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The Synergy of 3D Cone Beam Imaging
By Duane Grummons, DDS, MSD
(300-500 WORDS)
Adding new technologies to my practice is all about synergy (the interaction of multiple elements in a
system to produce an effect different from or greater than the sum of their individual effects.)
— continually striving to raise my practice to new levels of excellence in patient care. One of the newest
and well-proven advancements is 3D CBCT technology. i-CAT 3D cone beam imaging has helped me to
achieve this synergy and a heightened clinical edge in orthodontics. With our i-CAT Next Gen Platinum
system for 6 years, I have learned and experienced benefits and shared many insights from the scans
shared with referring colleagues.
Cone beam dicom imaging data and 3D renderings provide exceptional information about the
craniofacial structures we treat. CBCT in orthodontics equips clinicians regarding problems with
erupting teeth, facial asymmetry, craniofacial anomalies, temporomandibular joint (TMJ) disorders,
airway conditions, TAD’s planning, and true root information.
Diagnostic Strengths and Investment Aspects
When most people think of return investment (ROI), they think of a monetary aspect. However, 3D
imaging means much more than that. When I first got the i-CAT, besides using the unit for my
orthodontic practice, we set up an imaging center (Northpointe Imaging Center) us and colleagues in the
community. The imaging center staff is highly trained, motivated, inspired and thrives on the interesting
information discovered day after day. A maxillofacial radiologist reviews full volume scans and any
unusual findings to ensure they are interpreted correctly with a written report, which becomes a
tutorial. We have become stronger with interpretation of the scans by this pursuit of new knowledge.
Our referring practitioners are beginning to understand the advantages of 3D. Some simply do not. We
have been analyzing airway and obstructive breathing for almost 30 years, working closely with ENTs,
pediatric doctors and other dentists. 2D imaging left us with incomplete knowledge. When working with
ENTs, now we know exactly the location and extent of the obstructive problem. With volumetric
computations, we get more exacting in the care that we provide. Some ENT docs tell patients that what
we find on our iCAT scans is mostly what they trust and rely upon clinically. This has helped immensely
to improve our clinical effectiveness.
Keep ceph/pan machine. NIC – liability, marketing distinction, why? Income possibility.
Options:
A. Bundled vs separate 3D CBCT fees (ok)
B. Raise all fees $100-200 to cover CBCT costs (nope)
Car repair (battery fee); blood test – fee included for all pts (these concepts unfair to those
who don’t need CBCT; socialistic
C. Hire code specialist – KD9 + CPT (yes)
D. Hire medical code specialist – lag time to receive payments (yes)
E. Bill for reimbursement to patient (ok)
Dr. examine plus determine imaging need 1st vs. all patients get scan.
DOD – Degree of imaging difficulty
Imaging needs – small, medium, large
The Synergy of 3D Cone Beam Imaging
By Duane Grummons, DDS, MSD
Page 1
I-1 to I-5 plus rad report $80
Structural Analysis
CBCT data and anatomic cranial base superimposition areas make it possible to visualize and specify
Class II and Class III craniofacial structural etiology. Treatment progress and therapeutic changes can be
measured and viewed by utilizing and comparing maxillo-mandibular structures. Treatment changes
and comparatives can be truly created, viewed, measured, analyzed, and convincingly visualized!
Discovery and Visualization
i-CAT imaging allows me to see clinical anatomy that would not be visible with 2D imaging. In the TMJ
area, that includes previously undiscovered fractures and degenerative conditions on airways and
sinuses. We have seen lesions or tumors that extend into the cranial base of the skull that are actually
putting life at risk for some patients. Some frustrated patients have visited multiple doctors with a
problem; from the cone beam scan we have discovered the issues that allowed the specialist to
understand the anatomy of the condition. Then, we can help identify and co-manage these conditions.
After all, tumors and cysts around teeth must be treated first, before orthodontics can begin. 3D
imaging helps me to outline a course of orthodontics for a challenging case and make it navigate well, or
if treatment is not going according to course, we can find the reason and modify our approach.
Education and Communication
Patient education is an important part of our practice, and teaching about radiation exposure is a
priority. We don’t wait for patients to ask. We educate them before an image is even taken. We explain
and demonstrate why the size and resolution that we are choosing for the scan is best for their
individual needs or for the needs of their child. We explain by comparing the radiation from a scan to
the everyday environment, such as an extended airplane flight or weekly ambient radiation, which is
about 56 µSv and much more than one low dose limited FOV scan. 3D users must be ready to inform our
peers about radiation comparisons as well. If another dental colleague says that the panoramic image is
good enough, we must know enough about 3D imaging to explain the difference between radiation
from a 2D X-ray and a 3D scan and then compare how much more 3D benefits our diagnosis and
treatment planning. The technology just keeps getting better. The newest 3D CBCT from i-CAT, the i-CAT
FLX, offers a QuickScan+ feature that captures a full-dentition 3D scan at a lower dose than a panoramic
image.
Perceived Value and Exceptional Care
Patients recognize and appreciate the clinician who makes patient care the focal point of the practice.
Thriving dental practices and orthodontic understand that patients are our lifeblood. Success is
therefore determined by the quality of patient care provided and the overall patient experience.
