How MRI will transform dental diagnosis – Transcript

00:00Hey, everybody. Welcome back in to another edition of the drbicuspid.com podcast. My name is Kevin Henry. I'm the editor-in-chief for drbicuspid.com. We're going to talk about some things that our sister publication antminnie.com might be interested in as well today. And we're going to do that with Professor Don Tyndall. Dr. Tyndall, how are you today?

00:18>> I'm doing very well. Thank you. >> I'm excited to have you on. I'm excited to talk about this new technology that is coming into dentistry. But before we dive into that, I just love for us to know a little bit more about you, if you don't mind. Yes. Well, I'm obviously Dr.

00:31Don Tyndall. I work at the University of North Carolina Chapel Hill Adams School of Dentistry and the Maxillofacial Radiology division of the Department of Diagnostic Sciences. I know that's a long title. I've been here 46 years. I'm actually retiring July 1, but I'm coming back to work half time. I love what I do. And part of what I love is getting to do research in different areas of advanced and emerging technology, which

00:57is one of the reasons I've been involved with the dental dedicated MRI system. And I'm so excited to talk about this. I got a little sneak peek of it at the IDS meeting in Cologne, Germany back in March. >> Yes. Uh, you know, and and and again, we're linking to this in the show notes.

01:13We we published the release on drbicuspid.com, where Dentsply Sirona and Siemens worked together on this dedicated dental MRI. And let's start with a big 30,000 foot view question here. For our dental audience, can we just kind of talk about what MRI is and maybe how it could impact the dental industry? Yes. One of the chief features of dental MRI or any MRI unit has much more versatility in what it can see. Just kind of going over

01:40the basics, the elevator conversation about how dental MRI works, you put a patient in a strong magnetic field and then you pump radio waves at certain frequency, depending on the piece of anatomy you want to look at, that energizes some of these protons, gets magnetized, and then you turn off the radio waves, and much of that energy is re-emitted and picked up by a receiver coil. It's a

02:08simplistic way of saying it, but basically you're turning the patient into a radio transmitter. So, radio waves go in to a magnetized field, and then radio waves come out. That's the very simple description, but in that you have so many variations of sequences of waves, different like at this frequency, that frequency. So, you want to locate it in three-dimensional imaging, and you

02:33also can time the sequences differently. In other words, you have literally over 100 ways you can put different radio frequencies and and different radio strategies, I I might say, into the patient and get more information out.

02:48So, when we look at X-ray technology, you're basically looking at X-rays that are being absorbed or not absorbed, and they come into a detector, and so you can see bone, with medical CT some soft tissues, and you can see teeth, of course, but you're basically getting one type of image information. With MRI, you have many, I would call, channels of information. Different sequences like proton density, T1, T2. There are a

03:16number of these sequences that can be used to give you different kinds of information. So, you can look at the same problem, let's say you take a cone beam scan, you've done a root canal, and you see, maybe a year later there's a little radiolucency at the apex. Well, is it still inflamed? You can do a little bit of testing. How do you know it's just not an apical scar? Well, MRI is great at detecting inflammation. So, to have an MRI scan, which the time has

03:43been cut down quite a bit since a couple years ago, you can have this scan, and it'll show is there inflammation? There'll be a bright signal there. Whereas before with cone beam, you just see a little radiolucency. So, I think one of the greatest things that dental MRI or I would say dental dedicated MRI offers is the ability to accurately depict inflammation.

04:04Whereas cone beam, you can see bone loss or bone gain, but you can't see active inflammation. And that's one of the the biggest advantages. The dental MRI itself, by the way, when I say dental MRI, just read dedicated dental MRI. Cuz this is a system dedicated for dentistry. Although it obviously has some other purposes that can be used such as temporomandibular joint imaging, which is um MRI has been the standard for quite a while. But with this type of imaging,

04:31you can detect lesions more accurately, inflammation. You can also detect pulp vitality. I just say a patient comes in and well, it hurts here, it doesn't hurt here. Uh you're not really quite sure what tooth's involved. MRI can show you which one's the inflamed one. Or if you have a vital pulp or not. And some uh sequences, you can even detect maybe there's a tooth fracture and there's a little bit of fluid. And by the way, fluid is ba- water basically is what's

04:59being energized here. Uh you might be able to see in some cases some cracks in a tooth, not maybe not by the physical crack, but by the water that's in that crack or the the fluids, I would say. So, I think the biggest advantage for dental dedicated MRI is going to be identification of inflammation. But it doesn't stop there either.

05:18I'm sure not. It sounds like there's so many uses that it could be uh put in place for. Is this something that you see in the future actually being in dental practices or would this be something that's more, you university-based? What what are we looking at in terms of uh the rollout of this MRI?

