According to "Dr. Wo" Wm. Randol Womack, DDS Board Certified Orthodontist, Editorial Director, Orthotown Magazine


Technology, Technology:
The Hurrier I Go, the Behinder I Get!


Wm. Randol Womack, DDS
Editorial Director,
Orthotown Magazine
Ever since I joined Orthotown Magazine as the editorial director, I have been focused to a great extent on the explosion of technology into orthodontics. This was motivated by my attendance at the AAO Technology meeting in Las Vegas in 2008. It is still my opinion that adopting technology not only leads to better patient care but to more "tech-savy" adults and teens seeking treatment at your office over your nearest neighbor's office.

At a recent orthodontic meeting in Scottsdale, Arizona, that I attended as an "uninvited" guest (just to visit with some good friends from out of town), the iCAT representative (whom I knew) was very busy talking with doctors about this new machine that is rapidly coming to the forefront of orthodontic diagnosis and treatment planning. So my continued focus on the impact of technology in orthodontics has lead me to begin reviewing some of the less "technical" – but perhaps just as important – "issues" that impact the doctor who has a CBCT scan machine or who prescribes a CBCT scan from a radiology lab.

In articles for which I am researching and compiling for future issues of Orthotown Magazine, I am attempting to provide an answer to the question, "Where are we today?" with respect to responsibility, accountability and liability when we use the data produced by CBCT scans for diagnosis and treatment planning. In my June 2008 article, "The Future of Digital Imaging" I quoted Dr. James Mah who said, "Cone beam CT is a novel and disruptive technology in dentistry and, for a fairly traditional profession, there is apprehension." Notice the two italicized words in his quotation. I suspect that disruptive might be too mild a term for the issues I am discovering in my research.

I am finding that even the terminology is somewhat unsettled. Is it officially called Cone Beam Computed Tomography (CBCT) or Cone Beam Computed Imaging (CBVI) or Cone Beam Volume Tomography (CBVT)? Don't forget FOV (field of view) because you can order either a complete FOV or a limited FOV. Then what about the MIP (multiple image planes) and the ROI (region of interest) and the presence of MAC (medial arterial calsinosis) which is seen in patients with ESRD (end-stage renal disease)? And don't forget that the image data must be viewed in the X,Y and Z planes to insure that a comprehensive evaluation has been performed and documented.

In my digital imaging article, I also updated and previewed nine machines that were available as of June 2008. Do I need to say that the information we printed is now predictably inaccurate and that more machines – including new "hybrid" machines will be seen in Boston at the AAO meeting? Not really!

BIC (before I close), it seems that, in addition to the above, there are conflicting opinions about which path one needs to follow when incorporating CBCT scans into one's orthodontic practice. The opinion statement of the American Academy of Oral Maxillofacial Radiology executive committee seems to conflict with some prominent trial attorneys viewpoints. Some authors infer that the selection of the type of scan used or requested will change the impact of accountability and even liability of the doctor. Message boards have statements like, "You take it…You read it!" So, the more I dig into these issues, the muddier the water seems to become. Talk about disruption and apprehension!

If you share my concerns and confusion, I hope to see you at the 3rd International Congress on 3-D Imaging in Chicago, June 19-20, 2009. I'll be there.

So, going forward in Orthotown Magazine, you can expect to see some reports from one "fallible" orthodontist who is struggling to make some sense of what has been called "computer assisted dentistry."
Wish me luck … I feel I am going to need it!
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