Our practice utilizes cutting edge technologies to assist in the care of our patients.  We use surgical operating microscopes, adapted for dentistry, during all phases of your endodontic treatment. The microscope allows us to visualize fine details (up to 18x the magnification of the naked eye) inside your tooth thus making our treatment more precise. Incredible innovation has allowed for effective cleaning of the deepest, most complex portions of the root canal system.

We also use digital radiography to take radiographic images of your teeth, which can be viewed on monitors in each treatment room.

Our dental software allows you to register online and update your information at your convenience; additionally, your dentist can follow the progress of your care in our office in real time.

At Southern New Hampshire Endodontics, LLC, our goal is to provide our patients with the highest level of endodontic care possible and that includes true-to-life, 3D imaging made possible with cone beam CT technology (CBCT).  The CS 8100 3D is Carestream’s latest system and is capable of capturing both 3D and 2D images.  It delivers an accurate view of patients’ teeth and jaw anatomy for improved diagnoses and treatment planning and allows for viewing a tooth from every angle, with exact scale accuracy and without distortion or overlap of anatomy.  Plus, because it’s digital, images are available for viewing within seconds and can be safely stored in patients’ records.

Not every situation requires a 3D scan and conventional 2-dimensional images will suffice much of the time.  However, sometimes the anatomy of a tooth can be stunningly complex and there is obvious advantage for a dentist to be able to know these intricacies through 3D visualization.  Clearly the goal of saving a tooth is facilitated by this knowledge.  Just a few of the challenging situations include:   

• to determine definitively whether a tooth has an extra canal or root, which could not be located clinically; the system has a measuring function which then assists in its location, if one is present
• to locate a canal which has filled in with calcification over the years, to increase the chances of doing a complete root canal
• to determine the problem areas when a patient presents with an old, infected root canal, which allows for a more precise treatment plan and improves the prospects for a solution
• to look for cracks and fractures
• to map out and determine the extent of root resorption; many teeth with this problem are extracted because the affected area sometimes looks worse than it actually is and on the other hand sometimes substantial treatment time will be spent trying to save a tooth with this problem when a 3D scan would have demonstrated extraction was the better alternative.

These are just a few of the applications when a 3D scan provides an extra advantage in efforts to save a tooth.  And of tremendous benefit to a patient is that sometimes the information attained from the scan will indicate a tooth can’t be saved at all, without having to spend a long visit and substantial costs of actually having to work on the tooth to determine the same outcome.  

In addition, a 3D scan allows for the opportunity to detect other issues. In the December 2018 issue of the Journal of the American Dental Association, in an article titled Ameloblastoma incidentally detected in cone-beam computed tomography sialography, it was reported, “Cone-beam computerized tomographic (CBCT) imaging is increasingly used in the maxillofacial region for various purposes.  The volumetric dataset created by means of CBCT increases the possibility of detecting incidental findings”. 

Carestream has designed the CS 8100 with safety in mind and especially because we are studying a very limited area, the amount of radiation a patient is exposed to is typically in a range between the amount of natural, background exposure that occurs to all of us on a daily basis and that which occurs when we fly from coast to coast.  And with the cost of replacing a tooth with an extraction-implant-crown often times approaching several thousand dollars, it usually is desirable to save one’s tooth whenever it is feasible.  With the cost of a 3D scan being around a couple hundred dollars it makes great sense to take advantage of this newest technology whenever it is deemed useful.

RESEARCH REGARDING CBCT USE, AS REPORTED IN THE JOURNAL OF ENDODONTICS:

October 2020:  CBCT imaging considerably aids in an accurate diagnosis of lesions of odontogenic or nonodontogenic origin.  It also contributes to preoperative assessment of complex root anatomy and the evaluation of ...... external and internal resorptive defects, or imcomplete root fractures.  Recently, it has been shown that widespread use of CBCT imaging is taking place in everyday endodontic practice.  .... preoperative CBCT evaluation appears to enhance the level of endodontists' confidence to diagnose accurately and to decide the appropriate treatment plan, especially in difficult and  complex cases ....

AAE Webinar/lecture:  The Endo-Antral Conncection - February 25, 2020:  CBCT significantly improves the ability to detect odontogenic sources for sinusitis, has an improved ability to see lesion expansion into the sinus, mucosal changes seen 4 times more often compared to PA radiography and allows for the ability to assess positional relationships between the dental roots and the sinus. 

February 2020: In complex cases, CBCT increased endodontists' confidence to diagnose and plan treatment, when compared with periapical radiographs (conventional x-rays). 

July 2018:    CBCT was the best method for the detection of external root resorption defects.  The aim of this study was to compare the sensitivity and specificity of conventional radiographs and CBCT….

February 2018:  … when dealing with external cervical resorption, treatment plans developed with PA radiographs differed from those developed wit CBCT images in the majority of cases.

January 2018:  …The advantages of CBCT scanning (when investigating root canal morphology) are its high accuracy, minimal distortion, and 3D visualization.  Moreover, it is a non-destructive technique and can provide specific data.

October 2017:   … taking a CBCT scan when an MB2 canal is not found clinically can significantly increase the chances of finding an MB2 canal.

September 2017: … a preoperative CBCT image provides more information than a preoperative pa radiograph and that this information can directly influence retreatment strategies.

September 2017:  … the CBCT proved to be a reliable tool for the identification of the mandibular second molar C-shaped morphology …

September 2017:  …this study shows that CBCT imaging can be used to assess dentin wall thickness accurately. 

The microscope revolutionized the endodontic specialty and has become the standard of care for root canal treatment. It allows unprecedented visualization of the finest detail and precise execution of each aspect of treatment: access, clean, and seal the root canal system.

Digital Radiology is used instead of conventional x-rays resulting in substantially less radiation exposure and more efficient treatment.

Our office uses TDO, the universally acknowledged gold standard in endodontic electronic records. Designed by a leading endodontist, in conjunction with a community of endodontists dedicated to the foundational principle that the patient's care always come first, the software streamlines and simplifies patient registration, referral communication, medical history review, and clinical and imaging documentation. It operates off the Checklist Manifesto common in top hospitals and the airline industry to minimize errors and improve performance and patient outcomes.

Much more than a software, we are part of a community of top clinicians dedicated to mentoring each other, clinical excellence, and self-improvement and continual critical self appraisal so needed for professional improvement and development. As a user of the software, and as a member of the TDO community, our focus is on providing the highest level of care within the endodontic specialty.