05:33>> Yeah, it's a it's a great question and a very relevant question, of course. I think at first you're going to see it in universities or maybe military bases or large DSO organizations where you can have a central facility. Right now, the dental dedicated system being developed is using the Siemens Freemax. Now, the Freemax means sort of free of helium.

05:58Without getting too much in the details, magnets have to be basically super cooled. Just a few degrees above absolute zero. That way they're super conducting, so you don't have to keep pumping electricity into them. And it requires a lot of liquid helium to do this. And there issues with that. The Freemax, the helium, if I could use the word, is baked in, so to speak. It's inside the magnet and it's closed

06:23system. So, instead of like six or seven liters of helium to cool the magnet, now you've got 0.7 L. And they're not making a whole lot of helium lately. So, I think this is going to be the way of the future for all MRI eventually, but So, you're cooling it down with a baked in or it's inside the system. And that gives you the magnetic field strength you need in order to have MRI to work.

06:47I'm curious because, you know, we we in dentistry have talked for so long about how we're having to educate the patient on what comes next. And And in my mind, and correct me if I'm wrong, this is something that dentists and team members will need to be able to communicate to the patients about why an MRI might be needed and the benefits of it as well.

07:05Yeah. Uh let me back up and finish what I was getting ready to say. I I didn't Apologize. No, no, it's not you. It's just uh I got off on a tangent about the MRI system. Yeah, when will it get into general dental practices? It's again, it's a very good question. I think they're going to uh they'll be working on at some point a smaller unit. Cuz right now, this this Freemax is smaller than most uh MRI system. It's 0.55 T,

07:30whereas most systems in in medicine are 1.5 or 3.0 T. So, it's just a little bit smaller. The bore or the the the size of the compartment is larger actually than most systems. So, there's less claustrophobia. So, I think it'll be slow adoption like cone beam CT was. I'm not sure if it'll be as ubiquitous as cone beam is now, but when I started teaching way back in 1980,

07:56uh I I would have told somebody who said, "Well, we're going to have CT scans in dental offices by the year 2000 or 2020." I'd say, "I don't know what you're smoking." But, so you don't know. The future is very hard to predict. But, at this point, I think it'd be uh used in mostly universities or large facilities, military facilities. And that that'll be important because we need to do research to show what is this good at doing? What can it do better than cone beam? There's already research

08:23showing they can do everything cone beam does. So, you're not I suppose you could just have an MRI unit, but I want to caution people that this MRI dental MRI is not going to be replacing cone beam CT any more than medical MRI has replaced medical CT scanning or even two-dimensional images. But, it'll be something I think as people find out its uses, there'll be more people interested in it. And this is what happened with cone beam CT, you know, we'd hear, "Oh, I don't really need it." This, that, and

08:50the other. Now, you wouldn't put an implant in without it. Absolutely. A lot of surgeons say, "I use it to look for, you know, third molar evaluation where the nerve is pretty close." The other thing that dental MRI can do, it can show the lingual nerve, which is of great interest to all surgeons cuz there's a lot of damage to the lingual nerve. It's in soft tissue. And we're just finished a study here where you can actually see the lingual nerve. So, that's another example of things you can see that that cone beam can't see. So, how do you

09:17explain it to patients? We're going to have you have an MRI? Wait a minute. I don't have joint problems. So, they think of the usual MRI, but no, I think the fact that this will identify inflammation, it might identify areas of pain that that are it's hard to identify. There's something called neurography where inflamed nerves light up. Dental that all dedicated system isn't there yet, but uh it's in other uh

09:43scanner other MRI units. So, I think one of the biggest things with dental dedicated, uh we start here with this application, but then we find out more and more what it can do, and we benefit from any advances that are going on in the medical MRI world can add to it.

09:59Just like with cone beam CT, if you bought a unit in 2010 and kept the same unit by 2020, it's probably a better unit because of upgrades, different software, different enhancement features. I think we'll find the same thing, if not more, with MRI.

10:14Again, you've got so many different uh sequences uh and protocols, we call them, that you can use uh to identify these um different You can even see carries with MRI. Not really recommending you get your bite wings from dental MRI yet, but you can actually see the carries. Uh you can see bone loss very well. Again, you can do everything that um that uh cone beam can do. Some of the studies that are coming out of the University of Aarhus in Denmark, that's

10:41who I collaborate with with Professor Ruben Spinatto, we're able to see edema in the bone. We could see inflammation in the gingiva. We're able to see edema in the bone before there's any periodontal bone loss. Well, so, you know, the sooner you get that kind of information, the more effectively you can treat the patient.

10:58So, it really will I think will enhance patient care, bottom line. I'm I'm fascinated to see how where this goes. Uh you know, it it feels like right now in dentistry, we have such a growth of technology with all the AI that's coming in and so many things like this. Is Is there a way that maybe those two play together in your mind?