Confusion to Clarity: The Perfect CBCT 10 Steps to Making the Right

There are at least 50 different CBCT units in the US market. Selecting the best CBCT for your practice can be a confusing task. Every salesperson you speak with will try and convince you that they have the best CBCT solution for you. How do you decide? Selecting the best Cone Beam Computed Tomography (CBCT) system for your dental practice is a crucial decision that can impact the quality of your service, your workflow, and your overall patient satisfaction. With a vast array of CBCT systems in the market, it can be challenging to find the one that suits your unique needs. Here's a step-by-step guide to help you make an informed choice:

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Step 1: Understand Your Clinical Needs Start by assessing the needs of your practice for CBCT based on the procedures that you will be performing with the CBCT scans that you acquire. Consider the type of dental procedures you perform regularly. Will you be using CBCT for endodontic procedures, implant planning, oral surgery, orthodontics, or a combination? Do you need a device that can scan a single tooth with detail, a specific quadrant, or the entire maxillofacial area? Understand the field of view (FOV) that suits your clinical requirements and start by narrowing the field to just that machine.

The illustration below illustrates the nine different FOVs offered by the J.Morita 3D Accuitomo 170. This illustration is used to show the varying FOVs that CBCT can offer.

Step 2: Set Your Budget Dental CBCT systems can range significantly in cost. At the low end of the new CBCT price spectrum, small and medium FOVs start around $50K. Keep in mind that these “economy” units are less expensive for a reason. Typically, the build quality and image quality are going to be inferior to the most expensive units in the small to medium price range which can be in the $70-$80K range. Bear in mind that the overall cost includes the price of the system, installation, training, maintenance, and possible software updates. Some warranties include parts and labor while other warranties cover only parts. It is important to read your warranty and understand the limitations and exclusions. Also, realize that most warranties do not cover the PC and the IT maintenance related to the PC.

Remember, the cheapest is not necessarily the least costly as ROI determines true cost over a period of time. If you do not see the quality needed for diagnosis and the CBCT does not last until fully amortized, then the cheapest CBCT can actually be the most costly. This defines the difference between price and cost which is driven by true value.

Step 3: Analyze Image Quality. Image quality can vary widely amongst different FOVs and different CBCTs. Normally, smaller voxels produce greater detail. A voxel, or volume pixel, is the 3D equivalent of a pixel. It represents a value on a regular grid in three-dimensional space. These values can represent various types of data, such as color and transparency, in computer graphics and similar fields. The size of the voxel influences the resolution of the CBCT scan: smaller voxels result in higher resolution but require more computing power and time to process. Conversely, larger voxels result in lower resolution but are quicker and less computationally intensive to process. High-quality CBCT systems should produce images with high resolution, low noise, and precise details. However, small FOVs for endo as an example, will be taken with a lower voxel size (typically .075-.125mm) and show greater detail than a larger FOV scan taken for the airway. Larger FOV scans usually are taken with a voxel size of .20-.40mm as the detail required to determine airway obstruction is less than what is required to see a root fracture. Below are examples of a small FOV high-resolution endo scan and a large FOV low-resolution airway scan. Both are perfectly suited for their respective applications.

Hi-Resolution .08mm endo scan from the JMorita X800 F40

Low-Resolution .40mm Airway Scan

One way to evaluate image quality is to draw an MPR (Multi Planar Reconstruction) on the axial image and evaluate the slices with varying slice thicknesses and the smallest interval, typically .5 mm. The thickness refers to each slice and the interval is the spacing from slice to slice. Looking at this detail is where you will see quality separation among the various CBCT machines. Evaluate the detail in the minimum slice thickness as that represents a single voxel. The image presented will have more graininess than an image that has a greater thickness as it is a thinner slice with less information. An example of different slice thicknesses from slices taken from an MPR at the same location. For typical use, a 1mm thickness is very readable while appearing smooth. For evaluating fractures, being able to look at an image in the thinnest slice can be very helpful. Comparing the smallest voxel quality of scans is a good way to see what details the prospective CBCT is able to capture.

Example of an MPR curve. Slices are represented in the three panels.~ 1mm slice thickness.

Single Voxel .08mm thickness ~6 Voxels .5mm thickness ~12 Voxels 1mm thickness

Another way to evaluate true image quality is to request the manufacturer’s MTF numbers for each FOV and resolution from a particular machine. The modulation transfer function (MTF) is well known as a crucial parameter in the quality assurance of computed tomography (CT) scanners, which provides detailed information on both the contrast and resolution of CT images. Read the following study to learn more about MTF in the evaluation of CBCT image quality.

