At this point and time, the use of CBCT for implant diagnosis and treatment planning is not legally standard of care, but the day is on the horizon when it will be. Even then, it will be difficult to enforce unless a patients treatment lands you into a court of law.
Now, we all know that implants can be placed without the use of a CBCT, and have been for more than 40 years. With proper 2D radiographs and intra-oral ridge mapping, implant placement can be safe and predictable, but if the technology exists to make treatment even more predictable for you and safer for your patient, why wouldn't you use it? If it could enable you to do guided surgery to complete the treatment in a fraction of the time with a flapless approach, don't you think your patient should have that choice?
I realize that most of you do not have a CBCT in your office and if you send a patient out for a scan, the cost may be prohibitive for your patient and could prevent them from moving forward with treatment. But, your patient should at least be given the option of a scan and/or a guided surgery. Today it really is part of informed consent.
It could be presented this way:
"Mrs. Patient, I can place your dental implant with the conventional X-rays I have and the treatment is predictable and safe. My years of experience will come into play and your surgery will require a small incision along with a few stitches afterwards. The whole procedure should take about 45 minutes to an hour."
The other option you have is to have you get a "CAT scan" where I will be able to see all the anatomical structures including nerves and bone volume. This will make this safe procedure even more predictable. In addition, this scan would open up the option for me to do a guided surgery. If we take this route, your surgery will last approximately 15 minutes and likely not require any stitches. The cost for the scan and the guide will be $XXX. Which option are you interested in?"
What direction of treatment do you think your patients would take?
There are many imaging centers in most cities or offices that have their own CBCT machine who will take the CBCT for your patient at a nominal charge. Once you have done this, if the patient desires to have their surgery done guided, there are many options on the market for you. Once your CBCT's DICOM files are uploaded to them, they will put together a treatment plan with you, have the option of a radiologic interpretation to rule out any pathology and mill a guide for the system you are using. They can even produce temporary restorations for the day of surgery.
Three excellent options for this type of service are
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