From Diagnosis to Growth: A GP’s Success Story with CBCT

And here's what I really find amazing. All of these machines now, this imagery, we're able to track a historical line. So if I have a patient, for example, who comes in with a lot of restorations or they've had a lot of endo and you are missing teeth and you start to put pictures together what's going on, you can track the history. You can really create a timeline of each of those teeth. That's a very valuable tool down the road. Welcome to Austin, Texas, and welcome to the Phil Klein Dental Podcast. Today we'll be talking to a veteran general dentist who took her diagnostic game to the next level by fully embracing CBCT technology along with some of the AI that goes with it. For her, it wasn't about keeping up with trends. It was about diagnosing dental disease with greater accuracy, helping patients get the most appropriate treatment faster, essentially eliminating the guesswork. But what she didn't fully expect... was that incorporating CBCT would do more than sharpen her clinical eye. It would elevate her entire practice. According to our guest, her patients experience the wow factor when they see state-of-the-art technology in action, especially the 3D imaging and AI capabilities that CBCT brings to the operatory. In addition, she loves the way CBCT enhances visual education and makes case acceptance easier than ever. Today we're going to explore with our guest how one decision helped her streamline workflows, grow her practice, and ultimately deliver better care, often getting patients to the right treatment or the right specialist in fewer steps. So if you've been on the fence about investing in 3D imaging, I think hearing from our guest, Dr. Lori Trost, will be very informative and helpful in your decision making. Dr. Trost, as many of you know, is a recognized and sought-after dental educator, author, and clinical consultant who maintains a comprehensive restorative practice in the greater St. Louis, Missouri area. Before we bring in our guest, I do want to say that if you're enjoying these episodes and want to support the show, please follow us on Apple Podcasts or Spotify. You'll be the first to know about our new releases, and our entire production team will really appreciate it. Dr. Trost, it's great to have you on the show. Thank you, Phil. I really appreciate it. Nice to be here. We love having you on the show, Dr. Trost. You've been a great contributor to Viva over the years. We really appreciate it. This topic is really important. Now, in the old days, when I say old days, it's not that long ago, but CBCT has been around a while. The original early adopters were probably the dentists that were doing surgical implants, and they needed to see in 3D anatomically the structures of the... the jaw to make sure they weren't impinging upon anything, obviously, when they were planning their implant cases. But you're not a surgical implant person, Dr. Trost, but you still incorporated CBCT into your practice as a GP and find it invaluable. What compelled you to purchase a CBCT unit and integrate it into your workflow? Great question. So I started a boutique practice back in 2019. And I knew going in, I wanted to be a very comprehensive restorative dentist. And in order to do that, I needed to have a full diagnostic picture and CBCTs provide that. And after talking to so many colleagues and kind of seeing where the growth is, you know, initially when CBCTs came on the market. extremely expensive. The radiation was higher. Exposures were longer. We didn't really have necessarily the right workflow. We didn't have, they weren't as easy to use and implement and adopt into our practices. And I think as the digital stories have improved and the workflow is streamlined. digitally uh it is necessary absolutely if you're doing any kind of extractions endo if you're doing a comprehensive restorative exam you have got to have a cbct because it it just puts a full picture up for and patients are wowed by it absolutely every time i hear constantly i've never seen that before oh i didn't know that and it's it's eye-opening to me i look at the even for example the last week in my practice, I had a strange patient come in with a strange presentation. He had a vertical root fracture. Would have never found that without a CBCT. Yeah. And some of the oral radiologists, oral maxillofacial radiologists say, if you're using CBCT correctly, 100% of the time, you should be able to see a vertical root fracture. Now, that had various arguments to it from other dentists who said, no, I mean, CBCT, you can catch it, but you still have to be kind of lucky. But based on what I'm hearing from these oral maxillofacial radiologists, based on proper acquisition and using the technique properly, you could find them. Are you finding that as well? Yes, absolutely. And I also found a bony defect on a patient that I never knew existed. And there's all kinds of pathology. I talk in some of my programs about, I have patients that push back sometimes on even in just a 2D panorex, you know, you think about that, right? And it's like, no, we need to, and especially like on young 15, 16, 17 year old boys, you've