We're going to talk about uh CBCT technology. And um I think it's one of the most critical pieces of technology that every dentist needs to have in their office. And you know, I'm on the road lecturing about 100 to 120 days a year. And every time I'm lecturing, I'm always asking for people to raise their hands and tell me if you have a CBCT. And honestly, the number the percentage has been staying pretty steady at about 55 to somewhere between 55 and 65% of general dentists have CBCTs. And I'll tell you that in my own personal experience, um, I waited too long to buy my machine. And I really wish I would have purchased it earlier. It's probably the number one mistake that I made in my career. Um, I could have afforded one five or six years before I purchased one. I've had mine now for um getting pretty close to a decade at this point and I will tell you that without a doubt it's my greatest mistake that I made in my clinical career and some of these slides that I'll show you afterwards about all the ancillary things the incidental so to speak that we find on CBCTS is the re real reason why that is but a vast majority as well of my regret why I didn't buy a machine earlier comes from all the different things that we miss because if you think about about it and hopefully everybody can see my cursor on the screen here is that every time that we seem to get ourselves into a problem in clinical dentistry, it comes from a failure to diagnose. And when we don't diagnose a problem or if we don't diagnose all the things that are causing a problem uh that a patient may have, people have trouble adapting. And you know what what what does trouble adapting look like? Well, it could be that they're having difficulty with comfort after receiving treatment. They could have postoperative sensitivity. Um, they may have bite issues. And one of the things that we're going to focus in on today's lecture is we're going to focus in on airway. How um the CBCT can help us to be more sure that we aren't encountering an airway problem because people that have undiagnosed sleep apnea issues are very hard on their teeth. And when they're hard on the teeth, they're even harder on our restorations because even though we have amazing dental materials today, we still don't have materials that are better than what came out in our mouth in the first place. Um, joint diagnosis is another huge component that is oftent times overlooked by a vast majority of dentists. And we'll talk for a few minutes and we, you know, in an hour we have very little time to go into any specific detail, but the vast majority of dentists have very little ability to be able to diagnose the condition of the joint. And our founder, Dr. Peter Dawson, one of his favorite things to always say was if this up here is not stable and healthy, which means your joint health, anything that you do down and any changes that you make to the dentistician, that's not going to stay stable and healthy when the joint is not stable and healthy. And then we're also going to talk about how diagnosing and getting ahead of bacterial problems is also something that we can look at with a CBCT. But every time that we fail to diagnose the problem, whether it's in a general dentistry side or when we start getting into large multi-unit prostadonic cases, the more number of teeth that we're working on, the more magnified adapting problems become in our patient, if they're having trouble adapting. And when we don't know the problem that is in the way of a patient adapting correctly, then we own the problem because the patients are going to cause all put all the blame on us. And then when we don't know what's leading to the issues that we're encountering, that leads to stress and stress leads to fear. And when our dentistry is not predictable, that means it's not profitable. And then dentistry is just not very much fun for us at all. So, you know, my biggest thing when I tell you that I I should have bought mine five or six year years earlier, I was always thinking to myself, well, why in the world did I wait so long to buy this machine? And a lot of people think, well, could it be the cost of the investment? And dog on it, these things are expensive. I mean, they were really the the price of the technology seems to be coming down, which is good, but they're still very expensive machines. And, you know, it is going to be something that most of us we can't just stroke a check and get rid of it. we need to finance it and we need to be able to, you know, get a return on our investment. And the thing that I will tell you is that you will not have a tr not having difficulty getting a return on the investment on these machines because there are so many different ways that we can be using this and turning a profit, but also the things that you find when you are looking three-dimensionally, you're going to find more things that going to need to be fixed on patients anyway. And you know, will you use it? I mean, if you're doing implant restorations, if you are doing multi-unit uh restorations, then you need to be concerned about airway, you need to be concerned about the health of the temporal mandibular joints, and you need to be concerned about getting ahead of bacterial problems. Uh, another reason why I think a lot of people sometimes are hesitant to buy a machine is because they're worried about exposing radiation uh, exposing their patients to excessive radiation. Now, the machine that I own and I have no affiliation with them whatsoever. I brought bought a machine that's made