finding canals)

  • MSDO

  • Calcified cases

  • Facial pain cases to rule out odontogenic etiology

Extraordinary detail at low exposure levels

  • Diagnose endodontic pathosis

  • Assess canal morphology

  • Assess pathosis of non-endodontic origin

  • Evaluate root fractures and trauma

  • Analyze external and internal root resorption and invasive cervical resorption

  • Plan surgeries and implants




Top Left: 3D image with a 76 micron high resolution axial slice clearly reveals three canals in the mesial root of the lower left first molar.

Bottom Left: 2D imaging is often limited in its ability to provide the key diagnostic information needed to adequately assess the full apical and lateral extent of the canal morphology prior to treatment.

Bottom Middle: 2D image taken after root canal treatment demonstrating adequate obturation of the three canals in the mesial root. Prior diagnostic knowledge obtained from the 3D image allowed for identification of this canal pre-operatively.

Bottom Right: Intraoperative view confirms the exact canal anatomy as seen on the CS 9000 3D system image obtained pre-operatively. This diagnostic knowledge can lead to expedited and more predictable treatment.

FEW CASES HAVE BEEN PRESENTED HERE:

CASE 1:

The following example is a root canal that was done 13 months ago by an associate dentist in a general dental practice.

Root canal done 13 months earlier. Large periapical lesion on mesial root. Short root canal filling on mesial canals. The prognosis for this tooth was poor at the time of completion because the MB canal was not cleaned and obturated. Bacterial left behind will continue to cause periapical disease.


CBCT shows missed MB canal and short ML canal filling.


Missed MB canal located immediately with microscope.


All canals cleaned and shaped. This tooth now has good prognosis for success. As mentioned, bacteria left behind will cause failure of root canal treatment. Root canal failure is most often caused by failure to completely remove bacteria from the canal system or failure to seal out bacteria from re-entering the canal system

CASE 2:

CBCT as Aid In Removal of Separated File

Removal of a separated instrument is rarely a simple task. The closer to the apex, the more difficult the removal. In this case, tooth #19 had a separated instrument 6 yrs earlier. The tooth had become symptomatic and the patient was having extensive crown and bridge work done.


A CBCT was taken to evaluate the separation in 3D. This image was very helpful because it told us the anatomy of the mesial root. It shows clearly that the mesial root is a single root, rather than two separate roots. With this information, we can plan to remove some tooth structure between the MB and ML canals in our attempt to access and remove the separated instrument. It also showed us that there were 2 separated instruments in the MB canal. This information is crucial in our ability to remove the spearated instrument. (The radiographic imaging also warned us not to remove any dentin mesial to the prepared space to prevent root perforation)


This treatment can only be accomplished with the use of the dental operating microscope and use the of ultrasonic instrumentation. Approximately 1 hour of treatment time was used in removing the separated instruments.


2 separated instruments


Final obturation.

Always easier to prevent a separation than remove a separation. Patients should be informed if an instrument separation occurs. Advanced imaging (CBCT) provides valuable information that affects the course of treatment.
Microscopes are an indispensable tool in modern endodontic therapy.

CASE 3:

CBCT Reveals Root Resorption Unseen in Regular Radiography

The following patient returned to our office today for re-evaluation of #14. We previously looked at #14 which had some gingival swelling, yet we could not definitively diagnose the tooth as necrotic. We assumed the swelling was a periodontal abscess and had given him an antibiotic. He returned reporting no relief with the antibiotic and short, spontaneous episodes of severe pain. Once again our diagnostics were inconclusive. Normal to palpation, normal to percussion, normal to probing, responsive to cold on the lingual and unresponsive on the buccal, normal response to EPT. The canals were obviously calcified and the pdl looked normal around the roots. We decided we would take a CBCT to see if we could see any additional radiographic changes.

The CBCT clearly shows a resorptive defect on the palatal. The CBCT also tells us the location (mesio-palatal), the size of the defect which allows us to make a restorative call.

Look again at the initial film. There is no sign of this resorption with traditional 2D imaging.

CASE 4:

Cone Beam CT in Endodontic Diagnosis

Cone Beam Computed Tomography (CBCT) is a valuable radiographic tool in endodontic diagnosis. With traditional 2D radiography, you see only a coronal view. Historically in endodontics, we have taken the shift shots to try and give us an "angled" view of the tooth. Remember the rule of SLOB?

With CBCT, you can evaluate the tooth from sagittal, coronal & axial views. You also have a volume of data that can be manipulated by the computer to rotate the tooth 360 degrees and look at the tooth from any angle. The longer I use this technology, the more convinced I become of its importance and value.

The following case demonstrates the benefit of CBCT in endodontic diagnosis.


This patient was presented with a chief complaint of "pressure to biting and sensitive to brushing". Root canals on #14 and #15 were done approximately 10 years ago.

Our exam found mild palpation tenderness over #14 and #15. Both teeth were percussion sensitive and perio probings were normal. A large pa lesion was noted on the palatal root of #14, but since #15 was also so symptomatic, we decided to take a CBCT for more detailed radiographic exam.