got to absolutely have that kind of imagery. And I had a young man that came in 16 years old, played football. ball in senior year in high school. And we take a picture on him. Next thing you know, you see a very large radiolucency. And before you know it, it opens up to a whole lot more. So very critical to have all that imagery and be able to just have a full idea of what you need to plan for. That's just, it's good practice. So diagnostically, do you think that you had to do, did you find yourself going through a lot more training? given that your field of view is now possibly covering areas that you typically wouldn't see with a panographic x-ray. Yeah, absolutely. So how did you handle that? What did you do to make sure you felt confident of what you were looking at? We'll be getting right back to our guest in a second. But first... When it comes to digital workflow equipment, it's important to partner with companies that provide premium products with unparalleled service, all at an affordable price. That's why you should check out Shining 3D Dental, a company that offers a complete and integrated suite of high-quality and easy-to-use digital dental equipment. Their local offices are based in California and Florida, so you get in-time comprehensive support. In fact, Shining 3D Dental can furnish your office with an entire suite of digital equipment for under $27,000. This includes their AoralScan 3 wireless intraoral scanner, Metasmile 3D facial scanner, and the AccuFab 3D printer with its post-processing equipment. Plus, the Shining 3D Dental digital workflow solution includes cloud storage, synchronization, and software for consultation, analysis, and design. So whether you're taking... your first step into digital dentistry or you're looking to add additional equipment check out Shining 3D Dental's complete digital I think the training is critical. The training is twofold. One is for your team so that they know how to capture adequately all the images that you're looking at and understanding how the machine works, what the views mean, what they represent. And then secondarily for me to understand all that and how to integrate that. It's a commitment from your team. It's a commitment from you to work together, to work with the patients and to get ideal images. And then from there, translate that over to. you're examining your diagnostic picture of what you're going to provide. But honestly, you have to stay at it. I mean, it might take a couple months to really get that workflow down. You've got to get into it. Right. So you're talking workflow, but what about the actual anatomic education? The anatomic, it's ongoing. I try to take as many online courses as I can. Every time I see something with CBCT, I want to take it because it's interesting. I think so much of our... Uh, daily practice builds on CBT as like the, it builds on the anatomy. So for example, like doing local anesthetics, you know, giving a block. Okay. It reiterates that anatomy. Um, you go back and you think about that and you're like, oh, that light bulb goes on. Um, I, I constantly love to read. I, you can search anything now on the internet and find what you need, but courses, CBT courses are massive and also keeping that training. You know, a lot of these, these manufacturers offer very good training to your team members and help. They need to understand certain anatomical landmarks as well that they've got to capture. And it's important to start with a really good image. So again, commitment to that. And then for me is to constantly keep learning because the focal points are getting smaller and smaller. I mean, I look back, you know, 10, 12, 15 years ago, and we weren't even talking about what, I mean, we're talking about very small. you know, tens of millimeters now on focal points. And back then it was nothing of the sort. So it's gotten much more refined. So you're talking about the voxel detail. The voxel detail is unbelievable now. Yeah, without a doubt. And also dentists should know that there's services out there, radiologists that charge you. I don't know if they charge you by the case. It could be $90 to send them a digital file of a CBCT and they confirm that everything's okay. Or maybe they... alert you to some pathology that's out there that should be looked into further. Are you a fan of that? Like using an outside source for? Absolutely. I think any tool that you can use, again, talk to your colleagues, get in your study clubs and ask around and what they're using the most. Listen to respected clinicians who lecture on this and what they recommend too. I think any tool that you can use to make an easier and better diagnostic picture is a better thing for you to use and implement right off the bat because it's going to help. you i think down the road i mean to get that lift and then you get your wings you know down the road i think maybe and as programs again and more ai generation all of this will become way more efficient um i mean i look at some of the the assisting tools now on some of these different programs but on these different platforms but you know they can you can automatically draw the nerve canal it sees that or i mean