Featured Article - Getting the FULL picture

Dr. Michael Young has been using digital imaging systems in his practice since he established Forever Young Dentistry in Sterling Heights, Michigan, 15 years ago. In 2015, he decided to upgrade to 3D imaging. The decision has transformed his practice — from improving diagnostic capabilities to boosting his reputation with his patients.

When Dr. Young decided to grow his implant capabilities, “Rather than outsourcing my implant patients to an imaging center and inconveniencing them while potentially losing control of the case, I thought it would be more efficient to have the 3D imaging unit in my office,” he explains. 3D imaging provided so much more diagnostic information than 2D imaging that soon, Dr. Young was capturing scans for much more than implant placement. “I noticed that for some patients who were complaining of pain or discomfort, I couldn’t find anything on the traditional 2D PA. Inevitably, many of these people would return with the same issue. He says, “When we captured a 3D scan and discovered information not seen on a 2D, we would think, why didn’t we take a 3D image in the first place?”

“I noticed that for some patients who were complaining of pain or discomfort, I couldn’t find anything on the traditional 2D PA.”

“Minimizing radiation exposure to patients is not an issue with my cone beam system”, Dr. Young notes, and one of the reasons he chose a Planmeca system. “Traditional 2D dental radiography cannot view certain dental anomalies until there is extensive loss of bone, but since our system has an Ultra Low Dose capability, I can have quality diagnostics and a radiation exposure that is 30% of the radiation of one 2D digital intraoral X-ray.” He continues, “Many different machines and manufacturers offer a lot of different radiation exposure promises, but unfortunately many sacrifice diagnostic image quality for lower exposure.

“The Ultra Low Dose technology on my system and intelligent 3D algorithms result in high quality

After taking the image, Dr. Young looks at the pan/ ceph/3D image on his computer, and then easily pulls up images that he wants to show the patient on the operatory screen. (The unit also provides 3D photo and 3D model scans.) “I open my software (Romexis) and review the image slice by slice.” This advanced, easy-to-use software platform allows imaging data to be acquired for diagnosis and treatment planning with a rich set of tools for viewing enhancement, measurement, drawing, and annotations.

Low Dose technology and intelligent 3D algorithms result in high quality diagnostic images.

diagnostic images. I am able to obtain an average reduction in dose of 77% using the low dose protocols when compared with standard protocols. While this dose reduction is significant, no statistical reduction in image quality is seen. This proved to me that patient doses can be reduced without loss of diagnostic quality.”

When Dr. Young discusses the benefits of 3D with patients, their understanding leads to case acceptance. “You can’t treat what you can’t diagnose, and if you are only taking 2D periapical X-rays, you are going to miss a lot of information.” He explains to the patient, “As a person, you aren’t flat — you are 3 dimensional. Traditional X-rays flatten the information of the image and we lose information needed to diagnose efficiently and completely.”

“You can’t treat what you can’t diagnose, and if you are only taking 2D periapical X-rays, you are going to miss a lot of information.”

Dr. Young recalls one patient for whom 3D imaging caused a paradigm shift in his office. The patient complained of tooth pain, and a 2D X-ray showed nothing conclusive. After adjusting the bite and hoping that would help, the patient returned a year later with the same symptoms. Now, an upper tooth was painful as well. After another nonconclusive 2D image, Dr. Young adjusted the bite a bit more, and the patient went home. A year later, the patient returned again, this time disclosing he had sought a second opinion. The other dentist, also using 2D imaging, found nothing conclusive. Dr. Young shares, “He sat in the chair, obviously frustrated, and told me that he sought out another dentist because he didn’t think I knew what I was doing.” But, visits with two dentists could not change the fact that that he still could not eat on those teeth. Dr. Young then captured a 3D scan, which showed a huge infection above the original tooth and the upper tooth as well.

“That was a vindication of our paradigm shift,” said Dr. Young. “If we had taken a 3D scan earlier, we would have been able to treat him earlier. He wouldn’t have wasted his time and money going to another dentist, he wouldn’t have lost confidence in my diagnostic ability, and he would have been out of pain sooner. It would have been a win-win situation all around.” The patient needed two root canals. When he arrived for the second root canal,

would have not detected using 2D radiography, the machine is more than paying for itself every week.” While Dr. Young reads his own scans, he says that dentists who are uncomfortable reading scans can send them to an oral radiologist. He says that the manufacturer of his system offers training on reading scans, and also has strong customer service. “When you are looking to make a technology purchase, it’s important that the training and support are there.”

Intergrated software (Planmeca Romexis 6 pictured) makes it simple and accessible from any computer.

“He said to me, ‘I love you, man; you are my hero.’ I went from a potential disaster to a hero, and could have been a hero almost 2 years earlier.

My 3D system is easy to use.” Dr. Young says, “I’ve been in practice for 27 years, and I’m not a computer genius, but the software makes it simple. The different modules work together so that I can access files from any computer in the office or on my laptop. I can export the files to referring dentists or labs, or import files into my system from other sources. I can plan implants, surgical guides, smile design, and take 3D models and print them.”

Especially now in post-COVID times, office productivity should be kept as high as possible. With the use of 3D technology, dentists can avoid outsourcing to laboratories, imaging centers, or specialists. Dr. Young says, “Because I am able to diagnose more dental issues each week that I

Other products, such as his intraoral scanner and mill, have combined over the years to transform Dr. Young’s practice. When making a recommendation on cone beam to a colleague, Dr. Young notes, “I would recommend a bigger field of view, especially if wanting to do more comprehensive procedures like view TMJ and airway for sleep. My unit captures a clear view of the mandible and maxilla and offers an extended volume diameter size, increasing the diameter from Ø8 x 8 cm up to Ø11 x 8 cm.

He sums up, “I was an early adopter of digital dentistry in 2004. If I was starting a practice today, the first purchase I would make is a 3D imaging unit. You can’t treat what you can’t diagnose, and if you are only taking 2D X-rays, you are going to miss a lot of information and opportunities to treat patients. I don’t have to be a super GP, but I sure like that some of my patients think of me as a hero.”

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Extended volume diameter size, increasing the diameter from Ø80 x 80 mm up to Ø110 x 80 mm.

Michael Young, DDS An early adopter of digital dentistry, Dr. Michael Young operates a private practice in Sterling Heights , MI. He graduated from the University of Michigan School of Dentistry. He is a mentor for the Kois Center for Advanced Dental Learning and is a member of the American Dental Association, Michigan Dental Association, Detroit District Dental Association, Pierre Fauchard Academy, American College of Dentists, International College of Dentists, and American Academy of Oral Systemic Health.