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1
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2
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3
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4
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5
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6
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7
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- Where is Tom’s right central incisor?
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8
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9
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10
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11
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12
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- Is it really better than what you use?
- Or is it…
- Technology for technologies sake? (Lots of this going on….)
- (If it ain’t broke, don’t fix it….)
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13
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14
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- Five years in the US
- Killer app!
- Standard of care for implants in CA
- Film to direct digital ?
- Film to cone beam ?
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15
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16
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- Panoramic/film or $25/film 12.5 K
- Digident/indirect 18
K
- Denoptix/indirect 20 K
- ScanX/indirect 22 K
- Digora/indirect 28 K
- Gendex 43 K
- Trophy/direct 50 K
- Instrumentarium/direct 59 K
- Planmeca/direct 72 K
- Sirona/direct 72 K
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17
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- Kodak/direct (ceph) 1 sec
- Instrumentarium/direct 20 sec
- Sirona/direct 20 sec
- Planmeca/direct 20 sec
- ScanX/indirect 30 sec ++
- Digident/indirect 90 sec +
- Digora/indirect 90 sec +
- Denoptix/indirect 4.5 min ++
- Panoramic/film N/A
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18
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- Orthodontists
- Implants
- Maxillofacial surgeons
- Prosthedontists
- Medical
- Others…
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19
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- New Tom $229,000
- iCat $200,000
- Hitachi $300,000
- Iluma $194,000
- Morita 2-3 teeth
- Sirona $169,000
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20
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21
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22
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23
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- Retail price: $300,000 US
- AAO meeting price: ??
- Scan time: 10 seconds
- US installs 21
- Outside US 107
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24
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25
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26
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27
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28
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29
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30
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31
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- Retail Price: $210,000
- AAO Special: $194,000
- Scan:
- · 20 or 40 seconds
- Data processing time:
- · Depends on the
reconstruction voxel selected
- US installs 28
- Outside US installs 4
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32
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33
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34
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35
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- 9 inch FOV model retails for $189,900
- 12 inch FOV model retails for $229,900
- New vertical NewTom next month < $229,900
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36
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37
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- 14 second scan
- Radiation = one pano
- .15 voxel size
- First stand up machine
- 169 K
- Available February 2007
- First install at UNC 4 months ago
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38
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- Small FOV = 5.25 cm (No ceph)
- Software is unfriendly
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39
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- Retail $169,995.00
- Scan time 14 seconds
- Reconstruction time 7 minutes
- Field of view size 15 x 15 x 15 cm3
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40
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41
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42
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43
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44
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45
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46
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47
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- David Hatcher, DDI LAB
- Patient travels from Redding to Sacramento
- Technician images patient
- Prescription is read
- David determines cuts
- Pathology is determined
- Printouts/CD are sent
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48
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- You refer patient to a lab/university
- Patient is imaged by technician
- Cuts are determined?
- Sent via CD or Internet
- Pathology Hatcher type radiologist Hatcher/Mah board
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49
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- You refer patient to a lab or your machine
- Patient is imaged by technician
- You receive data via the Internet
- You determine cuts
- Pathology Hatcher type radiologist Hatcher/Mah board You do
it!
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50
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- Who chooses cuts
- Pathology/liability
- Radiation
- Resolution
- Software
- Vaporware
- Who should we conebeam today?
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51
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- Today Lab Hatcher type Lab tech
- Tomorrow Hatcher/Mah board New software ? You do it!
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52
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- What do we do with film today?
- A very simple example of a controversial issue…
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53
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- One image only
- No enhancements
- No new views
- Diagnose orthodontic issues
- Rule out pathology
- Learned in dental school and ortho
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54
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55
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- One image only
- Enhancements
- No new views
- Diagnose orthodontic issues
- Rule out pathology
- Learned in dental school and ortho
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56
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57
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- Many images
- Many enhancements
- Many views
- Diagnose orthodontic issues
- Rule out pathology ?
- Not learned in dental school and ortho
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58
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59
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60
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- Ignore the additional information
- Elevate your interpretation skills How?
- Use a radiologist
- AAO inquiry by the insurance companies Will they require a path
report?