Study on MTF with the J Morita Accuitomo 170.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC/

Step 4: Evaluate Usability Ease of usability involves the workflow from integration to your PMS, patient positioning, and image acquisition, to image reconstruction and visualization. Integration from PMS should minimally allow for creating a patient in the PMS (Dentrix, Eaglesoft, Open Dental, etc.) with one click of the mouse. When positioning a patient, it is important that the CBCT you choose allows for imaging short neck, big shoulder individuals as the C-Arm will often collide with the tops of the shoulders. Some CBCT machines allow for increasing the vertical distance between the rotating C-arm and the tops of the shoulders, while others do not. Non-adjustable machines are more prone to shoulder collisions upon rotation. There are patient positioning tricks to pull the tops of the shoulders down, but, it can be very useful if the CBCT unit allows for vertical adjustment of the sensor and tube head that hang down as the C-arm rotates.

Evaluate the ease of acquisition and the interface of the CBCT system. Acquisition of the CBCT image is critical in resultant quality. This means proper positioning and stability of the patient will determine the quality of the result. The center of focus of a CBCT scan always reflects the highest accuracy in the overall scan. For small FOVs like 40mmX40mm scans used for endo, getting the center of focus on the mid roots of the tooth being scanned is critical to optimizing quality. Using a CBCT with a two-directional scout function allows for taking a low-dose 2D coronal and sagittal image and then picking the exact location in each image that will be the center of the 3D scan. This means you will have the greatest level of detail where the scout image is taken. In the image below, that location is marked with a green crosshair and a number one.

Example of two-directional scouting offering precise locating for a 40X40 FOV.

The software provided by the CBCT manufacturer should allow for fast reconstruction times after the images are taken and easy tools to allow for the visualization of areas of concern quickly. Most programs allow for exporting volumes with a “lite” version of the software that will allow for evaluating the image quality and software functionality. It is important to get different FOV volumes from each manufacturer to evaluate carefully and objectively without a salesperson present.

Ease of usability involves the workflow from integration to your PMS, patient positioning, and image acquisition, to image reconstruction and visualization. Objectively evaluate the software. Does it offer the features you need like implant planning, airway analysis, TMJ analysis, cephalometric analysis, etc.? Remember, all CBCTs generate DICOM information. So, if you really like the quality of a particular unit and don’t like the planning software, you can choose to use different software for airway and implant planning. BlueSky Plan is a great option as the software is a pay as you use it fee where you only pay when you export STL scans for a purpose such as printing a surgical guide.

Example BlueSky Plan and creating a surgical guide

Video showing the "wizard" workflow in BlueSky Plan

Step 5: Review Training and Support The best CBCT system should come with comprehensive training for you and your staff. The manufacturer should offer prompt and reliable technical support to minimize downtime in case of system glitches or failures. Most manufacturers don’t sell directly to the end user but rely on distributors to sell and provide the first line of tech support to the purchasing dental practice. Make sure that the company selling you your CBCT is knowledgeable and can add value to your purchase by providing service when needed and training as well. It is good to ask to speak to other dentists who have used the prospective company to see how the service is after the sale. Also, see if the company and the manufacturer have ongoing educational materials like Dental TI’s CBCT portal produced by Oral Radiologist Bruno Acevedo accessible by the following link.. https://www.dentalti.com/cbct-education-portal-lp

This educational portal focuses on the J. Morita line of CBCTs. The portal offers eleven-plus hours on the four pillars of CBCT - Acquisition, Data Correction, Data Navigation, and 3D Interpretation. I typically say that most users range from 1-10 on expertise when it comes to CBCT. Most dentists who have not purchased CBCT range from a 1-3 on their knowledge level of CBCT and how to manage the four pillars that Dr. Acevedo teaches. Whereas most dentists will never have a knowledge level of 10, like Dr. Acevedo, watching and studying the eleven hours of education in the Dental TI portal is enough to get into the 5-7 range of CBCT knowledge. Taking in-person courses from CBCT experts can further elevate knowledge to the 8-9 range. It is important to note that CBCT education should be an ongoing journey, not a destination.

Step 6: Assess Space Requirements The size of the CBCT system is another factor to consider. Make sure you have enough space in your practice for the machine, operator, and patient to take scans comfortably. It is important that the space allows for wheelchair access to be ADA-compliant. Also, check your state’s rules on CBCT installation. Many states require that a physicist complete a shielding evaluation indicating that the machine is in a location where staff members will not be routinely exposed without adequate distance from the machine. If, for example, a CBCT is mounted on a wall that is opposed by a hygiene room where the hygienist is a few feet on the opposite side of the mounted CBCT, a thin sheet of lead or an extra thickness of drywall may be specified by the physicist for occupational safety.

