High Quality CT Images for Dental Implant Patients

Dr. Douglas Goldsmith and Dr. Gary Orentlicher are both board certified
oral and maxillofacial surgeons in private practice in Scarsdale, New
York. They co-founded Facial Imaging, LLC, a company that makes it easy
for doctors located both within and outside the United States to obtain
and utilize CT images for their dental implant patients. The process
produces high quality 3-D images quickly and economically for use in
developing patient treatment plans for implant placement and
restoration.

Facial Imaging can process CT or cone beam scan data for any 3-D
software program. The doctor can view a scan on his or her computer
just hours after a patient has had their CT scan performed. Facial
Imaging has partnered with over 30 imaging centers in New York,
Connecticut, and Massachusetts and is in the process of expanding their
geographic outreach. Facial Imaging also offers 3-D treatment planning
services. Read on to learn more about Facial Imaging. You can also visit their website at: www.facialimagingllc.com

OsseoNews: Thank you for taking time out of your busy schedules to discuss how Facial Imaging can greatly enhance the ability of dentists to treatment plan for dental implants.

Dr. Goldsmith: We took great care in creating a state-of-the-art system that simplifies the process from the ordering and scheduling of a CT scan, to the processing of the scan, to delivering the scan to the doctor. This process can usually be done the same day.

OsseoNews: Can you describe how the Facial Imaging process works?

Dr. Goldsmith: First, the patient has a scan at a Facial Imaging partner scan site. The data is then securely transmitted to Facial Imaging where it is processed using the SimPlant Master software or our proprietary ADDS software. This enhances the scan information.

The processed scan is then transferred to the doctor via the internet through Facial Imaging’s secure HIPAA compliant website or on a CD. The scan is then downloaded onto the doctor’s computer into their SimPlant Planner, Nobel Procera, or other software program. The doctor can then use these software programs to develop an ideal treatment plan for their patient. The data can be used to fabricate a surgical guide appliance to be used at the time of surgery.

Dr. Orentlicher: As part of our Quality Control protocol, each CT scan that is processed by Facial Imaging is first evaluated by our dental consultants. For example, if a doctor has ordered a NobelGuide scan, we will evaluate the 2 scans through the Nobel Procera software to make sure that the 2 scans can be successfully combined by the doctor. When a doctor receives a processed NobelGuide scan from Facial Imaging, they know ahead of time that the 2 scans can be successfully combined. This is all done by Facial Imaging prior to the doctor receiving the data.

If there is a problem with a scan, we first try to solve the problem and improve the quality of the data. If we feel that the CT scan needs to be retaken, we contact the scan site and they appoint the patient for a new CT scan at no charge.

OsseoNews: What kinds of problems did you encounter that made you realize there was a need for this type of service?

Dr. Goldsmith:
Most imaging facilities are more geared to taking CT scans for medical purposes and we realized that most technicians were not properly trained to take accurate CT scans to meet our needs.

We found that patients were often improperly positioned, scanned with the wrong scanning protocol, or had movement during the scan. This caused the scan information to be less accurate or of little value. Sometimes the scanners were outdated and not capable of providing the proper information.

At our partner imaging centers, we personally train the technicians. This leads to consistent, high quality, accurate scans.

Dr. Orentlicher: Another problem we encountered was the improper positioning of the scan appliance. There are cases where a CT scan is done with the patient wearing an appliance with denture type teeth in the positions of the desired final restoration.

The problem is that when the patient is positioned for the CT scan, the scan appliance can be dislodged or may not be seated properly. A trained technician can identify this and insure that the scan appliance is properly positioned. This again contributes to the quality of the CT scan and its appropriateness for our treatment planning needs.

OsseoNews: So both these problems are eliminated when patients have their CT scan at one of Facial Imaging’ss partner scan sites?

Dr. Goldsmith: Yes. Just to put this into perspective, before we started up Facial Imaging, we found that one or both of these problems occurred in 20% or more of our CT scans coming in from medical imaging sites. That is why we put such an emphasis on training our technicians.

Dr. Orentlicher: Another problem we recognized is that many dentists are not comfortable dealing with medical imaging centers. It can be somewhat intimidating if you are not used to dealing with the medical system. We eliminated this problem when we partnered with select CT imaging centers in New York, Connecticut, and Massachusetts.

OsseoNews: So by partnering with independent CT imaging centers you improved the quality of the CT scans you needed and you made it easier for dentists who are not familiar with the medical system to refer patients for CT scans.

Dr. Goldsmith: The imaging centers that have contracted with Facial Imaging are more accessible to patients. As of now we have partnerships with CT imaging centers throughout most of New York and Connecticut. We have an imaging center in Massachusetts and we are negotiating now to expand to New Jersey and Rhode Island. Our goal is to have enough imaging centers on board so that patients won’t have to drive long distances. We are focused on convenience and patient comfort.

Dr. Orentlicher: We have also brought the cost of CT scans down to make them more affordable to patients. The cost for a CT scan and all the support services that we provide is $4-500 for one jaw or $7-800 for both jaws. This in itself is a considerable savings just in the cost of the CT scan alone. We do not feel that high costs for CT scans should be an obstacle for patients.

