Dr. Ed Shellard interviews Dr. Thomas Eshraghi

Cone beam computed tomography (CBCT) has been a game changer - not just for doctors, but for patients as well.

Cone beam computed tomography (CBCT) has been a game changer - not just for doctors, but for patients as well. This month, I had the opportunity to speak with Dr. Thomas Eshraghi of Portland Implant Dentistry about the role imaging software plays in CBCT, ROI, and the future of 3-D imaging (and printing) technology.

What is most important to you in a CBCT unit?

The highest priorities for me are the image resolution and clarity. After that, the next priority would be X-ray exposure (dosage), the ability to switch between focused and full-field of view, and the functionality of the 3-D imaging software.

Could you touch on your selection criteria for imaging software?

My first criterion for imaging software is ease of use. Second, I prefer an open platform format with importability and exportability of the image files. A lot of times, we see patients for second or third opinions who come in with a DICOM dataset, but the software used to view the data is, in my opinion, far inferior to what I have with the Carestream Dental 3-D imaging software. I like to have the ability to import DICOM information from another manufacturer's unit, so I can then utilize the software I am comfortable with to view and trace as if I were on my own machine. That is key for me, and I appreciate the ability to do so.

How do you measure ROI when bringing new imaging technology, such as CBCT, into your office?

Obviously, there are dollars and cents and monetary value after a period of time - typically once the unit is paid off. But I would say the real return on investment is in patient acceptance. When we're able to review the CBCT image with patients, case acceptance improves greatly, in my opinion.

Additionally, it has made both me, as well as my business partners, much more efficient. We no longer have to go into a procedure blindfolded - we know exactly how much bone is sitting over the area we're working with. As a result, we have an understanding of how long things will take us because we have an idea as to how involved the procedure is. So I would say efficiency and patient acceptance (thanks to treatment visualization) are the greatest ROIs for CBCT technology.

Can you speak more about helping patients visualize treatment through CBCT images?

After every CBCT scan, I go through an axial cross section step-by-step to show the patient what I see and why it's important. When patients see this information on the screen, it makes a major improvement in their overall understanding of what's going on. They begin to understand the importance of the bone graft, the sinus, and so forth. It's a great visual tool for us, as well, providing an opportunity for us to go through our treatment recommendations with patients and enhance communication and education.

It's very common for patients to be wowed by it. When we take a full scan, patients are immediately impressed by the amount of data revealed in the 3-D representation of their skulls. Usually when patients have a relative sense that their skulls or mouths can be digitized and we can then take measurements directly on our computer screen, they're quite impressed by the 3-D recreation.

Where do you see dental technology going from here?

CBCT is definitely the wave of the future. The next evolution will be to produce rapid prototyping in our office with 3-D printers, as well as to create in-office surgical guides based on that data. At this point, CBCT and 3-D printing are all within their own realm and have not yet merged; however, I am excited about having the ability in the future to print my own surgical guides. By utilizing the CBCT data, I can create a fully-guided surgical approach - start to finish - without having to rely on intermediary labs or take additional steps to streamline the process.


Specializing in periodontal surgery and implants, Thomas Eshraghi, DMD, received both his Doctor of Dental Medicine and Specialty Certificate in Periodontics from Oregon Health & Science University. Dr. Eshraghi is a Diplomate of the American Board of Periodontology and maintains a private practice in Tualatin, OR. He can be reached at Eshraghi@portlandimplantdentistry.com.

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