there's just it's getting better and better it's going to help us and um i mean we haven't even talked about carries yet we've been talking about these other things yeah yeah so let's get into that so right a typical patient comes in they're getting their regular exam tell us how cbct is integrated into your workflow and how it is a major invaluable tool based on our discussions we've had before regarding your diagnostic capabilities So I think when a patient initially comes in, obviously we want to find out why they're there. You know, how can I help you? And then from that extrapolation, we start to see a whole myriad and we start to categorize where that patient is. We look in their mouth. I'm doing an oral health assessment, oral cancer screening. I'm looking at everything from the saliva, the tongue. I'm looking at markers in the mouth. I'm looking at how many restorations do they already have? What's their... their TMG. I'm feeling, I'm looking, I'm listening. I'm asking them what kind of dentifrices they use. What's their nutrition? I want to ask questions and encompass their nutrition. I want to find out what do they want to eat? Because many of them come into you and they want to have a goal of eating something. Many, many do. And we don't ask, you know, we don't ask that question. We need to. Many of these people have just a very, a very poor dentition. And I think the more that you can start to steer that and then build how you diagnostically are going to start to explain to them what they need in treatment. So then from there, does every patient need a CBT? Absolutely not. No. No, if they're low caries risk, if they have a, if things, you know, we don't need to do that. What about using CBCT for every patient so that you can incorporate that AI color mapping for explaining to them what's going on? Is that a reason to use it for every patient? I think that that is a very good reason to use it. And I think depending on what kind of style practice you have, and here's what I really find amazing. All of these machines now, this imagery, we're able to track a historical line. So if I have a patient, for example, who comes in with a lot of restorations or they've had a lot of endo and you are missing teeth and you start to put the pictures together what's going on, you can track the history. You can really create a timeline of each of those teeth. That's a very valuable tool down the road. You're doing that with the AI associated with the CBCT. Yes. So you're making the argument that maybe you should have. a scan on every patient? I think if someone has a lot of restorations in their mouth, absolutely. So you're talking about a 25-year-old that has a beautiful dentition that's just coming to the dentist because they know they have to go twice a year. You don't think that it's particularly necessary there. No, exactly. There's a very fine dentist. I'm not going to mention his name. He does a lot of implants, but he literally takes CBCT on every patient and never charges for it. You know, and I'm not an advocate of that. I just, I'm not in practice right now. But when I was an endodontist, you know, we did really good stuff. We helped the patient, but we charged patients for things we did. We didn't do free post and cores, for instance. A lot of endodontists were doing that. We didn't. But he says the ROI on doing a free scan using CBCT is so strong, that ROI, that he stopped charging for it. And he wants every patient to have it because he said the case acceptance on these bigger cases. Granted, he's an implantologist kind of guy. So he's doing these big cases. What's your feeling on that? So it's, I think, a multifold question. And I'm going to peel back some layers here. I think you have to look at what kind of practice you have if you're fee-for-service. that's going to be one issue versus other more insurance-driven models, okay? I think you have to look at what style of practice you have. If you're a bread and butter dentist, I think you have got to absolutely for certain, you've got to have that revenue, but here's what happens. When you're doing CBCT, you absolutely, those images will, they will show more dentistry than you've ever imagined. And to support your point of what you've talked about with this colleague, Absolutely. I believe it offsets that ROI in a second. And I see stats that run anywhere between on a low end of $8,000 a month up to $27,000 a month in general revenue off of restorative procedures that literally can offset that CBCT will find and then you can offset with that. So that's a very large, wide range. Again, depending on how many days you work, what kind of procedures you do. I mean, obviously if you're, you know, implants and endo. and you're doing extra, I mean, that's going to be a more higher value dollar amount. But I think traditional practices, I think you more than can recoup if you choose not to charge. Let me just interject for a second though, but you're on the same page as me, Dr. Trost. You are an advocate to charge for the things you do in your practice. So you are charging for CBCT. Yes, I think you need to charge. In our practice, we upcharge, I think we charge around $100 