This CBCT slice through #14 shows the extent of the pa lesion on the palatal root. It also shows the elevation of the floor of the sinus and the thickened adjacent sinus membrane. This appears to be a sinusitis of dental origin.


This CBCT slice through #15 shows a definite pa lesion on the MB root of #15. This also exhibits a halo effect. This image confirms the diagnosis of Symptomatic Apical Periodontitis on #15. Without this image, I would have recommended initiating treatment on #14 only. This image allows us to make a more confident diagnosis on #15 and treat both teeth simultaneously.


As an interesting side note, an inverted, impacted wisdom tooth is noted. This made the original radiograph difficult to read and see the MB lesion.

CASE 5:

Finding Missed Canals Using Cone Beam Computed Tomography (CBCT)

We have had lots of discussion regarding the use of CBCT in endodontic diagnosis and treatment planning. CBCT is the future of endodontics. 3D imaging as an adjunct to 2D imaging is superior to 2D imaging alone. The ability to evaluate a tooth in a sagittal and axial plane (in additional to the traditional coronal view of standard radiographs) provides valuable information that will lead to the preservation of teeth by improved endodontic treatment, endodontic retreatment and endodontic surgery.

There will be many who think this statement is over the top. However, I would compare the advent of focus-field, high resolution CBCT to the introduction of the operating microscope in endodontics. While there was initial resistance to adoption of the microscope, and still some continued resistance by a few in our specialty, the microscope has undoubtedly improved the quality of endodontic care. CBCT is the same. There will be some who argue that they don't need it, however, it undoubtedly will improve the quality of endodontic care and help preserve teeth.

As an example of the benefits of CBCT in improving endodontic diagnostics and treatment, I present the follow 4 cases. Each case completed by a different endodontist. All of these clinicians are highly skilled endodontists using microscopes. However, in each case, canals were missed and the patient continued to have issues. They have different stories, but all ended up in our office for an evaluation or second opinion. I have included myself as one of these 4 endodontists. (One of the cases is my own)

#1

#31 is the symptomatic tooth. Two canals have been filled to a good length.

CBCT slice of mesial root shows the two mesial canals join and exit at one apex.

This is another slice of mesial roots showing the buccal filling and the ML missed canal. The sagittal view tells us where to look when we retreat this tooth. Axial view also demonstrates the missed canal. Using these two views, when I retreat this tooth, I will know where to explore without perforating the root.

This particular endodontist refunded the patient and preferred that we retreat the tooth at our office.

#2

This root canal was treated by another endodontist and then retreated after symptoms failed to resolve. The obturated roots look filled to an ideal length.

CBCT reveals a missed MB#2 canal. Blue outline shows an axial slice of the MB root. The pear-shaped root outline reveals the missed canal.

The sagittal view also shows the MB#1 canal is off center of the long axis of the root. A lesion into the sinus cavity is noted. Note the distinct MB lesion visible in the CBCT.

#3

This root canal done in 2007. Recently became symptomatic.

CBCT shows lesion on MB and DB with elevation of floor of sinus. This corresponds to chronic sinus issue patient has been dealing with.

Cross sectional slice (axial) through the MB root shows the missed MB#2 canal. The pear-shaped or figure-8 shape of the MB root reveals the missed MB#2 canal.

This sagittal view shows that the missed MB#2 canal is actually a separate root. While the roots are fused all the way down, it has its own apex.

The CBCT is a map for retreatment. It tells us exactly where to look to find the missing canal.

#4 -Missed Canal Found with CBCT

This RCT was completed in Nov 2011. Palatal lesion seemed to improve, but patient symptoms returned. In this particular case, I found only 2 canals. After extensive searching under the microscope, I determined that this must be one of those tricky 2 rooted Mx molars. Since symptoms returned, a CBCT was taken to see if anything was missed.

CBCT reveals that a DB canal had been missed. However, looking closely at the axial view, my assumption that this is a 2 rooted molar was correct. The palatal and DB roots were fused as one. Sagittal view shows the missed DB canal. Axial view shows the missed DB as well. The CBCT is now a map for retreatment.

As explained, the axial and sagittal view provided by CBCT is invaluable. More information provides for better treatment. This post should demonstrate the level of complexity of molar endodontic therapy even with the use of the operating microscope and the benefit of 3D imaging over 2D imaging alone.

Implantology

3D images accurately portray the patient’s anatomy

  • Evaluate bone quantity and quality

  • Identify, localize, and annotate anatomical obstacles (mandibular canal, sinus)

  • Take precise measurements using true 1:1 ratio

  • Plan implants using specialized 3D software

  • Improve case acceptance

  • Collaborate with referrals

Implant planning with 3D imaging modalities is rapidly becoming mainstream. The CS 9000 3D system has the ability to scan a wide range of areas. For cases requiring an extended field of view, simply put the CS 9000 3D system into full-arch mode to acquire the maxillary or mandibular arch or acquire a single or dual arch with our versatile CS 9300 system. Our comprehensive CS 3D imaging implant planning software makes treatment planning very simple and helps improve case acceptance.



