Seeing is Believing

Dr. Samuel Cress describes the value in CBCT imaging, while using his Axeos 3D Imaging System for his dental sleep medicine practice.

by Samuel E. Cress, DDS

”CBCT is useless in dental sleep because people don’t sleep sitting upright.”

“CBCT is a wasteful expensive piece of equipment that unnecessarily radiates my patients.”

You have probably heard these types of statements in lectures or on social media. Maybe you’ve even cast similar aspersions. I’d say it’s inarguable that a clearer understanding of the guest’s anatomical features for implant placement, endodontics, and dental sleep medicine (DSM) enables you to become a better clinician.  In my experience, the data provided from 3D provide the best view and empowers me to provide the highest quality of care for my guests.

When I embarked on my DSM journey in 2008, I owned a bustling general dentistry practice. After education, the first investment I made when delving into DSM was a CBCT unit. However, the equipment had myriad uses unrelated to sleep. I used it for implant placement, endo, and ortho cases. It was a significant investment and though I used it for all those other procedures, I really paid for it in my sleep practice.

After providing oral appliance therapy (OAT) for over ten years, I recently launched a new journey by opening a practice dedicated entirely to the treatment of OSA and TMJ disorders. The standard of care in my practice is the use of CBCT to acquire data for evaluation of temporomandibular joints when treating pain and before treating any guests with OAT. I simply can’t imagine practicing without it and once again, when outfitting the new office, I went with a CBCT unit from Dentsply Sirona; this time in the form of the Axeos. It’s vitally important to capture pristine images of the nasal cavities down to the hypopharynx. Acquiring an excellent view of the individual’s condylar relationship is key in selecting and prescribing the appropriate appliance to treat OSA. Personally, I use the Axeos 17×13 cm field of view (FoV). The versatility of this 2D/3D unit guarantees that I efficiently capture everything I need to see.

While I’ve opted for the largest FoV, the Axeos 3D Imaging System is flexible to take smaller FoV in 5×5.5 cm, 8×8 cm, and 11×10 cm. The Axeos captures the airway, complete dentition, including both temporomandibular joints and the cranial base in one simple pass. Its 2D/3D hybrid capability, convenient 2D programs including extraoral bitewings, HD, SD, LD 3D settings, along with metal artifact reducing software, makes Axeos the top 3D unit on the market.  I’m no tech slouch but I’m not Bill Gates either and the Axeos is crazy intuitive. Its guest imaging assistant allowing for auto height adjustment and the patented auto positioner make this very easy to use. Axeos has been developed to embrace the ALARA (As Low As Reasonably Achievable) principle to allow for exceptional image quality at the lowest reasonable radiation dose. This negates any well-intentioned but misinformed concerns centered on radiation dosage.

The Axeos hardware is phenomenal but when paired with Dentsply Sirona’s SICAT Air software, a slew of new possibilities open up. The software gives a clear airway visualization and analysis which I use to more effectively convey to the guest what a typical airway volume should be and compare that with their own. This visualization helps guest more fully understand the concepts and importance in maintaining their airways. It eliminates much of the abstraction for guest which has dramatically increased my case acceptance.

The Axeos provides superior images, but what it really does is give me the clarity and confidence to do more. Better. Dentsply Sirona Axeos CBCT is the nucleus of digital workflow in my DSM practice.

Besides his Axeos 3D imaging system, Dr. Cress also uses oral appliances for sleep apnea treatment. Read more about it here: https://dentalsleeppractice.com/products/restorative-dentistry-in-airway-health/

Samuel E. Cress, DDS, director of The Center for Craniofacial & Dental Sleep Medicine located in Houston, Texas, received his Bachelor of Arts Degree from Austin College in Sherman, Texas. He completed his Doctorate of Dental Surgery from the University of Texas Health Science Center, San Antonio, Dental Branch. Dr. Cress also completed his residency in Dental Sleep Medicine at Tufts University School of Dental Medicine in Boston and his residency in TMD through the American Academy of Craniofacial Pain. In addition to his practice specializing in dental sleep medicine, TMD, cosmetic and Full Mouth Rehabilitation, Dr. Cress is a clinical instructor where he teaches other dentists the benefits of Airway Conscious Dentistry as well as diagnosis and treatment of patients suffering from TMD. Dr. Cress currently holds a duel patent on an oral appliance, the Meridian PM, for the treatment of OSA and TMD, recently granted FDA clearance. Dr. Cress has several published articles in the field of Dental Sleep Medicine and has presented at the TMJ Bioengineering Conference in Barcelona, Spain.

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