more than what we would charge for traditional panorex. And we have never had pushback on that. Yeah. And to me, a patient that gets a scan, CBCT scan, is so impressed with the technology and the AI associated with the way you could explain what's going on in their mouth, that just the word of mouth marketing alone, even if you don't generate a new case acceptance for something bigger, they're talking to their family and friends and saying, I saw my mouth in 3D. It was color coded. The dentist explained everything to me. And actually, it was almost like I could see my inside of my mouth where they were spinning it around on the screen. I saw it from every angle. I said, you know, I've never seen that before. No dentist has ever done that. Now, again, CBCT is not new. But some of the AI that's associated with it is relatively new, depending on the unit you buy, right? What influenced you as far as the actual unit that you decided to go with? So I wanted to have, first off, a unit that had a very small focal point. The smaller is better. I wanted to have really good customer service. I talked to a lot of colleagues before I went and made that purchase. I wanted to have great training. When you say focal point, do you mean voxel detail? Okay, voxel. And have the ability to really break down like the 5x5 and have a broader range too. And like I do some airways, so I want to make sure that I have that ability to do that and have a machine that is able to go into those spaces. Okay, so for endo, you're looking at more 5x5, but for stuff like airway, what is it? 10x12? Yeah, you're looking anywhere from 10x5. 10 by 5, you can look at 15 by 8. You can also look, sometimes some of these machines actually have a 17 by 12, and that's what mine has. Yeah, that's huge. If you're doing zygomatic implants, you can do it. Yes, yeah. But if you're looking at, I mean, if you're looking at the total airway, which there's three components of that, that really helps to bring a great picture. Now, do you have the anatomy knowledge of that space? Because we didn't get that in dental school. We'll be getting right back to our guest in a second. But first, if you're listening to this podcast, chances are you're always looking for ways to take your restorative anesthetic dentistry to the next level. And it really all starts with great dental photography. And the right camera can be the difference between getting the photos you need and actually using them to boost case acceptance. That's why so many practices choose the iSpecial digital dental camera from Shofu. It's designed specifically for dentistry, making clinical photography fast, easy, and incredibly consistent. So there's no guesswork and no frustration for your team. With high-res images, simple one-touch operation, a lightweight design, and a large touchscreen you can use even with gloves on, the iSpecial fits seamlessly into your workflow. And those clear, compelling before and after photos? They make treatment conversations easier and help patients say yes. Bottom line, this is a camera that pays for itself in no time. So check out the iSpecial digital camera from Shofu. You'll be glad you did. Visit Shofu.com and use the code VIVA for a special offer. No, we did not. And you really have to take a lot of courses, I think, to help with that. And again, to look at like, to learn how to measure volume and to see where the constrictures are and, you know, where's the hose kinking at, literally, you know, that's a really important thing to understand. Again, taking lots of courses and just practicing and reading and learning, relearning that anatomy. Yeah. And a lot of it we haven't learned. So when it comes to airway, which is becoming very popular now for dentists to look at, for you, A good dental history or sleep history is very important. If the person's partner is saying that that person is snoring half the night, even if they have a perfect dentition, you may take a CBCT because of that information, checking for airway constrictions. Absolutely. And again, back to the initial questions and how can I help you? Why did you come here today? And we can steer in that direction pretty quickly. Yeah. And speaking of airway, it's becoming very popular now in the general practice world, treating patients that have airway constrictions through appliances. Are you making appliances in your office? Are you taking it that far? Or are you sticking to the diagnostic side of it and then referring? I do not make appliances in the office. I have them made and measured, but I can tell you I've taken a myriad of courses over the past seven years. I believe that CBCT is really the only way to help calculate a total volume of the airway, which is interesting because, you know, we're using all these different anatomical planes and it helps to fill that picture in. But the most important thing is, I think, is finding a standard of care, creating a protocol, and CBCT helps. It answers to that. And I think for me, I want to tackle cases that I know that are in my realm that I know that I can get a result for that patient. And I think you have to take a really good measured history and not extend beyond the realm of