Digital Imaging from a new perspective

TREATMENT CENTRES HANDPIECES HYGIENE SYSTEMS X-RAY SYSTEMS CEREC TREATMENT CENTRES HANDPIECES HYGIENE SYSTEMS X-RAY SYSTEMS CEREC SIRONA CREATING AND MAINTAINING VALUE. You are right to expect a great deal from the world s only full-range supplier of dental equipment in particular, an extensive product portfolio, first-class service, outstanding quality and tremendous value for money. Sirona covers the entire dental equipment spectrum: treatment centres, handpieces, X-ray systems, hygiene systems, imaging systems and last but not least CEREC ceramic restoration systems. Building products that stand the test of time, Sirona is the professional partner for the dental profession. Dealer s stamp: Subject to technical changes and errors in the text, Order No. A91100-M47-A882-01-7600, Printed in Germany, Dispo No. 04602, 2013C9612 WS 05064. DIGITAL TRANSVERSAL SLICE ACQUISITION (TSA) WITH ORTHOPHOS XG PLUS Digital Imaging from a new perspective Sirona Dental Systems GmbH Fabrikstrasse 31 D-64625 Bensheim E-mail: contact@sirona.de www.sirona.com T h e D e n t a l C o m p a n y T h e D e n t a l C o m p a n y

Enhance the capabilities of panoramic X-ray imaging With digital transversal slice acquisitions (TSA) Digital panoramic X-ray unit ORTHOPHOS XG Plus. For most implant and oral-maxillofacial surgical procedures it is necessary to obtain cross-sectional images of the area for treatment. Sirona now offers the possibility for transversal slice acquisitions in combination with ORTHOPHOS XG Plus. TSA is a cost-effective, simple and low-dose alternative to Computed Tomography (CT) or Digital Volume Tomography (DVT) procedures. Digital TSA programs are optional and available as an upgrade to the ORTHOPHOS XG Plus at any time in the future. The upgrade process is simple: It involves exchanging the standard sensor for the combined Pan or Pan/Ceph TSA and the special system software. TSA is then available as additional mode on the Easypad touchscreen. The combined sensor for Pan/Ceph and TSA. 02 03

Diagnosis in a new dimension Digital TSA by Sirona Change the perspective of your practice Transversal slice acquisitions are the ideal addition to standard panoramic images. The additional cross-sectional images, orthogonal to the arch enable you to obtain an accurate image of the bone tissue and physical structures in the area of interest. The additional cross-sectional views of the arches result in a more accurate diagnosis and a more comprehensive patient consultation. TSA from Sirona is complimentary to computed tomography (CT) and digital volume tomography (DVT). It is available at a lower dose and at lower cost to make a pre-assessment of the patient, and treatment planning can be completed all at one time. Get the picture from all perspectives A summary of TSA applications Implantology: Determination of the bone quantity in the upper and lower jaw Display of the proximity of the nerve canal to the posterior teeth Guidance for implant planning and illustration of accurate, referenced measurements Oral and maxillofacial surgery: Display of the nerve canal proximity to the lower wisdom teeth Assessment of impacted, or supernumerary teeth in the upper and lower jaw Relation of the roots of the maxillary teeth to the sinus Determination of the extent of cyst involvement in hard tissue Fracture diagnosis in the upper and lower jaw Orthodontics: Diagnostics in the anterior and canine region Assessment of bone quality for anchoring implant placement Panoramic image Three main advantages of TSA CT DVT TSA Radiation dose Digital TSA images Time required Costs 04 05

