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Wired for Success: A Case for CBCT Volumes and Intra-oral Scans to Replace Plaster and Digital Model by Alan A. Curtis, DDS, MS, Editorial Director, Orthotown Magazine

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A Case for CBCT Volumes and Intra-oral Scans
to Replace Plaster and Digital Models

by Alan A. Curtis, DDS, MS, Editorial Director, Orthotown Magazine

In 2006, I graduated from my orthodontic residency and joined my father, an orthodontist of 35 years, in private practice. At the time we took plaster models before and after all cases. We sent off the pre-treatment casts to be polished and soaped. The strange thing was after spending $40 per model, they were promptly placed in storage never to be seen again until the debond final records were taken. At the time of debond, the models were pulled from storage and a retention protocol was developed. During treatment, every attempt was made not to violate intercanine width and excessive lower incisor proclination. As my father’s retirement approached, the looming question was how do we handle 35 years of orthodontic records stored in offsite storage.

During my residency, I used OrthoCAD digital models to digitally compare buccal tipping of bonded vs. banded RPEs for my master’s thesis. Feeling a need to have a digital record of the malocclusion, we transitioned to OrthoCAD digital models at the same time as we transitioned away from print photographs and film X-rays. A paper treatment chart was replaced by a digital or electronic medical record. New patient medical histories were scanned into our Dolphin practice database. Once again, digital models were sent out and promptly filed electronically once they arrived. For speed of retrieval, the 3D .stl file was captured into 2D jpeg standard views of occlusal, frontal and buccal orientations, and placed into our Dolphin imaging database. Images were captured 1:1 in order to accurately monitor archform and intercanine/intermolar widths.

Along comes October 2010 after the housing collapse of 2008/2009 a dentist colleague of mine approached me about buying his first generation i-CAT. He was forced to close his doors, being unable to keep his largely implant-based practice afloat. Justifying a four-year-old, $75,000 piece of equipment in the midst of an economic meltdown was one that kept me up at night for a week straight. Once I realized the opportunity cost, the decision was an easy one to make. At 20-30 starts per month and 15-20 debonds per month, the practice was spending close to $2,000 on digital models! Once we were able to justify accepting a 1:1 direct 3D image of the teeth and jaws as an alternative to a 3D model on the computer screen, the economic decision to invest in the future technology was a no brainer!

To offset the cost of the CBCT machine, we also began doing 3D scans for oral surgeons and periodontists. This revenue alone made the machine cash flow from the very first month. Another factor we did not expect was dramatically improved case acceptance. Patients were better able to see the difficulties they were facing and therefore signed up for treatment rather than sitting on the proverbial fence. The combined effect of decreasing costs from model creation and storage, to increased revenue from “outside” scans and increased case acceptance was a synergistic boost our practice needed at a time when other practices were feeling the crunch of a down economy.

The upcoming step in taking our practice to the next level will be to incorporate 3D intra-oral laser scanning into our current technology mix. Advances in technology from iTero, 3M and Ormco, to name a few, will make the dream of having a fully 3D digital office a reality.

The future is here; the future is now. Take the plunge and enter the world of 3D digital imaging for the health of your patients and your practice!
Orthotown Magazine
September 2025
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