what you know is in your wheelhouse. And I feel confident in the cases that I've treated and the feedback and then remeasuring again and seeing how the patients improve. So I think that's really important. Right. What's important to get out of this particular part of the episode that we're talking about now, when we're talking about airway, is that a GP could start off by just getting general knowledge of airway issues, right, from the standpoint of the fact that they're seeing the patient, they're looking at a CBCT. x-ray that will give them different views that will give them like you mentioned understanding of the volume constrictions and so forth and then they could refer out right they could say you know based on your history based on what i'm looking at in this cbct scan i don't do the treatment here but i could recommend someone that could help you and that's that's a tremendous service for the patient right it doesn't mean you have to create the appliances or have them on all this therapy where they're doing things to open up the airway. There's only so much you may want to do in airway, but at least you're knowledgeable on it and you have the radiographic power, the armamentarium to diagnose further. Does that make sense? It totally makes sense. And what I want to add to that is I think when you have a patient come in and you're taking their health history and you're asking them the questions that are pertinent to, you know, for an airway evaluation, you know, CBCT is really the only way that you can screen, right, to see constrictors. And we have that ability. And given the fact that many patients will see their dentist more likely than what their PCP business will be. it's our responsibility and i think dentists really have to step up and cbc2 really offers an incredible screening tool if nothing else now do you use 2d imaging at all anymore in your practice sometimes yeah you'll just pop in a periapical you'll take a quick periapical to see something yes yes so if someone comes in with an endodontic problem and tooth number 19 has decay and it's really hurting them and it's sensitive to hot and cold and it's prolonged pain and they get it spontaneously at night. You know, typically before CBCT, I would take a periapical and you go straight to CBCT for that, I would assume. Well, I'm going to say sometimes, yes, depending on, I personally do not do endo, so I will refer, but it's a great caveat to have that tool in my practice. And then I can, you know, collaborate with another colleague who's going to, a specialist who's going to manage that issue or an oral surgeon, perhaps, you know, and that's a oral surgeon, depending on what route we're going to take, you know, so that's a really great, and here's the thing, you get more definitive diagnosis quickly. It's right there. So even though you're not doing the endo, you would do the CBCT to help with the diagnosis of the endodontic problem. So you can then talk to the endodontist or send them the digital scan. You can share that scan. Yes. Yeah. And that's a great thing too, because, you know, often when you're diagnosing, you might have a misdiagnosis and they might send the patient when it really wasn't what, you know, it could be sinusitis, right? Or something crazy, right? And that happens. So you have a more definitive diagnosis. And what was the case with the vertical root fracture that you mentioned earlier? Oh, I, I, that was crazy. I had one of those, a number 19 here and it was just, uh, it was a second opinion. Patient came in and there it is, you know, so, um, and again, definitive right there. Okay. So the patient went to you as a second opinion as a GP, not as an adonist. Yes. Wow. So, and it does make a difference where you. practice too, because if you're in a rural office and you're 40 miles away from the closest specialist, I mean, there's not too many situations like that anymore, but maybe 20 miles, and the patient would rather not go to a specialist if they could get some information from the GP, that information that you really want in these tougher cases can only be gleaned from a CBCT scan, right? You just can't get that from 2D imaging anymore. Absolutely. And when you mentioned rural, I practice, probably the closest oral surgeon or endodontist is 25 to 30 miles away from me. Wow. That's another reason. And I think, again, it just adds value and certainty. Right. Oh, absolutely. You're giving that patient so much more information where then they can make the decision. Do I want to have this treated further or do I want to do I want to have root canal? Do I have an implant? Do I want to what do I want to do? And you could help them work that out, even though you're not doing the actual specialty work, which is so valuable to the patient. And to that point, when I share that imagery, with that certainty, now we're not wasting the patient's time. We're not wasting the specialist. I mean, we're really, we're down the road already. And we're already, say, for example, the root fracture, we're already talking about, obviously, extraction. We know now. We know now, okay, bone filler we're looking at, and we're going to look at implants. taking that