OsseoNews:
What happens if the doctor does not have SimPlant Planner, Nobel Procera Planner, or other planning software, but does have a computer?

Dr. Goldsmith: The doctor can then download free software from our website called SimPlant View. This will allow the doctor to view all the CT scan data, take measurements and zoom in on 3-D images.

OsseoNews: What happens if the doctor does not have a computer?

Dr. Goldsmith: In that case we print out all the data with 3-D images and mail them to the doctor. We can provide the doctor with prints that are an exact one to one of the patient’s scan.

OsseoNews:
Can your system accommodate other software programs?

Dr. Goldsmith:
We can accommodate any three dimensional implant treatment planning software product on the market.

Dr. Orentlicher: We can also process CT or cone beam scans from other scan sites, hospitals, or offices. The image data can be transmitted securely via the internet or put on a CD and mailed to Facial Imaging’s office. We will facilitate secure internet connectivity between other offices and Facial Imaging at no cost to that office.

OsseoNews: This sounds as though you have a rather versatile and comprehensive system. And just to clarify the cost factor, you stated the cost for the CT scan and processing is all inclusive.

Dr. Orentlicher: That is correct. That one fee we mentioned includes all of these services.

OsseoNews: Do you offer customer service?

Dr. Goldsmith: Yes. Our customer service office is open 9:00 AM to 5:00 PM EST Monday through Friday.

OsseoNews:
Any other new developments that we should be looking for?

Dr. Goldsmith: We have just launched a new treatment planning service that will make our system even more comprehensive. We have professional consultants on staff who will create a treatment plan with the planning software that the doctor utilizes. For instance, if the doctor is a NobelGuide user we will develop a treatment plan using NobelGuide software to the doctor’s specifications and transfer this information to the doctor. More specific treatment planning and consultation information is available on our website.

OsseoNews: What is the best way for our readers to find out more about Facial Imaging services?

Dr. Goldsmith: Gary, I’m glad you asked, because we just re-vamped our website. Now doctors, radiologists and patients can utilize our new site. All the information they need can be found at www.facialimagingllc.com. They can also call our toll free number (800) 881-4432.

OsseoNews: Thank you again for taking time out of your busy schedules for this interview.

Interview conducted by

Gary J. Kaplowitz, DDS, MA, M Ed, ABGD

Editor, OsseoNews.com

16 thoughts on “High Quality CT Images for Dental Implant Patients

  1. What you can get out of this service is only as good as the data going into the DESIGN of the scanning guide or template. The center piece of dentistry is for suppport and preservation of the lost tissues due to atrophy. Can Dr. Goldsmith discuss this issue? Thanks

  2. Currently most dentists do CT scans to view the 3-D anatomy that is present, and the patients do not wear a scan appliance. The best information is obtained by having the patient wear a scan appliance when the CT scan is taken. The appliance duplicates the restorations planned for the dental implants. This is the best way to view the relationship of the available bone to the planned restorations. I would agree with the questioner that it is important that the scan appliance accurately represents the planned restorations and fits properly or its benefits will be diminished. The most accurate way to place dental implants is to plan their placement with 3-D planning software, construct a surgical guide that duplicates this plan, and utilize the surgical guide to place the implants

  3. If I wish to have a seamless corridor between the resorbed residual ridge and the proper placement of teeth for functional esthetics It would seem logical to have a scan template as you say a duplicate of the definitive prosthesis in its pre determined position at the time of the scan. If I plan with out that prosthetic tool it leaves me too many choices where to place the implant. All may be correct in the bone, but not with the future placement of teeth. The scan appliance can have one level of barium for the teeth and one level for the vestibular support. This would also depict where we may need to graft. To me without that level of diagnostics the scan is just an expensive tomogram? This can prevent reactive decision making or at least reducing the later. The cornor stone of prosthodontics is diagnostic assessment and then treatment planning. With level 1 and 2 diagnostics we can be extremely predictable…Thanks

  4. What about cone beam volumetric scanners? I understand they take excellent CT scans with greater accuracy and require 10X less radiation than conventional medical scanners. If that’s the case, wouldn’t patients benefit from getting their CT scans on CBVT machines?

  5. In answering the above question, Facial Imaging processes scans from conebeam and medical CT scanners. We have extensive experience with both. Conebeam scanners have advantages and disadvantages. Conebeam is an excellent in office technology for taking 3D scans. It has less radiation and scatter. Because it uses a lower radiation, the scans have less definition. In addition, areas of less bone definition can be “burnt out.” For example, an area of Type 3 or 4 bone in the posterior maxilla may not show up in the scan and may appear as a hole in the bone. This can create limitations in its use in 3-D implant planning. Sometimes bone is present that does not show up on the reformatted scan. This can adversely effect your planning of implant placement. Remember that much of the treatment planning in the 3D planning softwares is done in the 3D views. Medical grade CT scanners are all based on Hounsfield Units, a measurement of bone density. Conebeam scans are based on Voxels. This prevents you from determining bone density in the area that you are placing implants when using a conebeam scanner. Please remember the above information when you are choosing between a medical CT or conebeam scanner for your patients.

