Q: I need dental Implants. My dentist wants me to get a scan that costs over $500 and is not covered by insurance, plus produces lots of radiation. Another doctor said he could do the case without the scan and just use a normal X-ray. Is this safe? How does a layperson make this decision?
A: I know all about being a layperson. Whenever my pension guy explains what he is doing for me and my staff’s retirement fund, my head spins around like Linda Blaire in The Exorcist. Plus, he has this nervous laugh that sounds exactly like Popeye; Ack ack ack ack ack ack.
Is a CAT Scan Needed for Dental Implants?
Don’t bother Googling this question. I did and all I found were private dental offices promoting their websites and practices by claiming that all implant cases need you to have them use their brand new $100,000 3D Cone Beam scanner. I spoke to several faculty at Tufts College of Dental Medicine who claim that only one out of ten cases require the CT scans. At this point in time, it is not the “standard of care” in implant dentistry for most cases.
Your dentist, if needed, can refer you to an imaging center to get a scan if need be; he does not have to have one in his office.
Standard digital X-rays show images in 2D. This means they will show the height and lateral (left to right) dimension of bone but, not the front to back dimension. The ridge of bone may be too thin in this dimension, preventing the placement of an implant. No bone; no go.
However, the height of bone is more crucial, as this reading keeps you from having your implant invade crucial structures such as certain nerves, the sinus and the base of the nasal cavity. Standard 2D x-rays will reveal this.
One can also measure the front to back “thinness” of bone without a 3D CAT scan by using a “ridge mapping caliper”; a scissor clamp-looking, device with two prongs that grip the boney ridge on both sides, giving you a pretty accurate measurement, similar to how a plumber measures the diameter of a piece copper pipe.
I place over 200 implants per year and I can count the times a CT scan was needed on one hand.
Dr. Mitchell Josephs practices Implant, Cosmetic and General Dentistry with an emphasis on implants, porcelain veneers, and complex crown and bridge treatment. He is on staff at JFK Medical Center and is a Faculty Advisory Board member at McGill University’s Faculty of Dentistry. He completed his residency at Manhattan’s Beth Israel Medical Center and Mt. Sinai Hospital.