Choosing The Right CBCT

The Dental CBCT industry has come a long way and produced plenty of winners (and losers, too) that define the current market landscape. And now with more options than ever, narrowing down your choices seems to have become a daunting task for many first time buyers. After consulting hundreds of dentists through their CBCT buying journeys, we've come to understand that the final decision ultimately comes down to satisfying these key factors:Your Scope of Use Available Space Evaluation of the Manufacturer & Support Structure Actual Selling Price Yes, there are additional questions of specifications, like the voxel size range, low radiation exposure options, and image processing algorithms, too. These are typically brought up as selling points that look really good in writing, so let's go ahead and address them as well. This is probably the first question you asked yourself before deciding that you need a CBCT unit for your practice. Simply put, a 3D image provides so much more information than a Pano or PAs ever could. The most accurate diagnosis can only come from more anatomical information, not less. This holds true for every potential case - implants, endodontics, TMJ, airway studies, impacted 3rd molar studies, guided bone regeneration, etc. F.O.V. (Field of View) - Have you started placing implants in the last 5 years? If so, did you imagine yourself performing those surgeries just 6-7 years ago? Probably not, and that's why you purchased a 2D Pano x-ray instead of a CBCT.  Similarly with TMJ, Airway, and advanced surgeries like GBR and Sinus augmentation, your need for a larger FOV may come sooner than you expect. Tip: Keep in mind that a CBCT purchase is a long term investment. Don't limit yourself to the minimum FOV & functions you only need for now. Voxel Sizes/Low Dose/Artifact Reduction - These and similar specifications all relate to the image quality presented to you after the scan is taken. How each number looks on the specs sheet really means nothing if you are unhappy with the clarity of the final volume you end up with. -100µm is about the thickness of a human hair. That is typically more than enough resolution to see vertical microfractures and hidden canals. Unless you see complicated endo cases all day, everyday, a higher resolution (smaller voxel size) may not even be necessary. -Digital sensor technology (CMOS, Flat Panel) has come such a long way within the past decade that the stigma of high dose radiation exposure associated with medical CTs is a thing of the past. The more sensitive the sensor, less X-ray is required to capture the same quality of image. On the same token, most manufacturers' "Low Dose Mode" typically spins the gantry faster to shorten the duration of exposure for the patient. With less data arriving at the sensor, you are ultimately sacrificing the quality of the final image. Just ask any of your colleagues how regularly they actually use a "Low Dose" function on their CBCT unit. Other machines control dosage by limiting the area of exposure with adjustable, smaller FOVs. -There is no CBCT machine in the market that does not employ some kind of image processing algorithm to reduce noise and scatter from metal artifacts. Tip: Ask your CBCT dealer to provide you a sample scan data (DICOM) with a 3D viewing software to judge the actual quality of the final volume. Does it Fit?  This is an obvious, yet crucial detail to discuss for your CBCT purchase. The space restriction in your office could rule out more than 50% of the machines available in the market today! While many extraoral x-ray units were purposely designed to fit into what used to be film developing rooms, just as many are not. But it doesn't stop there. Please consider the following points: Cephalometric Arm - If you require a cephalometric arm for your CBCT unit, the space requirement will change considerably. However, there are Extended FOV units available that can capture 3D images so large that a 2D cephalometric image could be extrapolated from the volume. Standalone Vs. Wall Mount - Some CBCT units must be installed squarely against a load supporting wall, while some can stand freely and comfortably in any irregularly shaped room. Patient/Operator Orientation - When a patient simply has to "walk-up" and face the unit, you need only to worry about the extra space to the side where the operator can stand. Then there are CBCT units where the patient & the operator need to stand facing each other, while standing perpendicular to the body of the main unit. These machines will ultimately require larger "operating space" beyond the machine's footprint. Tip: Don't fall in love with any 1 model before you've considered whether it's a good fit (literally) for your office. There are often more to consider than the dimensional drawings seen in catalogues, so be sure to speak with your CBCT dealer in great detail about your installation site. Brand Power?  