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Bookmark Utilizing CBCT for Emergent Patients

Watch how we turned a crown procedure into better patient care for an emergent patient. To allow us to diagnose a patient properly we charge a flat fee for a new patient consult – no matter what X-rays are needed. See how this process allowed us to uncover additional problems with the surrounding teeth and prevented us from providing the wrong solution.


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Video Transcript

Hi, Dr. Alex Touchston here. In this module, I want to share with you some ideas around leveraging our cone beam CT units to provide better care for emergent patients.

Now just real quickly this patient came in my office about a week ago and complained that there was crown missing on tooth number 30 and they insisted that the crown had only been missing for a week and they wanted me to only address that problem. However, my goal is to do a more comprehensive diagnosis and treatment plan and hopefully help his patient to avoid the sort of emergent problems in the future. So we charge a flat fee for our diagnostic services. So our new patient consult including any necessary x-rays is a single fee and therefore we take the fear or resistance from the patient over having to pay additional - in their mind - fees for say a cone beam off the table.

So I take a look in the patient's mouth and I'll say “Yes, I understand this is going on. How would you feel about me having a look around and getting any necessary x-rays to do a real good job of identifying any other problems?” They agreed and so as is our normal practice we took an FMX, we took a cone beam CT, and some photographs.

Now just to give you a little window, imagine if all I had captured was this and the bitewing. Let's look at the corresponding bitewing for just a second. So imagine these the only two pieces of information that I have for this case. We might incorrectly decide well that maxillary molar is super erupted because the patient was dishonest and the crown has been off for a while. The patient has some evidence of gum disease but we can address that later and we'll just go ahead and do a crown and recommend that the patient come back for periodontal evaluation. That would be a typical outcome in a lot of offices.

Now let’s take a bigger view, however. Let’s take a look at, first, the FMX and as we do so we see there are other things going on here. We've got this maxillary molar that has been heavily treated as you can see with a root canal and post and core and there's a lesion that seems to be associated with the post and core or post rather. And so there's something else going on there that needs attention and so let's then take a look at our cone beam CT. ... As we do so we learned that, my goodness, there is a very large lesion and that tooth is non-restorable.

So, do we make a crown to fit to a super erupted crown on an opposing tooth that is over a non-restorable natural tooth? I think not. So we need to have a conversation with a patient over other treatments that need to be done. Now obviously there are other things as well and I won't go to the whole list of findings but you get my point you know that would not have necessarily been obvious had we not at least taken an FMX and then reinforced what we saw with our cone beam CT.

Patients tend to understand this sort of picture much more readily than say even the FMX because you can show them where the post is perforated through the route and why this may be occurring and then the extent of the bone loss and you know why we're recommending that this tooth be removed. You can also talk about the relationship of this infection to the thickening of the membrane here, and possible odontogenic sinusitis, and certainly the risk of perforation of the Schneiderian membrane, and all those things that that lend themselves to an understanding of the importance and urgency of the treatment is being recommended.

So whereas this patient came in for a crown, they obviously had a much larger treatment plan and they accepted that treatment plan on the basis of the information that was being provided to them. Had they resisted the x-rays themselves based on fee that would not have happened. So that's why we charge a flat fee for all of our diagnostic services. That way we can do a better job. We end up doing better treatment plans, more comprehensive dentistry, better service to the patients and certainly more efficient and profitable way to work in the office.

Alex Touchstone

Submitted on
July 20, 2018
Last updated
March 14, 2019
Total views

About The Presenter

Alex Touchstone, DDS, FICOI, is a recognized pioneer in chairside dental CAD/CAM technology — and one of the most sought-after educators in digital dentistry. He is the founder of which provides interactive online training courses for dental professionals all over the world. He holds several U.S. and international patents and also shares his ideas through lectures and hands-on courses. Dr. Touchstone practices dentistry at Touchstone Dentistry in Hattiesburg, MS.


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