Dentaltown has recently released a new poll summarizing trends in digital imaging.  

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One the biggest challenges that dental professionals have is reducing patient anxiety and fear. In fact, increasing comfort and reducing anxiety is a main driver in patient retention for a successful dental practice. One area of opportunity comes with the cone beam scan in a dental office.

If you feel that the cone beam scan is appropriate, the patient may already be on edge. Perhaps the patient has never had a cone beam scan before, and doesn’t know what to expect. Many times, the patient (or the patient’s parent) will feel their anxiety spike higher with concerns of radiation risk. In fact, many patients may, consciously or subconsciously, use the logic that “wow, they are bringing out the big guns – this must be serious!”

Sometimes, counteracting this anxiety can be as simple as the words that are used. Our recommendation: don’t call it a “CT”.

Of course, it’s correct to call it a CT, as this stands for Computed Tomography, and is the general umbrella of all modalities that use this technique to gather data in three dimensions. It includes MRI and Catscan systems used in hospitals, as well as the dental cone beam.

The full abbreviation of CBCT, stands for Cone Beam Computed Tomography, and while it uses similar technology as these larger systems used in hospitals, the “Cone Beam” portion of the name highlights the key difference that will make your patient feel much better: the radiation dosage from a dental cone beam is a tiny fraction of that from a traditional CT they would find in a hospital.

However, when you use the phrase “CT” or “Dental CT”, the patient may associate the scan he or she is about to get with these larger machines. They may also associate these machines with larger radiation output, higher risk, and more serious diagnoses.

Given these associations, we believe it is more comforting to the patient to call it a “3D scan”, “cone beam scan”, or simply a “scan”. Using these words may alleviate the patient from additional anxiety.

Learn more about cone beam systems from ImageWorks

As more and more of the world of dentistry moves into 3D, there is a collision of two different data standards:  DICOM and STL.  To understand these standards and the roles that they play, it may be helpful to understand where they come from.

The first data format is called DICOM, which stands for Digital Imaging and Communications in Medicine.  For decades, this has been the standard for all medical digital radiography.    It not only covers the formats to be used for storage of digital medical images, but also covers the protocols related to the communication services which are useful in the medical imaging workflow.  Now, in the dental arena, digital radiographs are typically DICOM standard mainly to drive consistency in image file format.  The protocol standards that are defined by DICOM are less relevant to a typical dental office because they are used when communicating with a Picture Archiving and Communication System (PACS).  PACS are used in larger facilities (e.g. hospitals, prisons) that have a wide variety of digital radiographs that need to be performed, stored and managed.  

In a dental office, the traditional cone beam scan are typically stored by the imaging software in DICOM format.  For a dental cone beam, the data that makes up the volumes actually consist of many (typically hundreds) of 2D slices.  Each of these slices is also typically in DICOM format.

The second data format that has become more important to dentistry recently is STL, which is short for stereolithography (You might also hear it referred to as Standard Triangle Language or Standard Tessellation Language).  This format has it’s origins in the fields of 3D printing and Computer Aided Design and Computer Aided Manufacturing (sometimes referred to as CAD/CAM). It describes the surface geometry of a three-dimensional object and has become the data format that most 3D printers and milling systems require.  In a dental office, the traditional intraoral scanner will output in STL format.  

While the DICOM approach to 3D breaks the volume into slices.  The STL format breaks the surface of the volume down into “tiles” which are typically triangular.  As a result, the DICOM file tends to provide more information about what’s inside the volume, while the STL file tends to provide more information about the surface of the volume.  

When creating an implant plan, clearly both of these types of information become very useful.  Particularly when a surgical guide is being created because it utilizes information underneath the surface but also needs to know information about the surface itself including the soft tissue.

Commonly, the dental office does not need to worry about converting one format to the other because this is generally where the lab plays a role.  The lab has deep expertise and software tools to help them merge these different formats together to create the implant plan for the dental professional.  However, if a dental office would like to start performing chairside milling, or printing their own surgical guides, then it becomes more important to understand how these data formats work together.