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10 mCME Dental Tribune Middle East & Africa Edition | 6/2017 Essential communication: The use of technology for virtual patient records mCME articles in Dental Tribune have been approved by: HAAD as having educational content for 1 CME Credit Hour DHA awarded this program for 1 CPD Credit Point CAPP designates this activity for 1 CE Credit By Dr. Les Kalman & Mariana Capretz, Canada Introduction Records are an essential and inte- gral component of diagnosis and treatment planning.1 Moreover, the acquisition of records allows the required communication between the clinician, laboratory, patient, and other third party stakeholders.2 This is critical in all aspects of den- tistry, but holds immense value in implant dentistry. Unfortunately, there is a growing epidemic in which clinicians are utilizing the minimal amount of records.2 This becomes a paramount issue in the delivery of predictable and successful dental Records may take many forms, but they tend to originate from two dif- ferent groups: concrete and virtual. Concrete records include impres- sions and models, while virtual re- cords encompass modalities such as cone bone computed tomography (CBCT) and intraoral scans. Each group has their own strengths and weaknesses, yet the literature seems to suggest that CBCT provides an abundance of information, especial- ly for implant dentistry.3 Computed tomography Computed tomography (CT) has revolutionized diagnostic radiology.4 Since its inception in the 1970's, its use has increased rapidly, with the annual number of CT scans, in the United States alone, now being over 70 million.4, 5 By its nature, a CT unit involves larger radiation doses than the conventional X-ray imaging pro- cedures. Consequently, a typical CT series results in radiation doses that are associated with a small, yet statis- tically signifi cant increase in lifetime cancer risks.4-7 The quantity most rel- evant for assessing the risk of devel- oping cancer from a CT procedure is the ‘effective dose’.8 A diagnostic CT procedure produces an effective dose in the range of 1 to 10 mSv, with a dose of 10 mSv pos- sibly being associated with an in- crease in the likelihood of cancer of approximately 1 in 2000.8 The risk of radiation induced cancer is much smaller than the natural risk of can- cer; however, this small increase in risk for an individual becomes a pub- lic health concern if large numbers of people undergo increased numbers of CT screening procedures unnec- essarily.4, 9 There is strong evidence suggesting too many CT studies are mCME SELF INSTRUCTION PROGRAM CAPPmea together with Dental Tribune provides the opportunity with its mCME - Self Instruction Program a quick and simple way to meet your continuing education needs. mCME offers you the fl exibility to work at your own pace through the material from any location at any time. The content is international, drawn from the upper echelon of dental medicine, but also presents a regional outlook in terms of perspective and subject matter. Membership Yearly membership subscription for mCME: 1,100 AED One Time article newspaper subscription: 250 AED per issue. After the payment, you will receive your membership number and allowing you to start the program. Completion of mCME • • • • • • • • mCME participants are required to read the continuing medical education (CME) articles published in each issue. Each article offers 2 CME Credit and are followed by a quiz Questionnaire online, which is available on www.cappmea.com/ mCME/questionnaires.html. Each quiz has to be returned to events@cappmea.com or faxed to: +97143686883 in three months from the publication date. A minimum passing score of 80% must be achieved in order to claim credit. No more than two answered questions can be submitted at the same time Validity of the article – 3 months Validity of the subscription – 1 year Collection of Credit hours: You will receive the summary report with Certifi cate, maximum one month after the expiry date of your membership. For single subscription certifi cates and summary reports will be sent one month after the publication of the article. The answers and critiques published herein have been checked carefully and represent authoritative opinions about the questions concerned. Articles are available on www.cappmea.com after the publication. For more information please contact events@cappmea.com or +971 4 3616174 FOR INTERACTION WITH THE AUTHORS FIND THE CONTACT DETAILS AT THE END OF EACH ARTICLE. being performed in the United States and it has been speculated that one third could be replaced by alterna- tive approaches, or not performed at all.4 Furthermore, in the dental offi ce setting, the large size, high cost of the equipment and logistics makes it improbable for the clinician. Like- wise, with a cost per scan ranging in the hundreds to thousands, the procedure can be challenging for patients.10 Thus, although CT has nu- merous benefi cial aspects, there are barriers to the technology from both the clinician's and patient's perspec- tive. Subsequently, other records acquisition techniques have gained increasing popularity. Cone beam computed tomography Cone beam computed tomography (CBCT) is a variation of the tradi- tional computed tomography (CT) system.11 With CBCT, an X-ray beam, in the shape of a cone, rotates around the patient to produce a 3-D recon- struction of the craniofacial area.11, 12 Dental CBCT was developed so that dentists could have a small, less ex- pensive machine still capable of producing 3-D images.12 The equip- ment is used for various clinical ap- plications, including dental implant planning, visualization of abnormal teeth, evaluation of the jaws and face, cleft palate assessment, diag- nosis of dental caries, endodontic assessment and diagnosis of dental trauma.11 Thus, CBCT provides a fast, non-invasive method of address- ing a number of clinical questions.11 Moreover, compared to the conven- tional CT, it has a limited X-ray beam, offers a shorter scan time, uses a lower radiation dose, and contains fewer imaging artifacts.13 Neverthe- less, to accurately read a soft tissue phenomenon, a 24-bit contrast reso- lution is needed. The dynamic range of CBCT for contrast resolution can only reach 14-bit maximally and consequently, CBCT is not the best imaging modality to evaluate soft tissues.14 Additionally, it does not provide the full diagnostic informa- tion available with conventional CT.12 The aspect of cost, technology implementation, skills acquisition and radiation exposure also hinder the utilizing and implementation of CBCT in the dental offi ce. Intra-Oral Scanner Launched in the USA in October 2012, the True Defi nition Scanner (Fig. 1) is a relatively new digital in- traoral scanner..15 Its 3-D video cap- ture technology allows the dentist to digitally capture images of the pa- tient's dentition (Fig. 2). The scanner's technology instantaneously stitches Fig. 1: The True Defi nition Intra-Oral Scanner. Fig. 2: A Intraoral scan with possible rotation in the three planes. ÿPage 11 Fig. 3: A intraoral scan of the same patient with varying degrees of rotation.