Step 7: Ask for a Demonstration Once you have a shortlist, ask the vendors for a demonstration of their CBCT systems. This gives you a firsthand experience of how the system operates, its user-friendliness, and the quality of the images. Unless you go to an office that has the CBCT installed, you will likely have to rely on videos and scan volumes to make your decision. I recommend that for each machine you are considering, speak to at least two to three end users and ask about the entire experience from installation to training, and daily patient use.

Step 8: Research on Vendor Reputation Consider the reputation of the vendor. Are they known for their excellent customer service? How quickly do they respond to service calls? Look for reviews and ask for references from other dentists who have used their products and needed support. Was the support readily available and was the technician able to resolve the issue quickly?

Step 9: Think About Future Needs Lastly, keep your future needs in mind. As your practice grows and evolves, your needs may change. Therefore, consider a system that is upgradeable or one that will still meet your needs a few years down the line. For example, if you are an endodontist, will you only be taking small FOV scans (e.g. 40X40)? Or, may you take larger FOV scans for a fee for referring dentists? Most small FOVs are not upgradeable to a mid-FOV so making the correct decision means you will not have to sell your unit before fully amortized as your FOV needs increased. When there is a question of "maybe" using a larger FOV in the future, make the decision today to upsize FOV and protect the useful life of your investment.

Step 10: Take the plunge! Figure out the best way to purchase your CBCT (write a check or finance) and make it happen. Once you determine that CBCT will create a positive ROI for your practice, you are losing $ every day that you go without the technology.

Remember, the goal is not to find the most inexpensive CBCT system but rather the one that fits your specific needs while providing the best value for your investment. The right CBCT system will enhance your practice, improve your diagnosis, and ultimately lead to better patient outcomes. Dental TI has been an industry leader in providing high-quality installation, training, and after-sales support for over a decade. If you are looking at investing in Dental CBCT, click the link below to arrange a consultation with an expert. We can inform you of your best options so you can make an intelligent investment in a CBCT that is right for your specific needs. Now is a great time to call as Dental TI is introducing our "Summer of Savings" program that can save you thousands on your investment.

As a dental professional, you understand the importance of staying ahead of the curve when it comes to cutting-edge technology.

Enter cone beam computed tomography (CBCT).

A game-changer in dental imaging that has revolutionised the way dental professionals approach diagnosis and treatment planning.

This comprehensive guide is designed to assist you in selecting the best CBCT machine that aligns with your unique needs.

You can make an informed investment by striking the perfect balance between your current requirements and future growth aspirations.

An investment that not only meets your present demands, but also positions your practice for long-term success.

Understanding CBCT Technology

CBCT technology offers superior diagnostic capabilities compared to traditional X-rays.

These machines provide detailed 3D images of oral structures, aiding in accurate diagnosis and treatment planning with enhanced capabilities.

Advantages of In-House 3D Imaging with CBCT

Embracing in-house 3D imaging with CBCT can unlock a myriad of benefits for your practice.

For an in-depth exploration of these advantages, we invite you to read our dedicated article: The Benefits of In-House 3D Imaging Systems.

From enhancing the patient experience to boosting referral rates and elevating your practice’s value, the advantages are hard to ignore.

By offering a wider range of treatment options and instilling confidence in your patients through precise diagnoses, CBCT technology can pave the way for increased revenue streams within your practice.

Moreover, the market offers a diverse array of CBCT machines, each presenting unique advantages.

Investing in CBCT scanners can lead to significant returns on investment, especially in cases like single or two implant procedures where a certain number of scans can generate substantial value ROI.

CBCT vs. OPG – A Comparative Analysis

CBCT and OPG (Orthopantomography) are both pivotal in dental diagnostics, yet they serve different purposes and come with distinct advantages and considerations.

Understanding these differences is crucial for dental professionals when selecting the right imaging technology for their practice.

Technological Advantages

• CBCT: Utilises cone-shaped X-ray beams to produce three-dimensional images of the dental structures, soft tissues, nerve paths and bone in the craniofacial region. This technology is particularly beneficial for treatment planning in implantology, orthodontics, endodontics, and oral surgery.
• OPG: Provides a panoramic or wide-view X-ray of the lower face, which displays all the teeth of the upper and lower jaw on a single film. It is primarily used for general dental assessments, diagnosis of dental caries, and identification of dental pathologies.