we're already three four steps down the road yeah that's that's a huge that is a huge thing right there what you just said without a doubt you just cut two steps out that patient would have had to go to an endodontist first of all make an appointment maybe an emergency the doctor the endodontist might have done something just palliatively depending on how busy that endodontist was or if they're even in town so you just cut that whole journey very short in comparison, which is really, to me, that's efficient care. And that's what people, they really appreciate that. So again, what influenced you on the exact machine to get? And how did AI play a role in this? Like I know some of these CBCT units come with AI that are really useful for that machine. What went through your mind when you purchased yours? um first i talked to colleagues that was my my number one thing i wanted to see who was using and how and why and and what methods what you know how did it fit in their practice and i have a variety of friends who can really share and glean really good information you have to think about also too what kind of specialty um equipment you need, software, hardware, right? Because some of these systems, and since 2019, the AI has really kicked in. I mean, it just continually, and it's growing in exponential numbers. But AI wasn't really, honestly, back in 2019, a big discussion. And now it really is because it was a very early newborn then, but now it's an adolescent and it really taking off quickly. And I believe that. Each of these platforms now are going to be easier to integrate within your practice. I mean, it's interesting how the cut tools, the merging tools, the side by side comparisons, how you can overlap and move images in and quickly. And that's what you want to be able to do when you're building your picture and your storytelling. I mean, this is a storyteller to patients, right? So. And it reaches way beyond that operatory because it's so very powerful. So what are some of the things, Dr. Trost, that a general dentist should really be focusing on? What should be top of mind when it comes to spending the kind of money that these machines cost? Because you don't want to outgrow one. And if you're doing... general dentistry now that only requires a given field of view but then you decide to get more into airway or all the way up to zygomatic implants you're going to need a much bigger field of view so you don't want to outgrow your machine so what are some of the things you need to keep in mind when you make that purchase well you're bringing out really good points i think you have to discern again What's it going to do? How's it going to behave? And how's it going to be used in your practice? What kind of practice do you have? What kind of bells and whistles really make sense? Do I want to use this tool? I mean, this is, for me, a massive diagnostic tool. Huge. It opens so many eyes and creates so much work. It's unreal. And it provides a full complement. But I think what you have to... really drop back and look at is if anything can be added into these, some of these machines on systems, you can have an upgrade, you know, so you can find out, okay, I can start this level. And then they allow me to upgrade, which some of them before had cards and different hardware systems that were really, they were very robust, but they really took up and they had to be very dedicated. And I've seen all that. And we've kind of passed that now. So I think with these digital platforms now, the integration is better. The ability to upgrade, I think is a really valuable to see, say, for example, you're going to do some endo and you're going to do some extractions. But down the road, you think you want to take some implant courses and you want to learn how to go about that. Well, then maybe you can have that feature added down the road. I think, again, it's all in that discussion. Yeah, absolutely. And I think what you mentioned, the key thing is find a mentor, join a study club if you're not a member of already, talk to your peers. Mistakes that your peers have made already, you don't need to make again. Right. They've made exactly right. So not that you want to live off their mistakes, but listen, everybody does that. So talk to your peers and find out what works and what doesn't. And then ultimately, like you said, it's what procedures you feel comfortable doing and what do you think you might be doing in the future? Sometimes you don't know what you're going to be doing in the future. You never thought about doing airway and then you start getting into airway on a much bigger level, a deeper level, I should say. And then you would need. a machine that could accommodate that. It's really good stuff. I think once you start using CBCT, like you are, Dr. Trost, it's impossible to imagine what your practice would be like if they took it away. Absolutely. As always, Dr. Trost, great discussion. Thank you so much for your feedback. I hope our listeners got a better idea of how CBCT plays such an important role for the GP. And we certainly look forward to having you on future podcast programs. Thanks again for your time tonight. Good. Thank you. Bye.