Specialist prosthodontist Michael Mandikos has recently moved into his brand new practice, aptly named Brisbane Prosthodontics, in the inner-western suburb of Graceville, in Brisbane.
High on his list of must-haves for the practice were facilities for extraoral imaging.
"I'd been considering buying an OPG for some time and it became a requisite when it came time to move," Dr Mandikos said. "As a specialist practice, we see patients referred in for very specific procedures but we also see patients for full mouth rehabilitations. In those cases in particular, I find the diagnostic information from a clear, digital OPG is much easier to relate to than a full series of PAs.
"At the same time, I was also conscious that there were rapid developments in the area of 3-D cone beam imaging but the price difference between these units and a straight OPG (without 3-D) was considerable. I then became aware of the Vatech E-Woo imaging products distributed by IntegraDent. They have a range of options that allow you to shop based on price/performance and I started to see that having cone beam capability was viable for my practice.
"My needs are very specific for implant dentistry and I essentially don't need to image a patient's entire jaws very often. Hence I was looking at the combined OPG/cone beam systems that were capable of producing a regular digital OPG and then a cone beam image of a much smaller zone of around 3 teeth. This would have been ideal for single tooth implants for example, which I place often.
"In the midst of those negotiations, IntegraDent released a new model, the Uni-3D, that would image a larger field, now just short of a quadrant. If you aim it at a first premolar for example, you will get from just past the 6 to the edge of the central. This gave me much greater scope, albeit at a slightly higher cost, so I ended up purchasing this system instead."
Dr Mandikos said that the Vatech E-Woo Uni-3D ideally suits the diagnostic needs of his practice. It has two separate sensors – one for the OPG and one for the cone beam image. An optional one-shot ceph arm is also available for the unit.
"If you have the patient base that demands full arch rehabilitations and your goal is to do guided surgery frequently, then this may not be the machine for you. If your goal is to do single tooth implants or non-guided surgery, then it is ideal. You can't do a full arch scan and feed it into guided surgery software but the imaging software it comes with does include measuring tools and virtual implants that you can use to aid with diagnostics and treatment planning of individual implant or quadrant-sized cases.
"For me at this point in time, I'm not treating too many cases with guided surgery and in most instances, I'm raising a flap. From a clinical perspective, it is much easier to complete ridge augmentation or tissue enhancing procedures during placement and this requires flap-surgery. Whilst it can sometimes be applicable, doing everything flapless is not always the answer."
Dr Mandikos said that having an OPG in-house was much more convenient and the images are embedded directly into the patient's record in their Exact practice management software.
"As we'd never had an OPG in-house before, I did wonder how patients would react to having to pay more versus having it done under Medicare at a Radiology practice. Only two people have made any reference to the additional cost so far, however I actually assumed everyone would, so that was surprising! You read articles in Australasian Dental Practice that say patients don't care about the cost because of the convenience and you don't believe it, but it's true. You say do you mind if I shoot this CT of the area before we perform this surgery, and they see the benefit and never object.
"Patients are also fascinated by the 3D images. I hadn't really used cone beam scanning before and had always referred patients for medical CTs. The advantage of those is that you do get a formal report from a radiologist but it doesn't have the WOW factor of the 3-D image on your screen. You get sheets of film back instead and we would stick these on the windows to look up at as our reference during surgery. But with the medical CTs, you had to send the patient away, there were additional costs and it was very inconvenient. As a result, we didn't do it too often, and at times this made for very tentative surgery! The cone beam aspect and the size of the field viewed means that you can also minimise the radiation dose with the Uni-3D compared to a medical CT.
"We've now been using the system for 3 months and it's proving to be an invaluable tool. I am now comfortable with using the imaging software and am still discovering new features. It has proven to be a good investment and is both increasing our efficiency and the predictability of clinical outcomes thanks to the availability of highly detailed diagnostic information at the touch of a button."
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Monday, 19 January, 2026