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ePaper created 2014-12-05, 15:38:45 | version 1.33.01
10 I I opinion _ CBCT in dental office tion papers are used by professionals to influence thepracticeoftheirdiscipline.Asthepracticeofthe discipline changes in response to many factors in- cluding,butnotlimitedtocourtverdicts,experttes- timony, literature support, professional guidelines, cost of the technology, and reimbursement by third partypayers;therecommendations,guidelines,and positionpapersmayfacilitatetheevolutionofCBCT into a standard of care. Thus, in 2014 the profes- sional organisations that comprise dentistry may notformallydeclareCBCTisthestandardofcarefor every patient, but these organisations do recognise the influence CBCT is having on the profession. _Educational Institutional Participation For a technology to be considered a standard of care,thoseintheprofessionmustbeeducatedinits application in patient care. In US, 56 of the 57 den- tal schools (98 %) have CBCT available for patient care for pre-doctoral students. Forty-seven (84 %) incorporate CBCT education in their pre-doctoral curriculum. In a survey performed by the author andothers202generalpracticeresidency(GPR)and advanced education in general dentistry (AEGD) programmes were surveyed regarding use of CBCT bytheirresidents.Eighty-twoprogrammedirectors responded to the survey. Of the 82 respondents, 56 (68 %) of program directors (PDs) responded affirmativelywhenaskedifCBCTwasusedinpatient carebytheirresidents.Theauthoralsosurveyed102 PDs in oral and maxillofacial programs in the US. Fifty-fourPDsresponded.Ofthe54PDsresponding 47 (87 %) affirmatively when asked if CBCT is used in patient care by their residents. In a phone survey of endodontic residencies, 44 of 47 PDs indicated their residents use CBCT in patient care. All seven ADA-approved oral and maxillofacial radiology programmes use CBCT in patient care. Additionally, all51periodontalresidencyPDsindicatedthattheir residents employ CBCT technology in patient care. In orthodontics, 83 % of US-based orthodontic programmes use CBCT in patient care. _Cost and Availability The cost of CBCT machines today range from US$150,000toUS$250,000withyearlymaintenance feesintheUS$8,000toUS$20,000range.Aswithany emerging technology, advances create a secondary marketforslightlyusedmachines.Eachnewstepfor- wardintechnologyrenderstheCBCTmachineofonly afewyearsagoslightlyout-of-date,despiteitsobvious value and its superiority to two dimensional films. As time progresses and advancement in the quality and capabilities of the newest machines demon- strate themselves, the slightly non-contemporary machine will represent a significant advancement for the dentist versus 2-D radiography, while not burdening the dentist with significant cost. This will undoubtedly lead to an increase in the number of dentalprofessionalsutilisingCBCTintheirpractices. ThebottomlineformostpracticesinregardstoCBCT machines is: can I afford this for my practice? To determine affordability, the price of the machine(purchaseandmaintenance)mustbecon- sidered against potential revenue generated by the machine. Revenue can be directly from patients, insurance companies, or from other dentists who utilise the CBCT machine. A cost-effective alterna- tive to owning and operating a CBCT device can be theoutsourcingofthestudytoathirdparty(dentist or facility) and in-sourcing the software necessary to employ the images in treatment planning and diagnosis. CBCT machines are becoming ubiquitous as moredentistpurchasethemachinesandmorethird party non-dentist owned imaging centres enter the market. Since more dentist and more patients are becoming exposed to the technology, patient acceptance will increase, facilitating the incorpo- ration of CBCT into the mainstream culture of dentistry. The increasing omnipresence of CBCT technology will not singularly make it standard of care, but it will serve to increase patient awareness ofthetechnology,whichinturnwillinfluencewhat the public perceives as a standard of care. _The insurance industry Reimbursement from major insurance com - panies and government-sponsored health care is traditionally the last to embrace (i.e. pay for) a new service such as CBCT. Although codes for medical CBCTshavebeenaroundfordecades,specificcodes for in office CBCTs began to materialise in 2009. Current reimbursement rates for in-office CBCTs averagearoundUS$300,providedthestudyiscovered. By providing dentists with a CPT code, the in - surance industry has validated the technology of CBCT and thus acknowledged its value in treatment planning and diagnosis. As time progresses, in- surance companies may, as they have in the past, require CBCT owner/operators to obtain a certifi- cation via the IAC or some other regulating entity for an owner/operator to qualify for financial re- imbursement from any third party payer. Two of the major malpractice carriers of the insurance industry (OMNSIC and MedPro) have in- fluencedtheevolutionofCBCTasanewstandardof carebyofferingcoverageforCBCTowner/operators commensurate with the level of risk to which the cone beam4_2014 CBE0414_06-11_Whitesides 28.11.14 11:55 Seite 5 CBE0414_06-11_Whitesides 28.11.1411:55 Seite 5