THE THREE MAIN ADVANTAGES OF TSA: 1. Safe diagnosis through maximum image quality Always in the picture: With ORTHOPHOS XG Plus and TSA The more relevant the image information, the more accurate the diagnosis and treatment. Due to the special wide X-ray beam fan and the special wide sensor very thin cross-sectional image slices can be made. The following images show how perfectly the panoramic X-ray and transversal slice acquisition imaging process work together. Three steps to a new dimension In order to produce comprehensive cross-sectional images of the region to be treated, the system automatically makes a series of three exposures (acquisitions) at an average distance of 3 mm (anterior and canine region) or 5 mm (molars) apart. These single acquisitions, in groups of three are created based on a version of the panoramic principle. However, the slice shape in this application is thin and straight due to Sirona s unique approach. Diagnostics in a new dimension With ORTHOPHOS XG Plus, the sharp focus area in the anterior and canine region is only 1 mm thick. The slice thicknesses can be selected at 2, 6, or 8 mm for the pre-molars, molars and the posterior region. All objects that are located in front and behind the slice are blurred, removing them from, or reducing their effect on the image. Pre-programmed orbital paths enable acquisitions at a right angle (orthogonal) to the dental arch in any desired location. The panoramic X-ray image only shows two root fillings for tooth 37. Better image information due to small focus layer (thin slices) You know the phenomenon of thin focus layer from photography: A wide open shutter creates a narrow depth of field. With the wide beam tomography of Sirona using a special, wider TSA combination sensor, the advantages of a small focus layer can be realized: clearer acquisitions result in better diagnostic accuracy. Due to the thin focus layer, the enlarged TSA images clearly show three root fillings, which can be differentiated. Other systems Sirona: thin slices due to wide beam and wide sensor Additional examples from oral-maxillofacial surgery and implantology can be found on pages 10 13. 06 07

THE THREE MAIN ADVANTAGES OF TSA: 2. Simple and fast positioning THE THREE MAIN ADVANTAGES OF TSA: 3. Perfect technology for the perfect practice Reliability is everything. For this reason, Sirona has developed a simple system for accurate digital TSA images it includes an easy process for the definition of the region of interest, and guidance for correct positioning of the patient s head. Optimize the procedures in your practice. With ORTHOPHOS XG Plus and TSA you can give a motivated patient an instant answer about the feasibility of an implant treatment. And you can advise him/her with the help of images on the screen e.g. with the visualization of implants on X-ray images. No waiting time, no problems setting the slice area Following the patient positioning and input of the value of the region of interest, the system selects the correct orbital paths automatically and carries out a series of three image acquisitions. The second acquisition corresponds to the distance entered on the Easypad. Standard preset values are entered in order to capture the exposure of the specific area of the first, second or third tooth precisely. 1. The TSA ruler: Determine the distance between anterior teeth and the region to be sliced in the mouth of the patient or on a plaster model. Digital TSA, ORTHOPHOS XG Plus and your practice the perfect fit ORTHOPHOS XG Plus is advanced technology that s easy to use. The same simplicity characterizes the Transversal acquisition mode. Result: No time loss for the dentist or practice personnel and no unnecessary waiting times for the patient. The advantages in detail: Immediate transfer from Panoramic to TSA mode without sensor change, as the sensor has 2 different active surfaces for Pan (or Ceph) and TSA mode. Controllable cooling stages, so that the acquisition cycle 1 pan image + 1 TSA series can be done without any break. No processing of films or reading of phosphor plates. The images are available on the screen and go into the TSA template in SIDEXIS XG if selected. Increased treatment acceptance by the patient The supplied image processing software, SIDEXIS XG, is an excellent tool for patient consultation. The drawing tools and the integrated visualization of implants can assist with illustration of proposed treatment swiftly and clearly. 1 2 2. Easypad: Transfer the value determined on the ruler to the ORTHOPHOS XG Plus Easypad. Accurate images rely on good head position The TSA system of Sirona makes positioning of the patient s head easy and very precise. With the Easypad screen always in view as guidance for the operator consistent, accurate results are simple. 1. Ideal positioning of the head depends on the selected tooth region. Visualization of implants in X-ray images with SIDEXIS XG. 1 Maxilla, anterior region Mandible, posterior region 2 2. The ideal head position is displayed clearly on the Easypad. The ease of use of the ORTHOPHOS XG Plus prevents mistakes and delays. 08 09

