With W. Ronald Redmond, DDS, MS, FACD
OP: What is your current setup for imaging?
Redmond: I have purchased two cone-beam machines: a NewTom 3G in 2002 and an i-CAT in 2006. The first was given to the University of Southern California (USC), Los Angeles, and the second to University of the Pacific (UOP), San Francisco. My plan was to promote technical advances in the two orthodontic departments and to allow the universities to work out the protocols and idiosyncrasies. I have continued to use three digital panoramic/cephalometric (pan/ceph) units, which are reliable and have established protocols. Time is drawing near to move from 2D to 3D in our practice because of the recent advances made in cone-beam CT (CBCT) by UOP and USC.
OP: Do you plan to upgrade anytime soon? If so, what will you buy?
Redmond: The next few months will signal our decision to purchase a 3D device, probably the newest version of the i-CAT. Most of the CBCT machines are similar in their performance, although each promotes small advances periodically. The major recent advances in CBCT have been in 3D software. I have been using InVivo Dental volumetric software from Anatomage, San Jose, Calif, with great success. Recent advances include “stretching” a 2D photograph over the 3D volume to provide facial tones and eye color.
Jack Choi, CEO of Anatomage, has used the one-to-one characteristic of the CBCT volume and inserted scanned volumes of the plaster study models. This creates well-defined crowns that also have roots. In addition, InVivo Dental volumetric software has been used recently to determine the square area of the individual roots, creating a unique mechanism for determining anchorage. The last two advances are the ability to superimpose volumes using different 3D landmarks, and segregation of the individual teeth to simulate actual tooth movement. I believe tooth movement within the 3D facial volume will yield feedback related to facial changes heretofore unavailable.
OP: Can you run down the costs and benefits of outsourcing imaging versus buying your own equipment?
Redmond: In a presentation delivered to the American Association of Dental Maxillofacial Radiographic Technicians in 2004, I suggested that we “follow the money” as a view to our business future. Most orthodontists during the 1960s and 1970s preferred to take their own records (pan, ceph, photos, and study models), but beginning sometime in the 1980s, radiographic laboratories began to surface. The orthodontist received the records payment in the 1960s through the 1970s, but the payments were shifted to the labs during the 1980s, which turned out to be a boom time for radiographic labs. The mid-1990s saw a reversal of this trend, as more orthodontists purchased digital pan/ceph units for their offices.
I believe we will again see a boom time for radiographic labs as we venture into the 3D market. The average orthodontist will shy away from spending $180,000 to $200,000 for a cone-beam machine. Furthermore, each volume needs to be viewed by a radiologist to verify the nonexistence of pathology that the average orthodontist would not recognize. This process can be contracted easily by the radiographic labs because of the volume of 3D scans they will process. So, it appears that the dollar pendulum has swung back to the labs for the foreseeable future. There is little question that 3D will eventually replace 2D diagnosis and treatment planning.
OP: What other factors should an orthodontist take into consideration when looking for a new imaging system?
- To find 3D imaging products check out our online Buyer’s Guide.
Redmond: I’m not sure what factors other orthodontists are looking for in CBCT, but I would guess they will look at the cost model, ease of use, volumetric software bundled with the scanner, and cone-beam footprint (the space required to place the device in the office). I am waiting with eager anticipation for the cone-beam scanner and bundled volumetric software that will provide enough 3D detail to eliminate polyvinylsiloxane (PVS) impressions in my offices. The day I can transmit the 3D volume of the teeth directly to Invisalign rather than mailing PVS impressions will be a glorious day for me and my entire staff.
W. Ronald Redmond, DDS, MS, FACD, maintains four practice locations in California (San Clemente, Laguna Niguel, Irvine, and Trabuco Canyon) and two in Washington (Seattle and West Seattle) with his two sons. He lectures extensively and presented on CBCT advances at Peking University, Beijing, in September 2007. He can be reached at