by a company called Prexion and I can take an 8 by15 field of view which means that I can visualize all the teeth, the sinuses, the airway and the TMJs all in one scan and on a normal setting I am exposing my patient to 78 microceverts of radiation. And to give you a little bit of comparison to what that is, um the average digital bitewing is somewhere depending on your machines and your sensors somewhere between 2 to eight micro severts which means you know we're exposing our patients to somewhere between 30 50 60 microceverts. Most panorexes are topping out somewhere between 20 and 24 microceverts of effective doses. Now, in comparison, you know, we have patients that are all the time getting medical CTs. You know, our physician friends, if there's a problem, they don't hesitate to order a CT. And the average medical CT is somewhere between 2,000 and 30,000 microverberts of radiation. And also then for comparison, if you get on an airplane and you f fly from New York to Los Angeles, you're being exposed to the same amount of radiation that same type of radiation that we're being exposed to in a CBCT. And in that airplane flight, you're being exposed to about 50 microceverts of radiation in the duration of that airplane flight. And again, my machine, the effective dose that a patient is receiving is about 80 microceverts of radiation. Now the the great thing about uh a CBCT is that the the DICCom files that are being created we're getting information in three different planes in the coronal plane the sagittal plane and the axial plane. And now the great thing the re the ra the reason why we can have a three-dimensional reconstruction is because the brilliant people that create software can take these three forms of dicon data and then do a reconstruction which allows us to look at all the data in three dimensions. Now the other thing if you don't own a machine and you're shopping around is you want to be concerned about voxil size and this is the equivalent to pixel size. Like if you're going to buy a television, like the the more uh high definition that that a television is, like the smaller the pixel size is. Well, in a CBCT, what you're talking about is voxil size. And so, you want to have smaller voxil size because that gives you the greater resolution that you can see the difference on these two images. And if you look at the 0 2 millimeter voxil size, you have a lot more definition of the convergence of these different cones in there for it. So that's something that you want to be considering if you're purchasing a machine and also the ease of the software usage. You want the software to be intuitive and easy to manipulate and look at your data as well. Now when should you be using this thing? Well for the four ways that I use this is I use it for my implant planning. Now a few years back I was doing a lot of my own um you know relatively simple or predictable implant placement. I was doing it guided which I was using my threedimensional technology my CBCT for that. I don't do so much of that anymore because my uh as I uh became the clinical director here at the academy I had to cut back my clinical hours uh for my administrative purposes here. So I putting implants placing implants was something that I kind of started to step away from in my practice and I focus more on uh larger prostadona cases airway screening um also doing a pre-restorative diagnosis and I'll show you all the different things that we're looking at for that and then also looking for different forms of pathology detection. Now, you know, using it for a CBCT, you know, it allows us to identify the good place to put things, the good place to put the implant into bone, stay away from roots, stay away from cortical plates, stay away from anatomy, and utilizing this technology. It's amazing that we can go from the ground up or the implant up and making sure that we're not only putting the implant in the best possible position in the bone to increase our predictability, but also is it in a good position for our prostadonic outcome when we want to put a tooth on top of that. And it's just absolutely amazing that the accuracy of how we can get that implant when we're doing our guided procedures can get that exactly where we thought we wanted it to be by using the three-dimensional technology to do that. And honestly, I think it's becoming more and more standard of care. Making sure that that implant is properly placed within the bone. We don't have fenistrations. um all the complications that when you're freehanding an implant placement can sometimes be that you're trying to put it in blind. So wonderful use of the technology. Now in my practice where it gets the most use is airway screening, doing a pre-restorative diagnosis and looking for pathology. Now it used to be that we were trying to basically put our patients into three different buckets. We are looking for people that were having a problem related to bacteria and we also have people that are having problems related to function. These are the worn dentition cases. A lot of times people with TMJ problems and to where we're seeing a lot of expression of instability show up within the system. The wear, migration, mobility, stress fractures, ab fractions, clicking and popping TMJ, sore muscles amastication. Most of these types of expressions of instability in the system is coming from functional deficits. And functional deficits oftent times also produce aesthetic deficits. And most of our people with functionalbased problems, they want their teeth to look