Wyndham House Dental opens the door to its new CBCT room

Simon Hill is Principal Dentist at Wyndham House Dental in Llantwit Major, Vale of Glamorgan and has over 16 years’ experience placing implants and implant retained restorations, ranging from simple tooth replacement to complex full mouth rehabilitation

The practice caters for Private and NHS patients also offering cosmetic and specialist Periodontics, along with all other aspects of general dentistry. He recently purchased the building next door in order to expand the practice and incorporate a dedicated implant clinic.

“I wanted a new surgery specifically for my surgical implant dentistry so when the Bank became available, I saw this as a perfect opportunity to make it happen. Refurb was done in the new part of the building so we were able to keep the other side of the building operating. Building work was carried out by a local contractor and Woodlane supplied the plans and service drawings, along with helping with the design and layout of the new side of the building. We incorporated a new surgery, a specific de-con room and a dedicated CBCT room.”

Planmeca Virtual patient with ProFace technology

The original 5 surgery practice was operating very successfully when the Bank next door came up for sale providing the perfect opening to expand, as Simon explains “We bought it and turned it into a specialist implant clinic to make it 6 surgeries. The CBCT currently lives in the old vault so lead lining wasn’t an issue and this is where our relationship with Tom Cross and Woodlane Dental Equipment began.”

“We used Woodlane as we knew Tom from his previous roles; he actually used to repair some of our equipment when he was an engineer a few years back. We had been told by another engineer that Tom was now working at Woodlane and after the first meeting we decided not to look elsewhere!”

For anyone considering equipping a new surgery, a visit to a manufacturer showroom is a great place to start your research. “We went to the Woodlane Showroom and then they recommended going to the show at the NEC. We had a look at multiple CBCT software’s and units, and it was this experience of trying them all out that helped me make my final decision as being Planmeca.”

Romexis Implant plan upper

The footprint of the Planmeca ProMax CBCT unit suited the size of the room and Simon was also impressed by the Ultra-Low Dose protocol that reduces effective patient dose without a statistical reduction in 3D image quality. “The Ultra-Low Dose mode gets rid of any patients fears if they are scared. Some patients do ask, and I am able to say this is the lowest dose machine on the market”.

For a clinician considering investing in a CBCT unit, Simon has this advice. “You need to have a good look at what is out there and what you actually want to achieve with your digital workflow. For anyone considering digital dentistry in relation to implant dentistry then a CBCT is an essential bit of kit.”

Having their own CBCT unit onsite has made a significant difference to the practice, as well as to the patients. The unit is used alongside the user-friendly Planmeca Romexis dental software for implant planning and placement, as well as for patient education.

Post-installation training was an essential part of ensuring the practice could utilise the 3D unit to the maximum. Planmeca Territory Manager Steve Reed supported Wyndham House with clinical applications training which included guidance on image acquisition, x-ray dose parameters and resolutions, as well as software training for diagnosis, so that they had confidence in operating the equipment and planning treatment plans for patients.

Romexis Implant plan lower

“People come in for consultation and we can give them a more definitive answer straight away at the same visit, tell the patients much more specifically what their treatment is going to involve. It helps keep referrals in house, especially for extraction, as we can do an accurate assessment for extraction. It’s got a great 2D image on it which the Periodontist likes. Ease of export of any data is really easy to any referring practitioners. We have had increased patient acceptance as they feel confident that we are using the right/new technologies and not sending them off to other practices for this. It also makes so much economic sense, the amount we use it means it more than pays for itself.”

When asked if he’d do anything differently if he was to do it all again Simon replied “No, it was just easy from start to finish, Woodlane made things flow nice and easily. It was a seamless project and I do think that going to the show to see and clarify the dental equipment I was about to purchase was very worthwhile.”

Planmeca decreases patient doses for 3D images of the head – algorithms provide more detailed imaging and diagnostics

Planmeca has developed smart technologies that help decrease the amount of radiation required to produce medical images without compromising the diagnostic quality of the images. The algorithms developed for 3D imaging help produce more detailed images and diagnostics. Low-dose imaging is beneficial for any patient, but it is particularly significant for children, as a child’s body has comparably more radiation-sensitive red bone marrow than the body of an adult.

When new scientific studies on the subject were published around a decade ago, Planmeca began to develop its own dose measurement solutions. Planmeca believed that these solutions could help decrease ionising radiation doses in medical imaging.

