CBCT imaging has transformed modern dentistry, offering unprecedented diagnostic capabilities that extend far beyond implant placement. Yet many practitioners find themselves overwhelmed by technical specifications and sales pitches that may not reflect what truly matters in daily practice.

Dr. Steven Vorholt, a board-certified dental implant specialist practicing in Santa Barbara, California, has helped over 1,000 dentists place their first implants and brings a unique perspective to CBCT technology. After using these systems for a decade, he shares insights that can help practitioners make informed decisions about this game-changing technology.

The Sales Pitch vs. Reality

When Dr. Vorholt purchased his first CBCT in 2016, he fell into the same trap many dentists encounter at dental conferences. "The three things that I looked for," he explains, "were field of view, rendering quality, and voxels. It's all the technical stuff because dentists are very technical."

These flashy specifications, while impressive on paper, often don't translate to practical clinical value. The beautiful 3D renderings displayed at vendor booths and technical specifications like voxel size become secondary when you understand what actually impacts patient care and practice efficiency.

What Really Matters: The Three Essential Criteria

After years of experience and helping colleagues evaluate CBCT systems, Dr. Vorholt identifies three critical factors that should guide your purchasing decision:

1. Software Capabilities

"The thing that people don't know they need until they have the CT was something very user-friendly," Dr. Vorholt emphasizes. The software that allows you to navigate and interpret images is arguably the most important component of any CBCT system.

Key software considerations include:

• User-friendly interface — Complex software requiring engineering-level knowledge creates barriers to effective use
• Patient communication tools — Modern software should allow you to display and explain findings clearly to patients
• Integration capabilities — Seamless connection with intraoral scanners and treatment planning tools
• Built-in planning features — Integrated implant planning, surgical guide design, and inventory management

Dr. Vorholt notes the dramatic impact of quality software on case acceptance: "You can put that on a big screen in front of a patient and they can read the x-ray with you... it immediately gives you credence because the patient is kind of diagnosing along with you." ACTEON's X-Mind series with native AIS software exemplifies this integrated approach, eliminating the need for third-party programs while providing comprehensive imaging and treatment planning capabilities in a single platform.

2. Practice Flow and Size Considerations

Real estate constraints affect most dental practices, making the physical footprint of CBCT systems a critical consideration. Dr. Vorholt's experience in space-limited California practices highlights this challenge.

"We had an old closet that had like a washer dryer and we tore that down," he recalls. "We were able to fit the machine because it's one of the few wall-mounted CBCTs, extremely low profile, extremely easy to fit into previously done spaces." Systems like ACTEON's wall-mounted X-Mind Optima demonstrate how thoughtful engineering can maximize diagnostic capabilities while minimizing space requirements, making advanced imaging accessible even in retrofit situations.

Practical considerations include:

• Wall-mounted vs. floor-standing units — Wall-mounted systems maximize floor space for revenue-generating operatories
• Retrofit capability — Many practitioners purchase existing practices that need equipment upgrades
• Workflow integration — The system should enhance rather than disrupt existing patient flow
• Staff accessibility — Easy operation by trained team members increases efficiency

3. Diagnostic Quality That Matters

While salespeople focus on the smallest possible voxel size, practical diagnostic accuracy is what matters clinically. "Anything better than 0.2 [voxels] is what I looked for," Dr. Vorholt explains, referencing research showing this threshold for detecting vertical defects.

Understanding voxel specifications:

• Field of view relationship — Larger fields of view typically mean larger voxels
• Clinical relevance — Ultra-fine voxels may not provide meaningful diagnostic advantages
• Practical accuracy — Focus on resolution adequate for your intended applications

For endodontic applications, a 5x5 field of view with tight voxels (around 0.08 microns) provides excellent detail. For implant planning requiring sinus evaluation, larger fields of view (12x10 or 17x12) remain diagnostically adequate at 0.2 voxel resolution.

[blogad]

Field of View: Bigger Isn't Always Better, But Growth Potential Matters

Dr. Vorholt's initial purchase of an 8x8 system quickly proved limiting when he began sinus grafting procedures. "You take the first course and then the guy or the gal says, 'In order to accurately diagnose and treatment plan sinus lifting, you have to see the osteomeatal complex,'" he explains. An 8x8 field simply couldn't capture this critical anatomy.

The solution isn't necessarily purchasing the largest field of view available, but choosing a system that allows growth. Some manufacturers now offer upgradeable systems where larger fields of view can be unlocked as your practice evolves.

The Financial Model: Why Free Scans Make Sense

Dr. Vorholt's approach to CBCT economics challenges conventional wisdom. "I have never charged for a CT in my career," he states. "I have found so many more productable treatment plans through CT that I otherwise would not have found than I would have ever made in trying to charge $300 for a scan."

This strategy offers several advantages:

• Eliminates financial barriers — Patients usually don't opt out of necessary diagnostics
• Increases case acceptance — Visual evidence of pathology is compelling
• Demonstrates technology leadership — Patients appreciate cutting-edge care
• Discovers hidden pathology — Previously undetected issues become treatment opportunities

The key is efficiency. Dr. Vorholt can complete comprehensive implant planning, including digital wax-ups and surgical guide design, in approximately 10 minutes using integrated software.

The AI Revolution in CBCT Technology

Artificial intelligence is rapidly transforming CBCT capabilities, with developments that promise to revolutionize workflow efficiency. Current AI applications include:

• Automatic panoramic curve generation — Eliminates manual curve adjustments
• Seamless scan integration — One-button alignment of intraoral and CBCT scans
• Bone segmentation — Automatic conversion of DICOM files to 3D-printable STL files
• Pathology detection — Automated identification of anatomical abnormalities

Looking ahead, Dr. Vorholt envisions AI handling implant planning, inventory management, and surgical guide design with minimal operator input. "The perfect use of AI because they can look at a thousand implant plans, ten thousand implant plans, and the machine can learn why and where and how big and how long."

Beyond Implants: The Diagnostic Power of CBCT

While implant planning often drives CBCT adoption, the technology's diagnostic capabilities extend throughout dentistry:

• Endodontic applications — Precise identification of root canal anatomy and pathology
• Orthodontic treatment planning — Comprehensive evaluation of tooth position and development
• Pathology detection — Early identification of cysts, tumors, and other abnormalities
• Periodontal assessment — Detailed bone level evaluation
• TMJ evaluation — Joint structure and pathology visualization

"Even if I wasn't doing implant surgery, I mean, the amount of pathology you find for endo lesions or fractured teeth or orthodontic treatment planning, it's amazing," Dr. Vorholt notes.

Making the Investment Decision

For practitioners considering CBCT technology, Dr. Vorholt offers clear guidance: "When someone is starting to practice or buying a new practice, to me, the CT is a necessary piece of equipment. I couldn't practice without it."

Current pricing makes this technology more accessible than ever. Where CBCT systems once cost $125,000, quality units with full diagnostic capability are now available for significantly less.

Conclusion

CBCT technology represents one of the most significant advances in dental diagnostics, but choosing the right system requires focusing on practical rather than promotional factors. Prioritize user-friendly software, appropriate sizing for your space and workflow, and diagnostic quality that matches your clinical needs.

As AI integration accelerates and costs continue to decrease, CBCT is transitioning from luxury to necessity in modern dental practice. The question isn't whether to invest in this technology, but how to choose the system that will best serve your patients and practice for years to come.

Remember Dr. Vorholt's perspective: "We’re no longer limited by the price of these machines... in today’s modern office, it's a necessary piece of equipment." The diagnostic capabilities, case acceptance benefits, and workflow improvements make CBCT an investment in both better patient care and practice success.