Above: CS 9300 system with 10 cm x 10 cm field of view. Implant planning utilizing the robust implant planning module integrated into the 3D viewer allows for comprehensive evaluation and treatment planning of the implant recipient sites in all dimensions.

Top Right: CS 9300 system. The implant planning module’s unlimited viewing abilities allows the implant recipient site to be seen from any angle around the implant template, revealing all anatomical unknowns pre-operatively. This image represents a 300 micron slice at the center of the implant in the sagittal view. The implant locator feature also allows you to quickly align the slice with the implant template.

Bottom Right: CS 9300 system. Volumetric rendering of the completed implant plan with 1 to 1 representations of the implant’s position and true orientation within the arch provides a tool for patient consultation. The implant planning software is also a powerful collaboration tool between colleagues.

Orthodontics

Complement your cephalometric and panoramic imaging

  • Analyze skeletal symmetry

  • Assess alveolar ridge shape and volume limitations

  • Assess temporomandibular joints and occlusion

  • Plan placement of temporary anchorage devices

  • Plan orthognathic surgical treatment

  • Evaluate ectopic and impacted teeth

  • Assess growth

  • Design custom appliances and image-guided treatment
Impacted supernumerary teeth can often be difficult to visualize with limited 2D imaging modalities. Fortunately, high-resolution 3D imaging simplifies this process. Information gained from the CS 9000 3D system allows the practitioner to evaluate the presence of supernumerary teeth, their position relative to adjacent teeth, and any pathology associated with the impaction—all with anatomical accuracy. This information promotes a more confident and comprehensive treatment plan, as well as key determinants for surgical approaches to removal, if required.



The CS 9300 system gives you the ability to provide comprehensive dental and skeletal assessment of your patients prior to beginning treatment. Create all necessary images from just one 3D scan, including 2D lateral and frontal cephalometric, panoramic, SMV and TMJ images. This scan can even be used to produce a digital model.




The CS 9300 system 8 cm x 8 cm field of view is perfect for multiple impactions cases while limiting the exposure to the area of interest and is very beneficial for performing 3D radiological examinations of the patient before, during, or after orthodontic treatment. In this case, it reveals the exact location of the impacted mandibular canines and their exact position relative to adjacent teeth.

Periodontics

The details you need when you need them

  • Evaluate bone anatomy and proximity to pertinent anatomical areas for implant placement and case planning

  • Analyze furcation involvements and intrabony defect patterns

  • Diagnose the extent and significance of tooth and alveolar fractures

  • Evaluate facial bone plate and associated tooth position for perio-orthodontic considerations in mucogingival or periodontally accelerated osteogenic orthodontic therapy

  • Evaluate bone loss patterns in periodontitis and associated regenerative potential of defect morphology

  • Evaluate pre- and post- operative bone grafting sites

  • Evaluate the patency of the ostium before sinus bone grafting surgery is performed

  • Identify exact location of vital structures such as the mandibular nerve and nasopalatine canal

3D orthogonal views show in detail the periodontal diagnostic imaging challenges facing practitioners every day. Generalized moderate periodontitis, evident on the panoramic view and supported by the axial and sagittal slices. The volumetric and sagittal views show virtual implant placement. The advanced periodontitis on the coronal slice and sagittal view, showing class III nonrepairable furcation involvement providing unsurpassed diagnostic information to create the proper treatment plan.

3D sagittal slice identifies a maxillary right cuspid root fracture and large area of periapical low density, consistent with abscess formation. The palatal cortical plate of bone is still attached while the facial cortical plate is breached at the level of the fracture. Extraction and socket grafting is needed to repair and prepare the site for future implantation.


On the 3D image above, the panoramic curved slicing, volumetric, sagittal, and axial views all show different orthogonal aspects of the failing tooth 6. These views also confirm the adjacent teeth 5 and 7 are viable and are unaffected by the failing tooth 6. The image on the left demonstrates a transaxial slice, showing the root fracture and the consequential bone loss in greater detail than 2D imaging alone.

Oral Surgery

Plan treatments more thoroughly than ever

  • Identify relationships between impacted teeth and vital anatomical structures

  • Visualize cysts and periapical lesions

  • Define surgical protocol for impacted tooth extractions, cyst removals, or periapical lesion treatments

  • Increase case acceptance rates by allowing patients to visualize and fully understand your treatment plan

  • Improve referral relationships by sharing critical 2D and 3D data with referring dentists

  • Eliminate office bottlenecks by taking x-ray development out of the equation—2D image acquisition takes a mere 13 seconds

  • Easily share images across multiple office locations





3D imaging with the CS 9300 system’s CBCT images allows oral and maxillofacial surgeons to perform complete preoperative and post-operative assessments.

Advanced visualization modules built into the 3D imaging module provide more accurate assessment of trauma cases, bone grafting, and pre- and post-implant surgeries.


Contact Us

Location

Plot No. 11, Pratibhanagar Main Road,
Kolhapur - 416 006
Phone: +91 231 6094400

Email:info@orascancbct.com