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Tarun “T-Bone” Agarwal, D.D.S.
Brandie: What led you to begin using CBCT for sleep and
airway evaluation?
Dr. Agarwal: About 3 – 4
years ago I started learning
more about DSM myself. One
of the challenges I was facing was how to get begin the
discussion with my patients.
90% of the patients with OSA
don’t even know they have it.
We have to create awareness. Using the larger Field of
View (FOV) CBCT we’re able
to capture the airway in the
cone beam image itself.
Before, we were simply using a black and white image
to show them the airway as it
was captured. There was no
segmentation or ability to do
anything, but it was a way for
me to show the patient what
their airway looked like. Now,
with airway segmentation
software, we are able to seg-
ment out the airway and have
a color rendition. This allows
us to show the patient exactly
how large their airway is. Using
it as a conversation starter is
what ultimately led me to begin using it for sleep.
Brandie: How does CBCT fit
into your sleep patient work
flow?
Dr. Agarwal: Personally, CBCT
imaging has 3 main purposes for sleep apnea and in our
practice, it’s a team-driven
workflow.
1. Create awareness. We take
a 3D image on all our new patients as appropriate based
on age, cancer conditions, etc.
It has completely replaced the
panorex in our practice. In the
hygiene room or in the consultation session, team members will utilize it to show the
airway through segmentation.
2. Digital fabrication of an appliance. When the patient is
diagnosed with OSA through
a sleep test, we’re able to use
the airway software combined with digital impressions
to fabricate our sleep appliances. Instead of taking a traditional George Gauge bite,
we take a scan with the patient in the bite position. We
then take digital impressions
of the arches. The software
combines those and virtually
mounts that into the airway
position. We are able to see
the jaw joints in the treatment
position, allowing us to determine if the bite position is potentially causing stress on the
joints or putting them in an
unfavorable position.
3. Post-op objective evaluation of any airway changes.
Since we have a pre-treatment airway analysis, we’re
now able to have a post-treat-