Application in Dental Practices

• CBCT: Ideal for more complex cases where three-dimensional imaging can significantly impact treatment planning and outcome. It’s extensively used in planning dental implants, evaluating jaw disorders, cleft palate assessments and complex endodontic cases.
• OPG: Suited for routine dental examinations and quick assessments. It is often the first imaging choice for identifying common dental issues, orthodontic assessments and initial evaluations for wisdom tooth extraction.

Radiation Exposure

Advancements in CBCT technology have significantly reduced radiation doses, making them safer for patients while delivering detailed information necessary for effective dental procedures.

In comparison, OPG gives a 2D panoramic view with even lower radiation exposure, making it suitable for initial assessments and routine check-ups.

* The Planmeca ProMax 3D Classic captures CBCT images at doses comparable to or even lower than panoramic images, and the Vatech Green 16/18 CBCT also provides low-dose X-ray radiography.

Quality of Diagnostic Information

• CBCT: Offers exceptional detail and clarity in three dimensions, allowing for precise treatment planning. It reveals anatomical structures that are not visible with 2D imaging techniques, providing a comprehensive understanding of the patient’s dental anatomy.
• OPG: Although providing less detail than CBCT, OPG images are sufficient for a wide range of diagnostic purposes, including the assessment of tooth alignment, detection of oral cancer and evaluation of the periodontal bone level.

Comparative Analysis of CBCT and OPG:

FeatureCBCTOPGImaging Type3D2DPrimary UseImplant planning, orthodontics, endodontics, oral surgeryGeneral dental assessments, orthodontic planningRadiation ExposureReduced compared to traditional X-rays, but higher than OPG *Lower than CBCTImage DetailHigh resolution, detailed 3D imagesPanoramic view, less detail compared to CBCTDiagnostic ValueComprehensive diagnostic information for complex casesSuitable for routine exams and initial assessments

Choosing between CBCT and OPG depends on the specific needs of the dental practice, the type of procedures commonly performed, and the level of detail required for diagnosis and treatment planning.

If you’re looking for expert guidance to choose the right machine that aligns with your dental practice’s specific needs, our equipment specialists are here to help.

Contact us today to explore the best options tailored to your practice’s requirements and ensure you make an informed investment.

Evaluating Your Current and Future Practice Needs

It’s crucial to take a comprehensive approach to investing in CBCT technology by evaluating both your current operational demands and future growth aspirations.

This proactive mindset will ensure that the CBCT machine you choose not only caters to your present imaging requirements but also accommodates the potential expansion and evolution of your practice.

By carefully assessing your current patient volume, treatment offerings and diagnostic imaging needs, you can identify the specific functionalities and capabilities required.

Simultaneously, considering your long-term goals, potential new service lines, and evolving industry trends will help you make a future-proof investment that positions your practice for continued success, enabling you to buy for growth.

Additional resources:
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CBCT Room Requirements and Installation Considerations

Alongside evaluating your practice’s imaging needs, a key consideration is the physical space and technical requirements for housing a CBCT machine.

Some compact models are designed to be wall-mounted, optimising space utilisation. For example, the Acteon X-MIND Prime 2 in our DH Keen surgery case study.

Factors such as radiation safety protocols, electrical and plumbing specifications, and potential room renovations or conversions must be carefully assessed.

We were asked to convert a stock room into a CBCT room, with very short notice by Crowborough Gentle Dental.

CBCT Guidance and Safety

Ensuring adherence to radiation protection legislation and best practices for patient safety is paramount.

Guidance documents like those provided by the Health Protection Agency (HPA) offer invaluable resources to ensure the safe use of dental CBCT equipment within your practice, providing guidelines on radiation safety measures.

By thoughtfully considering these spatial and technical factors, you can optimise your practice’s layout, maximise efficient use of available space and create a seamless integration of CBCT technology into your existing workflow.

With the wide array of CBCT machines available in the market, it’s essential to navigate the options carefully when choosing the right CBCT unit.

Seeking expert advice on selecting the perfect imaging machine for your dental practice?

Our team of equipment specialists is ready to assist you. Contact us on , us at or fill out our Equipment Enquiry form.

Financial Considerations

When it comes to investing in a CBCT machine, you will need to break down the cost aspects to make an informed decision.

The purchase price is a significant factor, but it’s important to consider the overall investment, including operational costs and potential financing options.

While the upfront CBCT machine cost may seem substantial, it’s crucial to weigh this against the long-term benefits and potential return on investment.

For financing options see our article on How to Secure Financing for Your Dental Practice.

Additionally, it’s wise to consider the ongoing operational costs associated with running a CBCT machine, such as maintenance, software updates, and staff training.