- The Art Curley opinion
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61
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62
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- Hatcher/Mah board
- Loma Linda/Joe Caruso Residents are “cone beam fluent”
- USC/Peter Sinclair Determine cuts CD to David Hatcher for
liability
- David Hatcher course
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63
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- Constant versus pulse
- Hitachi radiation/UNC study
- Case story
- Palomo TB paper 2 ma is good enough for ortho
- Hatcher/Mah concept
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64
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65
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66
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- The dose from cosmic X-rays during a coast to coast flight is about 30
µSv.
- The dose from a cone beam exposure is about 40-135 µSv.
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67
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- How good does it need to be? Best voxel size = 0.2 mm
- Probably needs to be 0.1 mm?
- Higher dose = better resolution
- Low dose for bone
- High dose for soft tissue
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68
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- The start for…
- Virtual target setup
- eModels
- OrthoCad
- Invisalign
- Orametrix
- Insignia
- Lingualcare
- Retainer fabrication
- History!
- Study models
- Impressions
- Individual Xrays Pano Ceph Occlusal Periapical Tomogram
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69
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- Proprietary with the machine Basic and elementary
- Third party
- Dolphin 3D
- Anatomage/InVivo
- 3DMd/Vultus
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70
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- Orthocad features
- Measure the teeth
- Bolton analysis
- Move the teeth
- Extract
- Target setup
- Fabricate appliances!
- One click ceph
- One click pano
- On screen models
- Segmented teeth
- VTO capability
- On screen articulator
- Superimpose dicoms
- Auto cuts
- Pathology cuts
- Affordable
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71
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- PVS impressions and dicom file
- Create virtual models
- Compare their accuracy
- Neil Warshawsky/Iluma
- David Hime/iCat
- David Birdwell/new iCat
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72
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73
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74
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75
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76
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77
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78
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- Segment the teeth with roots
- Dicom t1 and t2 superimposition
- 3D facial photo with your digital camera
- No 3DmD 55 K hardware
- No Dolphin Di3D 35 K hardware
- On screen virtual articulator
- Orhocad features soon
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79
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80
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81
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82
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83
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84
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- Orthocad features
- Measure the teeth
- Bolton analysis
- Move the teeth
- Extract
- Target setup
- Fabricate appliances!
- One click ceph
- One click pano
- On screen models
- Segmented teeth
- On screen articulator
- Superimpose dicoms
- Auto cuts
- Pathology cuts
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85
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86
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87
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- Crowding
- A-P problems
- Facial pattern/incisor position
- Transverse problems
- Whatever is important to me (art form)
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88
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89
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90
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91
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- Headgear
- Non compliant Class II mechanics
- Mini pins
- RPE
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92
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93
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94
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95
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96
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- NewTom1 to NewTom3 = two years
- iCAt sensor Software versus new sensor
- One year
- Convert a 2D system to cone beam? Planmeca – Yes, for teeth Sirona –
No, full rebate
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97
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- Loma Linda, 5 years, 100 % Ivan Dus, 8 years, 100 %
- USC, 4 years selected, now 100 %
- UOP, 1 year 100 %
- Case Western, 1 year, 100 %
- UCSF, 1 year 100 %
- UCLA, 1 year 100%
- UNC, selected, surgery condyles
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98
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- Selected starts…
- Who to select?
- All starts…
- Radiation problem
- Looking for a needle in a haystack
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99
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- Decide on research projects that will improve diagnosis and treatment
plans…
- Ivan Dus
- Loma Linda
- USC
- UCSF
- UNC
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100
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- Cone beaming all starts will reveal a 20% incidence of future TMD
problems in all patients…
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101
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102
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- Cone beam images of the facial bone of the lower incisors will
demonstrate their ability to be advanced…
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103
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- New Tom $350,000 Schools and labs
- Hitachi $300,000 Schools and labs
- iCat $180,000 Your office
- Iluma $215,000 Your office
- Morita 2-3 teeth ??
- Sirona $169,000 Your office
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104
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- Will the 2D’ers go cone beam?
- When?
- How much?
- When will we be conebeaming starts?
- When will cone beam data replace our current tools?
- Standard of care
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105
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- Who chooses cuts
- Pathology/liability
- Radiation
- Resolution
- Software
- Vaporware
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106
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- Should I stay on film and wait?
- My film machine died and I have to switch, so…
- I believe Planmeca will convert
- I believe Sirona will rebate
- I’m going to start my own lab
- I’m going to buy one for my office
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107
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Notes