TSA IN OPERATION: Digital TSA in implantology Implant planning in the right mandible Implant planning with the help of reference objects Very good differentiation of the crown on tooth 47 and the pontic replacing tooth 46 on the right side. Exact representation of the nerve canal. Gap due to missing tooth 11, with narrow alveolar ridge. The maxilla is clearly visible with minimal overlapping by adjacent teeth, no bony abnormalities. Exact representation on TSA of very thin layer of cortical bone. Ball bearings as image reference objects (included TSA Accessories) allow precise localization of the TSA slices and a reference tool for length measurement using SIDEXIS XG imaging software. Implant planning in the right maxilla Implant planning in the left mandible Tooth 3 with root canal filling and deep bone pocket at the mesial root. The gap of tooth 36 is accurately represented. No overlapping by adjacent teeth. Characterized by a round, well-defined radiolucency, the nerve canal runs slightly lingual in the lower half of the mandible. 10 11

TSA IN OPERATION: Digital TSA in oral and maxillofacial surgery Close relationship of the apex of tooth 48 to the nerve canal Control image after an apicoectomy at the post-filled root of tooth 22 The mandibular nerve canal is represented as a circle of clearly defined radiolucency. The nerve canal is located caudal to the apex of tooth 48 and runs buccal of the apices in the distal direction. In both planes, tooth 22 shows a wide periodontal space. The radiolucency in the apical area indicates apical periodontitis. Good representation, even labially, of the periodontal space on the TSA. Overfilling in the maxilla Supernumerary tooth in the anterior region of the maxilla Root filling material in the upper left sinus, from root canal procedure on tooth 26. The mesiodens is located palatinal between tooth 11 and tooth 21. Its incisal edge is at the same height than the apices of the proximal teeth. Good combination of Sirona s thick layer panoramic program P12 and TSA. 12 13

TSA FROM SIRONA: Summary of features and technical data Overview of the benefits of digital TSA ORTHOPHOS XG Plus Operational simplicity: Efficient patient positioning Intuitive control via the Easypad touchscreen Preview image of X-ray exposure displayed on the unit Reliable diagnosis: Intuitive programme structure Extended diagnostic possibilities Individual adaptation to the patient Investment security: Practice-proven optimal workflow Quickshot mode selectable for Pan and Ceph Future software and operational upgrades Transversal Slice Acquisition (TSA) Option Medium distance between 2 acquisitions Anterior and canine region: 3 mm Posterior region: 5 mm Focus layer (slice thickness): Anterior and canine region: 1 mm Posterior region: 2, 6 or 8 mm Magnification factor (in the middle of the slice) depending on region: 1.36 1.40 Reference object for measurements required Dose of a digital panoramic X-ray exposure: 0.25 0.6 mgy Dose digital TSA (series of 3 images): 0.5 0.6 mgy 1. Increased image quality through the principle of wide beam tomography for thin focus layer. 2. Simplified positioning, intuitive operation, logical concepts. 3. Efficient patient consultation with the SIDEXIS XG Software: Drawing tools, visualization of implants on X-ray images changes the perspective of the practice and helps with treatment acceptance. 4. Low dose. A series of 3 digital TSA exposures requires the same low dose as one digital panoramic X-ray exposure. 5. Patient-friendly diagnostic method: short waiting times, reduced costs, no additional visits to the radiologist. 6. Perfect adjustment to the workflow in the dental practice. Complete utilization of all of the benefits of direct digital X-ray technology. 7. Lower acquisition cost, radiation dosage and time compared to CT and DVT. 8. Additional added value for the practice through support of expanded treatment capabilities. TSA IN THE SCIENTIFIC ASSESSMENT: TSA extends X-ray diagnostics by another dimension. The practitioner can diagnose with greater accuracy than before and plan the appropriate surgical procedure without losing time. The education of the patient is improved significantly with the help of TSA and the relationship between dentist and patient is improved with this valuable additional functionality. Dr. Andreas Fuhrmann, Universitätsklinikum Hamburg-Eppendorf, Germany The transversal slices are an option of the ORTHOPHOS XG Plus DS or XG Plus DS Ceph respectively. Upgrading is possible at any time in the future. 14 15