good once we restore them. And one of the things that we weren't really considering for a long period of time in dentistry is the effect of airway. And I'll tell you, I've been in I'm in my 27th year of private practice. And for about the first 15 years or so, it's like our profession didn't realize that people actually need to breathe. And now what we do know is that airway problems need to be di diagnosed immediately and the priority needs to go at the front of the front of the train right up there with getting control of bacterial issues. You know a lot of times people that have airway airway issues they have a clench and a grind that is associated with that which creates functionalbased issues. A lot of times the kissing cousin of an airway problem is acid issues from gird that creates functionalbased issues as people are losing their tooth structure. A lot of times dentists will recognize these things and want to put people into a night guard, which a night guard is simply what dentists prescribe people with, which is an acute acrylic deficiency. And I don't know what to do, so I'm just going to jam a piece of plastic in there. Well, the problem with that is what the statistics and the studies are showing us is that if you have a patient with a compromised airway and now you stick a piece of plastic in their mouth, about 65 or 70% of the time you're actually going to be exacerbating their airway problem. So that's why looking for air wastebased issues becomes ever more critical. And the thing that I'll tell you is that many times these people are simply hiding in plain sight. You know, it used to be that, well, we're only going to really think about an airway problem on that 55year-old overweight middle-aged man. And I will tell you that what we have to assume is that everybody has an airway problem until we show that they don't. And I'll show you exactly why in a minute. And we don't have any time to get into any of the detail with this at the academy. But when we go into our treatment planning and we're talking about our six elements of global aesthetics, one of the first things that we are considering is face, airway, and bite. Making sure that the skeleton is in a position to support the bite. Making sure that the skeleton is in a position not to compromise the airway, and also make sure it's not compromising our aesthetics. And so the reason why we want to be concerned about this is because we have so many people that have compromised airways because of dentistry. You know, orthodontists unfortunately have been creating airway problems for the last 40 to 60 years. And the reason why this is so prevalent is that so many people have a Bolton's discrepancy to where there's not enough room in the arch form for all the teeth to erupt. And so people have crowding. Well, the dentist, the orthodontists recognize this and the way that they gain the room is they do four on the floor and extract four preolars. Well, typically what that results then is an excessive amount of space. And the solution was then to pull everything back. And that's so contrary to what most people need because most people they actually need to be expanded. They need to be expanded to support the maxilla to be able to provide room in the garage to park the car. And what I mean by that is there room in the pallet for the tongue to be able to go up in a rest position. Because if there isn't sufficient maxillary room, then the tongue ends up going down and backwards and the car instead of being in the garage goes in the driveway or out on the street. And when that occurs, then we start to have patients in the growth and developmental stage that develop upper airway issues or transverse issues. They develop narrow pallets. They develop end toend occlusions or even posterior cross bites. They have the high palatal arches. And remember that the roof of your nose, I'm sorry, the roof of your mouth is the base of the nose and the maxillary sinuses. So those can become in involved. Again, a lot of our adult patients are experiencing lower airway problems. Four in the floor, everything gets pulled back. They develop collapsed envelopes of function. And now we have all kinds of problems there. Now, the average volume in the average adult, they should have a fair airway of about 20 cc's of volume. And the scary thing that I will tell you is I see so many very fit young females and males that you would look at them and not s for a single reason think that they have an airway problem. But when we do a three-dimensional reconstruction of the airway, we find that they're breathing through a coffee straw. And if these people are breathing through a coffee straw and you have an airway problem, the reflux at nighttime when you're dying in your sleep is to drive your mandible forward and to reestablish patency of the airway. Here's another one. 3.9 cc's of airway. Average should be 20. This scan was a patient of mine who was a female that was about 5 foot tall and weighed about 95 or 100 pounds. Never in a million years would you think that this patient would have an airway problem. But what we need to do is assume that they do unless we can prove that they don't. Because if we go in there and we start to make changes to people's occlusion, if we go in there and start to restore and change the shape and the position of patients anterior teeth and we don't respect the way that that they might have an undiagnosed airway problem, bad things can happen. These are the people that they like to spit. They just like to spit porcelain