Once patients see the incredible amount of information we can gain from the scans, they understand
that there is more benefit than risk. As a part of the imaging education and the clinical process, we apply
software such as Anatomage and Dolphin 3D to manage the data and formulate presentations. We can
zoom in on certain areas and rotate the 3D volume 360 degrees to show every angle of the teeth and
how we are going to move them for our desired outcomes. As as result, patients become excited and
enthusiastic about beginning treatment with us, and they perceive what sets our practice apart from the
competition.
The Synergy of 3D Cone Beam Imaging
By Duane Grummons, DDS, MSD
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Invest in Your Practice
Investing in equipment and technology upgrades can provide a number of benefits for your practice – a
competitive advantage, expanded services, improved efficiency, and overall patient comfort. These
advantages can certainly make a difference to your bottom line, especially when you incorporate
significant tax incentives for investing in your practice and yourself. A couple of tax code provisions that
have been very beneficial to dentists are known as Section 179 and Bonus Depreciation. Both provisions
allow for accelerated deductions even when purchases are financed.
Investing in equipment and technology upgrades can provide a number of benefits for your practice – a
competitive advantage, expanded services, improved efficiency, and overall patient comfort. These
advantages can certainly make a difference to your bottom line, especially when you incorporate
significant tax incentives for investing in your practice and yourself. A couple of tax code provisions that
have been very beneficial to dentists are known as Section 179 and Bonus Depreciation. Both provisions
allow for accelerated deductions even when purchases are financed. I trust their true objective in
upgrading their practice is not to simply create a tax deduction, but rather to provide better services and
improved care.
Tax Laws and Deductions
Today’s tax laws allowing accelerated deductions have led many dentists to rightfully consider them as a
key aspect of their yearly tax and financial planning. Investing in the practice provides a reward for
dentists far beyond income and tax deductions – the peace of mind of knowing that they are delivering
the highest level of patient care possible. Section 179 of the IRS Tax Code was introduced as a way to
stimulate the economy by allowing business owners to deduct the full cost of a qualified asset in the
year it is acquired. Bonus Depreciation is currently scheduled to end on January 1, 2014.
Looking ahead, the law has deduction limits scheduled to drop all the way down to $25,000 for 2014,
unless Congress acts to change the law and keep the deduction limit elevated. The maximum deduction
for Section 179 for 2013 was originally set at $25,000. However, during Congressional wrangling early in
the year to address the ominous “fiscal cliff” predictions, Congress adjusted the law to again allow a
maximum Section 179 deduction in the amount of $500,000. Section 179 provides tax incentives for
purchasing both new and used equipment and technology. The complementary Bonus Depreciation
provides incentives for new purchases only. There is greater incentive to invest in yourself and your
practice. Historically low interest rates on equipment loans have made it easier to incorporate practice
upgrades that may have seemed out of reach just a few years ago.
When considering the tax deduction laws, and the recent significant tax rates increases for those making
$250,000 or more, it makes sense to invest in equipment and technology where needed. When you
couple this with low interest rates, which may soon be on the rise, there was a window of opportunity
for dentists to make their purchases during 2013. I strongly advise my colleagues to invest in their
practices and purchase equipment and technology, provided it’s for the right reasons. After all, it is not
tax rates, accelerated tax deductions, or even low interest rates that determine whether or not you
need to invest in your practice. It’s the need to continually take extraordinary care of your patients. So
if you need to invest to deliver the care you desire, why wouldn’t you take advantage of Section 179 and
Bonus Depreciation to help you accomplish your professional goals? It makes great sense!
The Synergy of 3D Cone Beam Imaging
By Duane Grummons, DDS, MSD
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Concluding Remarks
Imaging goals and CBCT protocol seek answers to specific clinical questions utilizing a precise display of
relevant anatomical representation, with individualized patient findings closely viewed by the clinician.
Each of us has a huge capacity to continuously learn and achieve and become brighter and better. One
is not a successful clinician until fullest efforts have been made to become the best one can be for finest
individualized patient care.
Keeping educated on the various aspects of 3D imaging is an ongoing commitment. I am also dedicated
to investing in seminars for me and my staff, both in person and online to be strong in our knowledge
and to apply it well. Once you are in the “pro-league,” you just want to learn more and be able to lead
the way. I feel that i-CAT sets the standard for 3D CBCT imaging, and we want to offer those high
standards to our patients as well.
Author and physician Oliver Wendell Holmes, once said, “Man’s mind, once stretched by a new idea,
never regains its original dimensions.” The added dimension of 3D cone beam imaging has stretched the
capabilities of my practice, and I belief it will continue to expand my practice’s possibilities. The future is
now. Together, we lead the way with i-CAT cone beam and related technologies in modern orthodontic
practice.
Dr. Duane Grummons is a board certified orthodontist, and has lectured before most
American and worldwide orthodontic organizations. His frontal analysis, TMD
publications and appliance innovations are sensible, useful and extensively utilized.
Dr. Grummons is internationally recognized for his clinically sensible approaches to
facial orthopedics, frontal facial asymmetry, TMD management and non-extraction
orthodontic treatments. Dr. Grummons is an associate professor of orthodontics at
the Loma Linda University Medical Center. He practices in Spokane, Washington and
can be contacted at [email protected].
The Synergy of 3D Cone Beam Imaging
By Duane Grummons, DDS, MSD
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The Synergy of 3D Cone Beam Imaging
By Duane Grummons, DDS, MSD
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