Juha Koivisto, Planmeca’s Chief Physicist and a long-time employee, decided to write his doctoral dissertation on the subject at the University of Helsinki – We noticed during our research that we could decrease the radiation dose without affecting the diagnostic quality of our images. When we compared our low-dose imaging solution to traditional methods used in the field, we discovered that the radiation dose could be reduced by 77%, says Koivisto.

Using a dosimeter to observe how radiation is formed
Planmeca Ultra Low Dose is a smart, algorithm-based low-dose imaging protocol that was launched in 2014. Before the company could develop the new product, it first needed to create a real-time dosimeter. The device allows the company’s researchers to observe how a radiation dose is formed.

– The dosimeter includes a patient model called a phantom, which has sensors that measure radiation doses. When a phantom is exposed to a radiation beam produced by a CBCT unit or another X-ray device, these sensors measure residual dose levels in tissues in order to derive effective doses. This allows us to gain an understanding of the organs the beam reaches and the makeup of the effective dose in the head region. Different organs have different weighting factors, notes Juha Koivisto.

For example, bone marrow, which is renewed at the fastest rate, has the largest weighting factor. If it is exposed to radiation, the effective dose is larger than a dose that is aimed at skin or the brain, Koivisto continues.

The dosimeter was used to review every imaging protocol used by Planmeca.

Diagnostic requirements determine the area, precision and radiation dose of an image
Planmeca is developing its clinical 3D imaging applications for implant and orthodontic treatments, respiratory tract and sinus examinations, and maxillofacial surgeries.

With Planmeca’s devices, dentists and radiologists can now base the right imaging protocols and radiation doses on each patient’s diagnostic needs. Professionals in the field usually have a good understanding of the radiation doses required to achieve images of a certain quality. The Finnish Radiation Act mandates that a patient should not be subjected to more than the minimum amount of radiation necessary for the diagnosis in question – If, for example, one wants to diagnose a patient’s frontal or maxillary sinuses, a smaller radiation dose is usually enough to obtain a sufficiently detailed image, notes Koivisto.

Implant or root area treatments require more enhanced and detailed 3D images, and the imaging of these smaller regions often requires larger radiation doses. However, the jaw area images used as part of orthodontic treatments usually require images of a lower resolution and a smaller radiation dose.

Planmeca’s devices can capture images of a 10 X 10 cm area with a radiation dose as low as 12 microsieverts. Physicians can lower the dose by, for example, limiting the size of the volume or by decreasing the imaging values used, i.e. by changing the quality of the image. In practice, the low dose imaging process has been made to be as quick and easy as possible – all you need to do is press a green button.

The goal is to decrease cumulative radiation exposure in the populace
Juha Koivisto explains that the statistical risk of radiation is very small for an individual, but this figure can still be significant at the wider population level – We want to further decrease the cumulative risk that radiation poses to the populace and we can achieve this by decreasing the radiation doses of our devices to a level that is as low as possible, he notes.

Planmeca’s devices can capture a medical 3D image with a dose as low as 12 microsieverts, which is the equivalent of four days of background radiation in Finland – According to the Radiation and Nuclear Safety Authority, we are exposed to around 0.15 microsieverts of radiation per hour. For example, on a transatlantic flight you are exposed to around 80 microsieverts of radiation, which is significantly higher than the lowest radiation dose produced by CBCT imaging, Koivisto describes.

Planmeca’s objective is to decrease the radiation doses of its devices even further, to the lowest levels possible, in accordance with the ethical standard of “as low as diagnostically acceptable” (ALADA). This principle is part of Planmeca’s ethical imaging philosophym– Even though an individual patient is not subjected to any great risks when an image is captured of their head region, on a wider scale this can become a national health issue, which is why it is advisable to further decrease radiation doses, Juha Koivisto says.

New principles inspire debate
The European Commission drafts evidence-based guidelines on which imaging protocols are to be used for different cases, and it also publishes the average radiation dose values used in medical imaging.

Antti Airisto, an Area Export Manager at Planmeca, explains that these policies inspire a great deal of debate among professionals in the field. Today, medical images are acquired using both 2D and 3D imaging devices, which also affects the average values.

There has also been discussion, for example, surrounding the use of 3D imaging for wisdom tooth removal cases. Among other things, 3D images can help reveal cases where the root of a patient’s tooth is tangled around a nerve canal.

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