The power of any major brand comes from its recognition. It has outshined the competition and surely deserves the trust of its potential customers. Right? Well.. It's Called What Now? - You've surely seen the same X-ray machine with different brand logos printed on them, yes? Is Dexis KaVo? Or was it Instrumentarium? Owandy is Acteon? What's going on now? Acquisitions and mergers are a regular part of corporate growth, but how does it impact your practice and your patients? Have you ever tried to order repair parts from a company (or a division of a company) that's currently being sold? Have you ever caught a fire-sale of an otherwise more expensive equipment only to find out that the customer/tech support no longer exists? Tip: Before committing to a purchase, call the equipment manufacturer's technical support line and see how long it takes until you get the right person on the phone. Tip: Take your time to vet direct-from-manufacturer sales that seem too good to be true (typically in the 4th quarter). If you can't reach their Customer Support as easily as their Sales Department, it might be a point of major concern. Parts & Labor Warranties - Parts are covered under the manufacturer's warranty while on-site labor is provided by the certified dealer. While labor expenses are predictable ($90 ~ $115/hr) even after the warranty period, the cost of parts tell an entirely different story. Replacement part costs for some major components like detector panels (sensors) and x-ray tubes can reach upwards of $40,000 after the warranty has expired. Even more, in cases of "discontinued" or clearance models, those parts may not even be available when you need them. Tip: Pay particular attention to the parts warranty provided by the equipment manufacturer. It speaks volumes to their confidence in the equipment as well as how long they are willing to support that model. Heart & Soul of the CBCT  - The most expensive components in any x-ray equipment is the sensor(s) followed by the x-ray tube assembly. Many describe them as similar to the engine & transmission in a car. This explains why the equipment's prices jump by large margins as the maximum FOV increases. But even here not everything is as it seems. Common Tricks to Avoid -Beware of machines that are advertised with no clear mention of the actual Field of View. These models usually have variations with different size sensors (and very different prices), but are lumped together under one name. You may see (*optional) next to the largest FOV for that machine, meaning the exact unit capable of capturing that volume is on an entirely different pricing tier. Many salespersons like to then offer you the "next best thing" at what seems like a good  deal. -Next is not necessarily a "trick" but something to be aware of. More economically priced machines can achieve larger FOVs using smaller sensors through different scanning methods. A "Double Scan" technique scans the object twice, as the name suggests, then stitches the 2 volumes together during processing to produce a larger image. Some machines move the gantry housing both the sensor & generator along oblong shapes to create "anatomical" volumes whose farthest edges measure larger than the typically cylindrical shape. These are both smart ideas to reduce the cost of manufacturing, but they only benefit you if they are priced economically. -Short or ambiguous warranty period/coverage - This should be a huge red flag for the buyer. As a new equipment seller, we have been asked by dozens of our customers to help them dispose of their broken machines. Nearly every time the story goes: "it started having problems shortly after the warranty expired. The repair costs were so extravagant, we decided to buy a new machine with a longer warranty." Stories like this would not be surprising if we were talking about some unknown, inexpensive machines. You'd be surprised how many "premium" brands/models have this problem. Tip: Try a quick internet search of the Used CBCT Market and you'll see which brands & models are most often discarded. Tip: Be VERY wary of used equipment in general. They may seem like a good bargain at first, but chances are extremely high that you're inheriting someone else's headache. Tip: Get clear answers on the Max FOV (and whether it is a single or multiple scan), the warranty period & coverage. Tip: If you're looking at a CBCT machine with only 2-3 year warranty, ask about the cost of extended warranties. A single year extension could cost between $6,000 to $20,000, depending on when you ask. MSRP / Low Sell / Actual Price  -MSRP - No CBCT ever sells at the manufacturer's suggested retail price. This number is only used to maintain the perceived value of the brand and model by the public, according the manufacturer's own standards. -"Low Sell" - This is what the manufacturers allow authorized dealers to publicly advertise online and in print. Again, this is controlled by the manufacturer and the price most customers find as "On Sale" or "At a Bargain" price. Most dealers are happy to sell at this price, but the savviest shoppers are wise to push this limit. -Actual Price - This is what truly matters to you, the buyer. There are many legal & policy barriers that prevent dealers from openly communicating this number. This is why you see "Call for Quote" on most catalogues & website. As a rule of thumb, most dealers take a 21% -25% margin on their wholesale cost. Tip: Always speak with the dealer by phone or in person instead of text/email.