Dr Massimo Giovarruscio is a Specialist Endodontist recognised in the UK and abroad as a talented clinician, teacher and postgraduate lecturer. He originally graduated in Italy in 1996 and has since gained extensive experience in restorative and aesthetic dentistry, as well as becoming a GDC registered Specialist in Endodontics in 2010. In addition to working within several leading dental practices in Bristol and Gloucestershire, Massimo is a founding member of and tutor instructor at the Delta Dental Academy.
He discusses the decision-making process for replacing his CBCT machine with a new model from Vatech – the GreenX.
When I was first introduced to CBCT imaging about 10 years ago, I was pessimistic about its advantages in endodontics. Today, my opinion couldn’t be more different. I have seen just how critical CBCT imaging is for an accurate diagnosis as an endodontist and it has become the best investment I can make in my practice. I now believe it is a mandatory part of the initial patient assessment, as only with the detailed information a CBCT scan provides can I make the right diagnosis. I use CBCT imaging for every single patient that I see, whether they are attending for the suspected treatment of a primary tooth or for retreatment.
I would strongly recommend that colleagues offering endodontic and general dental services do the same. CBCT imaging should be utilised routinely to ensure that we are working with all the information we possibly can when designing treatment. It is not only a great way of ensuring accurate treatment plans with minimal complications, but it also provides peace of mind from a medico-legal perspective too.
ADVANTAGES OF AN INHOUSE CBCT SCANNER
Though I have not done so for some time, I do appreciate the potential challenges of referring a patient out for a CBCT scan. This process can cause significant delays to the treatment journey, impacting both patient and practice. It is impossible to complete the diagnosis and plan without the images, so everything is on hold until these are sent to the practitioner. While there is a considerable investment involved, the advantages of an in-house CBCT are multiple and the cost is justified with demand. For those not able to invest, referring to the right practice for imaging is key.
I often receive referrals from fellow dentists who need assistance for endodontic cases that are more complex than they initially thought. For example, I commonly see patients whose GDPs have accessed a cavity but struggled to identify the root canal anatomy. With a CBCT, I am typically able to find missed or additional canals, and often come across perforations in the tooth caused because the dentist didn’t originally have the facilities to properly visualise the root canal system. With the additional detail that a CBCT scan provides, I can more predictably decide if a case is treatable or not.
HIGH QUALITY IMAGES
With my previous CBCT machine needing an upgrade, I was on the market for new technology. I turned to Vatech as I had been introduced to the company through John Anderton at Digital Dental. I was most interested in the quality of the images that would be provided – given that I use the CBCT every single day, this was very important to me. When John demonstrated the images from the Green X CBCT, I immediately noticed the difference from scans I could obtain using my old equipment, which were nowhere near the same quality.
I also loved that the machine could deliver high-quality images at a low radiation dose, which ended up being the main factor in my decision-making process. Again, using the CBCT routinely means that I need to do so in a safe way for my patients, and keeping the dosage as low as possible is how I can achieve this.
The many field of view (FOV) options are also very good, allowing me to narrow down what I want to look at where appropriate. The smallest voxel size is 0.0495 microns, which still provides unbeatable high-definition image quality in the 4x4 Endo Mode. In addition, I have been impressed that the Ez3D-I software shows a 3D root canal image and that you can both adjust the pulp level and segment the teeth to differentiate between the jawbone and teeth. I have only had a few weeks of experience with the equipment so I am still becoming familiar with it, but so far, these features have been very useful.
The service from Digital Dental is making the learning curve as simple as it can be. From the installation process – which was smooth and efficient – to the ongoing support available, the team have been extremely helpful. The training has been delivered by Digital Dental and Vatech, providing a good amount of information for my experience level with the equipment at the time. I hope to look into the Scout View next so that I can be even more precise when I select a single tooth.
I have been impressed by the equipment and service from Vatech – and so have my patients. They have commented on and appreciate the good design and the sophistication of the machine, with features such as playing music during their scan proving popular. I would definitely recommend the GreenX CBCT and Vatech to colleagues looking for new technologies for their practices. It has been the best investment I have made in my practice.