back at you because there's nothing stopping them. Here's another example of one one of the reasons why not buying my machine earlier than I did, it really makes me upset at myself is because this patient came in. You look at her airway volume, you know, less than five cc's. And the reason is she had a malignant tumor growing in her neck that was completely asymptomatic. And we were able to find that by imaging using our three-dimensional technology and the use of an oral and maxacial radiologist. Now make no mistake anytime that I am taking a scan that is showing me a large field of view outside of the dentition. So, I told you that I'm taking most every scan I'm taking is a 15 by8 field of view, which means I'm seeing the sinuses, the joints, all the teeth, and the airway. That is a big field of view. And I always tell people, look, I'm a country dentist. I do not have the training to be able to evaluate every single component of everything that we see on a large fieldof view scan. I probably never would have found this in a million years. And that's why we always want to make sure that we're using a professional. I use beam readers. There's a lot of different companies out there. I have no affiliation with beam readers. Um, but I'm just telling everybody that's who I use when I need to use a radiologist to evaluate a scan. Now, if you don't have a CBCT right now and you're interested and you're like, gosh, that Lenny, you just scared the living daylights out of me. I had no idea that all these people that you never would think have an airway problem have an airway problem. You know, it's not the only thing that we can do. We can be looking for indications like snoring. Have they previously been diagnosed? Do they still have their tonsils? Because remember, an airway, it can be constricted three-dimensionally. It can be constricted laterally from the tonsils. I mean, you can see these children a lot of times that have their tonsils and adenoids touching at the midline. It can be I've seen patients having their constriction from posterior to anterior because their cervical spi spine was collapsing and bowing to the anterior and then a lot of our patients have from the anterior to the posterior because of being overweight four on the floor with the orthodontist having a collapsed envelope of function which can make the mandible be driven to the distal or backwards. So, size of the neck, male and petty score, um doing a stop bang evaluation, all these questions, these are things that we can look for. And if you have a question based on the shape of the pal arch, if they have a posterior crossbite, an anterior open bite, if they've had extraction, orthodontist, orthodontist, these are all screenshots from um doing a complete examination, which is what we teach dentists to do at the Dawson Academy. We can look for these things and if you're if you're worried about it, get them to a sleep physician. Patients don't need referrals these days. All they need to do is call a sleep clinic and go get looked at for them. But we want to make sure that we're moving people towards the appropriate treatment before we go in there and start to change teeth. Now, another huge reason why we need to all be thinking about having CBCTs is unfortunately in dental school, all we were taught to do is look for problems related to bacteria. Almost none of us were trained to deal with people that are having functionalbased problems. the worn dentistician, collapsed envelopes of function, all the things that mo make most people destroy their teeth, destroy our dentistry, and have major problems that a lot of times lead them to have loss of their teeth when they when they get older and as they age. None of us were taught in dental school how to properly diagnose the health of the temporal mandibular joints. None of us were taught how to treat the temporal mandibular joint, which is horrifying when you think about it because most of us don't realize that the most complicated joint in the human body is the temporal mandibular joint. And the doctors that are responsible for treating it is us. And we weren't trained how to do it in dental school. And so most of us don't know what to do. We don't understand how health of the joint can influence what we're seeing the dentistician. And I'm in the unenviable position unfortunately in my community that I get a lot of people coming to me for second opinions. And I will tell you that a vast majority of the time when I see a case that is going sideways and another dentist is involved and maybe the patient's in fullmouth provisionals or a lot's going on and things are going sideways. Almost every time the dentist started to implement very drastic or very large changes to the occlusion, the shape, the size, the position of teeth, and they didn't realize that they're doing this on somebody with unstable joints. And the reason why it's so easy to get lulled into this overconfidence that the joints aren't a problem is because most of these people are hiding in plain sight. Most people with debilitating TMJ problems, they've been that way for so long that they aren't, it's just their normality. They're used to being uncomfortable. They've adapted their lifestyle to allow them to be able to not be discomforted. They know I don't bite into big things. I don't try to bite into apples. I don't get big burgers that I have to try to bite into them big. I don't order chewy things at a restaurant. I don't have bagels. I don't get a stake. I if I try to do things I have to chew a lot, I