Local dentists seek CTs as CON changes loom

February 5, 2010
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A state commission has agreed to review regulations that Michigan dentists say have deterred many in their ranks from acquiring the latest state-of-the-art equipment.

Computerized tomography machines are regulated by Michigan Department of Community Health’s Certificate of Need system, including the scaled-down versions used in dentistry. Dental CTs have been on the market only since the mid-2000s.

“Michigan is the only state in the union … where you can’t use it without going through a lot of red tape. It’s the same process as if I’m building a whole new hospital,” said Dr. Bradley Dykstra, DDS, who is seeking a CON for an add-on that will turn his panoramic X-ray machine into a CT scanner.

“In many states, dental CT is the standard of care. I think the state needs to address this quickly,” said Dykstra.

The CON Commission met last month to decide on the standards it will review this year. MDCH spokesman James McCurtis Jr. said the commission agreed to consider regulations on dental CTs. Under its procedures, the commission will appoint a committee that will consider information about the machines and then make recommendations for regulations.

Caroline Ruddell, director of legislative and insurance advocacy for the Michigan Dental Association, said dentists would be eager to see some changes.

“The application process is very detailed and it is quite cumbersome,” Ruddell said. “In no other state besides Michigan do CT laws cover this equipment.”

Dental CTs are the first dental equipment that has fallen under CON jurisdiction, she said. That’s because of the technology they use. “It’s labeled CT,” she said. “Dentists feel this is so close to a panorex (panoramic X-ray), why should it be covered? It’s going to be the standard of practice in the future. It could replace the panorex.”

Dykstra, who practices with associate Dr. Brian Yared at Hudsonville Dental Associates, is seeking a CON to upgrade his panorex to a small field three-dimensional volumetric cone beam CT, at a cost of $45,000. The X-ray unit is already located in a lead-lined room of 60 square feet in the 3,800-square-foot dental clinic at 3250 Central Blvd.

Also seeking a CON for a dental CT scanner is dentist Dennis Webb, who practices with Travis Kragt at Great Lakes Dental Care PC, 933 Three Mile Road NW. Great Lakes Dental Care is proposing to replace its panorex with a leased cone beam CT scanner, to be located in the same 100-square-foot area.

“Basically, it will improve the quality of care we’re giving, especially with the placement of implants,” Webb said. “It gives us a three-dimensional aspect of that. We felt that to kind of bring our practice to the next level, this was a logical thing to move toward.”

In their application to the state, Kragt and Webb said the equipment would cost $170,999. Webb said the expense of the cone-beam CT scanners that are used in dental offices is enough to deter those who don’t do many implants.

“It’s still a pretty expensive technology,” Webb said. “But we found in our practice that technology that makes our job easier is sometimes more important than trying to make a profit.”

Webb said Great Lakes Dental Care intends to keep the charge for a CT scan in the same $158 range as a panorex, which shows teeth and their roots, the jawbone and the sinuses.

He said he expects the use of a CT scanner to save money and time by reducing the number of procedures that need to be altered or take extra time because of the X-ray’s two-dimensional imaging capability.

CT scans are used primarily for cases that involve implants because they allow the dentist a better view of the anatomy of the jaw area, Dykstra said. He said the scans also are being used for root canal cases.

Ruddell said Michigan has fewer than two dozen dental CT scanners. She said the expense and hassle of dealing with CON regulations has limited the spread of CT scans in the state.

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