Chapter 1: Application of 3D Technology in Practice
My name is Mark Novelen, I’m a dentist, I graduated in 1980 from Marquette University. I did a residency for one year at Denver General Hospital. Formed Acacia Dental Group with my partner, Damien Mulvany back in 1986 and we have been in the Englewood area ever since.We have a general practice but we also include many specialty areas of dentistry.
We added the 3D technology because we do implant dentistry, we treat tempromandibular joint dis-function. We know viewing human structure in it’s natural state which is 3-dimensional would give us more diagnostical ability and more treatment options. I looked at most of the 3D technology available today.
The first thing we were looking for was image quality. Suni by far had the best image quality even comparing it to the Gendex 500 and the Kodak 9000, Suni by far had the best image quality.
The second thing we were looking for was the configuration of the machine. As general dentists, our bread and butter of x-rays are the panorex. So we wanted a machine that took a good panorex, sefalometriks and 3D. The Suni provided all three of those. Many of the other systems do not have that configuration.
I’m Damien Mulvany, I’m a general dentist in Englewood Colorado. I have practiced general dentistry for 28 years. I did a general practice residency and formed a partnership with Mark Novelen and we call ourselves Acacia Dental Group. We have been practicing in the Englewood area for over 20 years and I believe we have been placing implants since around 1995. We have a very diverse general practice, we do a lot of surgery, we place implants, we also do orthodontics as well as reconstructive dentistry.
The reason Dr. Novelen and I chose the Suni 3D system was based primary on image quality. I think the one antidote I can give you that probably defines it is that one of my patients who is a radiologist came in and I had him look at one of the images and he made one statement, and he said, “Perfect”. So I think that in itself says what image quality is with Suni.
The primary advantage of 3D imaging over 2D imaging for me is in the placement of implants in the maxillary arch, how much dimension I have in the terms of the sinus. And in the mandibular arch, how much dimension I have between the crest of the ridge and the alveolar nerve. 3D enables us to measure the diameter of the ridge and the vertical height to the alveolar nerve in the mandibular arch. And in the maxillary arch, similarly it gives us the ability to measure the width of the arch as well as the distance between the vertical distance between the height of the ridge and the sinus.
Dr. Novelen speaking: Some of the other features of the Suni 3D system that made it attractive to us where definitely, would it be easy to train our staff to use this machine to take images. Yes it was. It was one of the easiest machines to use and I thought the software was very user friendly. Which was important to us also because I didn’t want to spend a lot of time having to learn another software program. This one you could walk into and start using it immediately.
Dr. Mulvany speaking: Since 3D imaging has become the standard of care, we have found that by having the system in our office it has enabled us to present a lot more dentistry in a way that our patients are accepting it. We feel a greater degree of confidence and so we’re able to show patients that we can safely and predictably place implants. Their acceptance after viewing the 3D images and using the software to show the placement of the implants has been tremendous in terms of enabling us to get some form of return of investment on the system. Additionally, being able to treat more complicated cases which we may have had to refer out. So I think there is a significant return on invest with the Suni 3D.
Dr. Novelen speaking: We measure the affordability of the Suni 3D system and compared it to all the other units. It was the least expensive but had the highest quality, which was a great combination for us.
Dr. Mulvany speaking: I would say to all the general dentists that are contemplating 3D technology, I would strongly recommend the Suni 3D system. We have been tremendously satisfied with it. The ease of use, our staff likes it. I want to be doing dentistry, I don’t want to be sitting there manipulating images. So for me one of the major attractions of this product is that I can easily come after the staff has captured the images, I can do some simple manipulations using the bundled software and clearly show the patient the necessary anatomical structures that are relative to the procedure we’re doing, whether it’s and endodontic procedure or an implant procedure or whether it’s an orthodontic procedure.
Dr. Novelen speaking: The Suni technology is definitely an investment in the future of your practice. It aides in your clinical delivery of dentistry, it allows you to deliver a better quality of dentistry. Diagnostically you’re better to diagnose things better. You’re able to plan your cases better. It might seem like an expensive piece of equipment when you’re looking at them but it will pay for itself in no time and the quality of the dentistry will be much better.
This is a transcript of the above video.
Chapter 2: Why Add 3D Technology?
Dr. Novelen speaking: The reason that you would want 3D images as compared to 2D images is because a 2D image being a static image does not give you the feeling of volume. The human structure is volume metric, it’s 3-dimensional. 3D imaging gives you the ability to explore that. It also gives you the chance to identify where the anatomical structures are, bone volume, all the things that are necessary when you’re doing implant dentistry. Also when you’re doing complex third molar extractions and complex endodontic procedures.
3D imaging allows you to identify key anatomical structures which is very important when you’re placing implants. For instance, in the lower posterior mandible where you want to identify the mandibular canal and you want to measure the distance you have and the length of the implant that can be placed. It also gives you the ability to measure the width of the bone to determine whether bone grafting is necessary and/or which diameter of implant you can place in the area. When you’re in the post maxillary area it identifies the location of the sinus, the volume of the sinus and again it allows you to pick the diameter and length of implant and/or grafting procedures that will be necessary in order to place an implant in that area.
Dr. Mulvany speaking: The primary advantage of 3D imaging over 2D imaging for me is in the placement of implants in maxillary arch and how much dimension I have in terms of the sinus. And in the mandibular arch how much dimension I have in the crest of the ridge and the alveolar nerve. 3D enables us to measure the diameter of the ridge and vertical height to the alveolar nerve in the mandibular arch. And in the maxillary arch similarly it gives us the ability to measure the width of the arch as well as the distance between the vertical distance between the height of the ridge and the sinus.
From a lesser application, from a endodontic prospective, if we’re trying to separate out roots to see what the root configuration is in the endodontically treated tooth. And to some extent we have used it in third molar surgery where if we’re trying to evaluate the mandibular nerve position in relative to the roots of the third molar. All of these are applications we have used with the Suni 3D system.
This is a transcript of the above video.
Chapter 3: Case Study 1: Implantology
Dr. Mulvany speaking: The case I want to show is an implant case. The image I am showing here is after the implants where placed. The importance of the Suni 3D imaging in this case is more retrospective. I want to show you I had a minor complication because I did not have the Suni 3D image to begin with. One of the dangers of experienced implant placement is that there is a tendency for us to extrapolate if you will from a 2D image such as this very excellent panorex, but what we really need here is 3D. What I’m referring to specifically is the lack of clarity as to the area of the mandibular nerve. This is a superb image but you can see that the mandibular nerve kind of disappears down in this area. The other thing I would note is that if you look closely there is a lesion here that appears to be very close to where that distal implant was placed.
Let me go now to the 3D and I will show you what I’m specifically talking about. So here is the 3D image, as we go over to enhance this, you will see that the distal implant is right at the top of that legion. The mandibular nerve is here but this is a lesion that a radiologist has pointed out to me is some kind of vascular lesion. At the time of the implant procedure we got significant bleeding, we were able to control, successfully place the implant and the patient has full sensation. So for those of you that are saying, well that looks like the mandibular canal, I would agree with you but anatomically that is not what we encountered. I think the canal is here and the patient has no nerve impingement and has full feeling in their lip.
With that said, in hindsight I wish I would have had the Suni 3D imaging to choose a different location for the implant. I would have perhaps gone a little more palatable because from this image you can see I have tremendous width and I would have been able to avoid this structure.