have trouble. I start to get soreness, pain, and I may pay the price for a few weeks. And therefore, they don't complain about it. And most dentists aren't asking the proper questions to find out. And if you look on the screen right now, you see a patient. This is the same patient. This is the right side TMJ and this is the left time TMJ on this is anatomic on the left side of your screen. And I hope you can all appreciate a very drastic difference in these condiles. On the left side or the patient's left side, the right side of your screen, you see a condile that is normal and healthy. You see cortical bone. You see beautiful meillary bone. And you see space on the meial and on the lateral that is allowing room for the disc to be in its proper position. I hope you can appreciate on this other side that you see a drastic difference in the shape of the condile because this condile has undergone degenerative joint disease. And you can see that there is not cortification. This is active breakdown at the level of the joint. And you can see on the medial aspect here there is not room for a disc which means the disc is anterly displaced. You have bonetobone contact. You have ad you have active remodeling and adaptation occurring at the level of bone. And when that occurs, you also then start to see this change occur at the level of the teeth. And that that particular patient that you see in here, she was coming in, I will show you her case in a few minutes, in a lot of pain, a lot of discomfort, and was having a lot of problems adapting to all the changes that were occurring at the level of her occlusion. And so so many times you see all this breakdown like on this patient right here. Look at the shape of this condile. Look as we move from the lateral towards the medial. Look at how different the shape of this condile is. You see this anvil head formation, this bird beaking. A lot of times you can see this on a panorex. But this is active remodeling that has occurred at the level of the joint. And the thing that I want you to all remember the reason why the temporalmandibular joint is the most complicated joint in the human body. It is the only joint that goes to a fully seated position rotates around a fixed axis of rotation but then is also capable of translating which means that condile leaves leaves the glenoid fausa travels down the articular eminence and then it has to return to that position. And so as a quick refresher, I'm just going to take you through how the breakdown occurs in rotation and the for closer and the closer we are to a seated position in centric relation. We don't have any time to go into centric relation and it's a very emotional thing to talk to for a lot of people because a lot of dentists don't understand that it's the eighth wonder of the world and it is the solution to so many of our problems with comfort for our patients and the way that we can build an interference-free occlusion that all the force is on the medial pole the inner medial pole and when we go into translation the force translates out to the lateral pole and our condiles in face are orientated where your lateral pole is more anterior in position than your medial pole. And if I show you some animations of why this is when we are in a fully seated position, the center of force is located on the inner or the medial pole of your condular head. And that first from zero to the first about 15 to 20 millm of opening, that is a pure hinged rotation of the mandible. And then once we go into translation, the center of force goes from the medial out to the lateral pole of your condular head. Now, this is important because I want you to realize that when we're in centric relation and the closer and closer that we are to it, all of that force is focalized on the medial aspect. And the thickest, most buttressed bone in your glenoid fausa is on this medial aspect. the orientation of your main elevator muscle which is your medial terragoid from the origination to the insertion. Those muscle fibers are obliquely orientated towards the midline and the sppheninoid plate which means that when these muscles contract it is putting the force on that inner medial pole. And if this condile disassembly is not in its normal position, which most people don't have this because the teeth are interfering with the ability of the condile to seat all the way, then over time we start to have breakdown occur at the level of the joint. All of us come out of the womb with a structurally intact temporal mandibular joint, which means we have a bone disc bone relationship both on the lateral and on the medial pole. And then when things start to go wrong, when we don't have harmony between function at the level of the teeth and at the level of the joints, when we have that disharmony, most people they start to have issues that start off with asymptomatic, non-p painful clicking and popping on the lateral poles. And then if this progresses, a certain percentage of patients will progress to medial pole displacement. And so a great quote from Dr. Dawson is if the TMJs are not stable the occlusion will not be stable. So it is a risky proposition to undertake acclusal changes without knowing the condition of the temporalmandibular joints. And just to show you all cadaavver slides of how this actually is transpiring an anatomically most people we have sufficient by concavity of our articular disc and the disc by having its bicon cavity automatically wants to stay over the condular head and be positioned properly. In a normal healthy joint