By factoring in these expenses, you can create a comprehensive financial plan and ensure that your investment in CBCT technology is sustainable and profitable for your practice.

Maximising Your CBCT Investment

Investing in CBCT technology is a strategic decision that can yield significant returns for your practice.

By leveraging the advanced imaging capabilities of CBCT machines, you can elevate your treatment planning processes, offering patients comprehensive solutions tailored to their unique needs.

By clearly communicating treatment options and potential outcomes, you can foster trust and confidence in your practice, leading to increased referrals and a stronger reputation in your community.

Upgrading and Scaling Your CBCT Capabilities

As your practice grows and evolves, your imaging needs may also change.

It’s important to recognise the signs that indicate your practice might need to upgrade its CBCT capabilities.

These indicators may include an increase in patient volume, expansion into new treatment areas, or the need for more advanced imaging features to support your clinical expertise.

By staying attuned to these signals, you can ensure that your practice remains at the forefront of technological advancements, providing your patients with the highest quality of care and positioning your practice for continued success.

Strategies for Upgrading

If you’ve identified the need to upgrade your CBCT capabilities, there are several strategies you can explore to scale your imaging services effectively.

One option is to trade in your existing CBCT machine for a more advanced model, taking advantage of any trade-in programs offered by manufacturers.

Collaboration with other dental practices or imaging centres can also be a viable strategy, allowing you to share resources and access advanced CBCT capabilities when needed, without the need for a significant upfront investment.

Making the Purchase Decision

When investing in a CBCT machine, it’s crucial to consider the after-sales support provided by the manufacturer or supplier.

Reliable customer service, comprehensive training, and ongoing maintenance are key factors that can make or break the success of your CBCT implementation.

At Eclipse Dental, we understand the importance of after-sales support.

Our team of experts is dedicated to guiding you through the entire process, from selection and installation to staff training and ongoing technical assistance.

We ensure that your practice has the resources and knowledge necessary to seamlessly integrate CBCT technology into your workflow, maximising your investment and enabling you to deliver exceptional patient care.

Conclusion

Choosing the right CBCT machine is a critical decision that can significantly impact the success and growth of your dental practice.

By carefully evaluating your current and future needs, understanding the financial implications, and considering the potential for practice expansion, you can make an informed investment that aligns with your clinical aspirations and business objectives.

Remember, CBCT technology is not just a diagnostic tool; it’s a gateway to enhanced patient care, improved treatment outcomes and a competitive edge in the dental industry.

Embrace the possibilities that CBCT has to offer, and partner with a trusted supplier like Eclipse Dental to ensure seamless integration and a maximised return on your investment.

FAQs (Frequently Asked Questions)

Which is the best CBCT machine?

There is no one-size-fits-all answer to this question, as the “best” CBCT machine will depend on your specific dental practice’s needs, specialities, and budget.

Factors such as field of view (FOV) size, image quality, radiation exposure, and software capabilities should be carefully evaluated.

It’s essential to consider both your current requirements and future growth plans when selecting a CBCT machine.

Why is CBCT better than OPG?

CBCT (Cone Beam Computed Tomography) technology offers several advantages over traditional panoramic radiography (OPG).

CBCT provides superior diagnostic capabilities by offering detailed 3D images of oral structures, enabling accurate diagnosis and precise treatment planning.

Unlike 2D OPG images, CBCT scans provide a comprehensive view of the patient’s dentition, jawbone, and surrounding anatomical structures, allowing for better assessment of bone levels, detection of bony defects, and identification of potential complications.

Additionally, CBCT scans typically involve lower radiation exposure compared to traditional X-rays, ensuring patient safety while delivering the necessary diagnostic information.

How much does a CBCT machine cost?

The cost of a CBCT machine can vary significantly depending on factors such as the manufacturer, model, features, and capabilities.

Entry-level CBCT machines can range from £50,000 to £100,000, while more advanced models with larger fields of view and higher resolutions can cost upwards of £200,000.

It’s important to consider not only the upfront purchase price but also the ongoing operational costs, such as maintenance, software updates, and staff training.

How do I integrate CBCT technology into my dental practice?

Integrating CBCT technology into your dental practice requires careful planning and execution.

It’s essential to evaluate your practice’s specific needs and select a CBCT machine that aligns with your specialities and treatment offerings.

Additionally, you’ll need to consider factors such as room requirements, radiation safety protocols, and staff training.

Partnering with a reputable supplier like Eclipse Dental can be beneficial, as we offer comprehensive support services, including installation, staff training, and ongoing technical assistance.

Effective marketing strategies should also be implemented to communicate the benefits of your new CBCT capabilities to existing and potential patients.