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being looked upon with curiosity, but now it is be- coming the standard of care for dental radiography. Educationinthepossibilitiesthat3-Dimagingbrings to the practice is invaluable. While 2-D still has its place in the dental practice, manypatientsneedmoreforoptimalcare.Changeis not easy, but it is necessary to change, to move for- ward and to provide patient care in a better manner. Three-dimensional imaging is definitely a paradigm shift, letting dental professionals see the same in- formation in an entirely different way. Nothing else really describes what is going on here. _What do you tell general practitioners who mayfeelintimidatedbythistechnology? Dr Flucke:Thatquestionisexactlythereasonthat I entitled my seminar Scrabble and Alphabet Soup —BringingSimplicitytoCone-BeamTechnology.There is a lot of hesitation on the part of some general dentiststhatconebeamisjustfortherealmofthespe- cialistorthedentalschool.Whenfacedwithacronyms such as CBCT, cone-beam computerised tomography, or terms such as voxel, the 3-D equivalent of a pixel, they get intimidated by the mishmash of initials and unfamiliarwords.TheyjustwantanX-ray. After becoming educated about 3-D imaging, they realise that it is not as intimidating as they first expected. I am not an electrical engineer or radiolo- gist; I am just a dentist who uses 3-D cone beam to improve patient care, and that is why it is important to hear about this technology from people like me. Far more important than the Scrabble and alphabet soup,imagingisallaboutprovidingthebestpossible outcome for the patient. _Canyoushareacasefromyourownpractice? Dr Flucke: There are so many cases, but this case inparticularwasverysatisfying.Anewpatientarrived at my practice eight months after seeing her pre- viousdentist,whoshehadseenforthepasttenyears. The patient had always been diligent, almost fanati- cal, about her dental health, but was two months overdue for a cleaning. We took a CBCT scan and found an undetected cyst growing in the mandible almost to the point of causing a fracture of the mandible (Fig. 3). When we pointed this out, the patient responded, “Maybe that is why my lip goes numb sometimes, and I get these shooting pains in my jaw.” Whilethepatientwonderedwhy,eventhroughout her regular visits to the dentist this condition went undiagnosed, I recognised that the previous dentist wasnotreallyatfault.Thedentisthadbeentakingthe necessaryrequiredradiographsovertheyears,20film 2-D surveys, but this patient needed more. Because of the various options in viewing 3-D technology, I sent the scan out toaradiologistandsubsequently referred the patient to an oral surgeon. The CBCT showed that as the cyst grew, it was putting pressure on the nerve, causing the pain and numbness. Four different outcomes were possible for this condi- tion, and two could have either been life-altering or life-threat- ening. Fortunately, the situation turned out to be benign, neces- sitating some extractions and bonegrafting.Afterward,thepa- tient asked, “Why did I go some- where else for ten years, and the dentist never saw this, when you found this after ten min- utes?”ItwasallthankstoCBCT. _Whatisyourmainmessage todentistscontemplatingimplementationofCBCT? Dr Flucke: I’m a general dentist. I use and believe in this technology. I have seen so many scans that have changed the course of treatment or provided the missing information for difficult diagnoses. By beingaspeakerattheInternationalCongresson3-D Dental Imaging, this is what I want people to know: Don’t be afraid to use 3-D imaging. Use it because itisthesmartandthebestthingtodo.Theendgame is making the lives of our patients better and cone- beam 3-D imaging is the best way to do that. Dr Guttenberg: To say it with George Bernard Shaw’s words: “Progress is impossible without change, and those who cannot change their minds cannot change anything.”_ Fig. 2_Amazing views into a patient’s anatomy. Fig. 3_Previously undiagnosed disease found on a CBCT scan. I 23 feature _ interview I CAD/CAM 2_2010 Fig. 3 Fig. 2 Dr John Flucke practices in Lee’s Summit,Mis- souri,USA.He is a well-recognised expert and edu- cator in dental technology. Dr Steven Guttenberg is an oral and maxillofacial surgeon,practicing inWashington,DC,USA,where he is director of theWashington Institute for Mouth, Face and Jaw Surgery. _about the interviewees CAD/CAM