  6. I am into making my life as easy as I can when it comes to delivering quality dentistry.
    What I have found (out the hard way) it is sooooo much easier working with a trained tech,like the ones, that work with Facial Imaging. I have taken it one step further and had the consultants help me with the Noble Guide software planning for the implants. The software is not easy to use and there is a great learning curve. Facial imaging could not have been more helpful and I thought the fee was very reasonable considering the size of the cases. My hat comes off to the Docs that started this serive. Thanks so much.

  7. For those of you who do not know what Dr. Hoos is referring to, Facial Imaging has started a treatment planning service. Our consultant doctors can aide you in treatment planning cases using NobelGuide, Simplant, or any other 3D implant treatment planning software. Details can be found on facialimagingllc.com

  8. Responding to the Dec. 22 posting of Dr. Orentlicher, I beg to differ.

    1) He wrote: “In addition, areas of less bone definition can be “burnt out.” For example, an area of Type 3 or 4 bone in the posterior maxilla may not show up in the scan and may appear as a hole in the bone”. This is due to the necessity of computer software having to extrapolate data that is often not present, due to the limited number of x-ray slices some of the systems utilize. With more advanced Cone Beam Systems that are using 512 respectively 1024 images per rotation, the need for such extrapolation is greatly reduced and all bone tissue does show up.
    2) While it is correct that the Cone Beam Systems basic definition is that of a Voxel (a three dimensional pixel) some of the software systems now available also furnish measurements in Hounsfield units.

  9. In response to the above writers comments: Your comments regarding the software extrapolating data that is not present is simply not true. The CAT scan slice thickness necessary for use in the 3D implant planning softwares is a maximum of 1mm (Simplant). Some of the softwares (ie Nobel) require 0.5mm slice thickness. This is an extremely small, precise thickness cut, generating very precise images. As we all know, medical grade CT scanners are used throughout medicine. Their precision is used to identify and map the location of brain tumors for guided brain surgery. When a medical grade CT scan is processed using any of the 3D softwares, it only shows what is present in the patient’s bone. What you see is what you get! The same is not always true of a conebeam scan. I encourage you to compare the cross sectional cuts to the 3D reformaton images in your Type 3 or 4 cases. In some cases bone will not be present in the 3D reformations that shows in the cross sectional cuts. I have had the opportunity to compare a few cases that had both conebeam and CT scans (same patient) the difference is obvious.

  10. There is at least one Cone Beam System on the market that has a slice thickness of 0.080 mm (or higher, if wanted). That system, while not a medical CT scanner performs very well and uses only 1/40th of the standard CT radiation dose.

  11. Regardless of your statement regarding the slice thickness of this one conebeam scanner, the above facts that I have previously written regarding the relationship and possible problems between the 3D planning softwares and conebeam scans in Type 3 and 4 cases remains true. The issue is not slice thickness.

  12. adding to the discussion about cone beam ct scanners. the i-cat cone beam volumetric ct can generate voxels to 0.2mm which is more accurate than anyone in oral and maxillofacial surgery needs. that is about the width of two slices of notebook paper. the algorythms have grately improved to minimize distortion as well as the harware for interpolation. I have processed many medical ct scans with both simplant and noblelguide and have found the only way to truly gage soft bone is to clinically evaluate the area. I think cone beam ct technology will revolutionize oral surgery and dentistry. conventional 2D films have not changed much in the last 75 years in their basic format for prividing information.

  13. http://www.facialimagingllc.com/compare/index.htm

    referencing the above link….

    Regarding the images taken by a medical ct and the icat cone beam scanner. I have to say that I own a icat and have both simplant and nobelguide software and my scans are much better than what they present for the i-cat. This has to make me wonder what the motivation is (money) regarding the people at facial imaging. Obviously they make less money if people use conebeam scanners on their own and not medical scanners.
    “If you want the truth… you need to follow the money.”

  14. look at the reference:

    Winter AA, Pollack AS, Frommer HH, Koenig L.
    Park Avenue Periodontal Associates, New York, New York, USA.

    This article describes the benefits and dental applications of a three-dimensional imaging technique known as cone beam volumetric tomography (CBVT). When compared to conventional medical CT scanners, CBVT is more accurate, requires less radiation, captures the maxilla and mandible in a single rotation of the X-ray source, and is cost-effective for patients

  15. My above comments have nothing to do with anything financial. As I have said many times before, I think that conebeam is a very good technology. Facial Imaging has both medical CT and conebeam sites in our network (over 30 sites total.) We are currently negotiating to add 3 more conebeam sites to our network, with more in the future.

    My comments regarding 3D treatment planning using the various softwares in Type 3 and 4 bone have nothing to do with slice thickness, but with the inherant problems of a technology that uses Voxels, not Hounsfield Units, and a lower radiation. The 3D implant planning softwares were written, by software engineers in Europe, using medical CT scan technology based on Hounsfield Units, not Voxels. The images in the link, comparing 2 scans taken on the same patient, are accurate. I stand by my previous comments.

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