you see beautiful cortic cortification of the articular eminence and the condular head and you don't see a lot of hyperemia or inflammation occurring in the medularary bone. As we start to have discrepancies between centric relation and our patients maximum intercuspation a lot of our patients start to develop lateral pole clicking and popping. And here is an example of the condile going into translation. and we see a reduction of the disc over the condular head and then because the bicon cavity is being lost it can't stay in its normal position. I also want you to notice how on the lateral pole as you start to see the breakdown occurring you start to see more inflammation and hyperemia occur in the meillary bone. As this progresses over time patients then start to develop displacement off the inner or the medial pole. And now we see examples of the articular disc being anterly displaced on both the lateral and the medial pole. The retroiscal tissue is dragged over the condular head. And that's the only that's the only portion of the TMJ that's innervated. And so now these people are patients that start to develop range of motion issues. They start to have pain on loading and through normal function. And again, I want you to notice how much hyperemia and inflammation you see in the medularary bone and how you see a loss of cortification on the condular head and a flattening of the articular eminence. As things progress, people start to develop degenerative joint disease. And here's an example of once your patients are pulverizing through the retroiscal tissue, now you start to have bone on bone contact at the level of the joint and you have active remodeling. you see flattening of the condular head, you lose that concavity or the convexity, I'm sorry to say, and you start to have flattening of the articular eminence. And these patients, you will always see the ramifications of this show up at the level of the occlusion. And a lot of these people, it shows up the level of the occlusion and then we need to restore their dentition and do a full mouth rehabilitation on them. And if this breakdown is active, we start to see it show up. So, here's that same patient I showed you just a few minutes ago. And the problem, and you'll notice here that this patient had reconstruction. The mandibular permanent restorations were placed. She was still in maxillary full arch provisional restorations and she was complaining about being in constant pain. Well, you can look at the height of the clinical crowns. Look at how tall these posterior clinical crowns are. And you can see just how much this patient's vertical dimension of occlusion was opened while she was having horrible changes occurring at the level of the joint. You can also clearly visualize that as these teeth were being restored in the incorrect position. Look at how distalized her condiles are showing up on the CBCT. She also, if you back up, had abscesses clearly visible on the newly restored teeth on the left and on the right side. You can see a clinical crown already breaking off on the left side. Abscesses on two of the maxillary teeth. And all of these things can sometimes hide in plain sight on a two-dimensional parapical radioraph, but they can't hide when we look at things three-dimensionally. So, just to very quickly, and I know I'm going so quick because I'm trying to give you as much information as I can in a very short period of time on a very complicated topic here, but you can very clearly see up here that we have erosion starting to occur at the condular head. And if you look here as we go from the lateral out towards the medial here, lateral towards the medial, look at how much cortification is missing from this condular head. This is somebody with active rapid breakdown at the level of the joints. And let me let me just give everybody a real a real scare right now. This patient came in not complaining about being in a lot of pain. Here's a great example of a lateral pole displacement. You can see that there's no room on this lateral component for the joint. Here's somebody that was having extreme degenerative changes at the level of the joint. And she also had senovial condrotosis. And this patient ended up having to have actual joint replacement surgery. These people are everywhere. They're hiding in plain sight. Look, look at the remodeling that's occurred on this condular head. And this patient again came in not complaining about being in pain, but look at the drastic difference on her left side joint shape and anatomy and on the right side condular shape and anatomy. They are everywhere. And so these patients, even though they're not complaining about being in pain, if we are able to perform a complete examination and go through the step to become a physician of the mascatory system, these people can't hide from us because we have the ability to go in and find them. We're just not relying on patient symptoms because we all know that so many problems that we have in our human body. A lot of times they are not related to symptoms and we are able and as a physician of the mascatory system, we should be able to go in there and look for these signs and symptoms before they become obvious to our patients. And that's one of the big things that we teach people to do here at the Dawson Academy is to become a physician of the mascatory system. Now, as we wrap things up here for another five or six minutes and we start talking about answering questions, the other reason why our three-dimensional technology is so critical for us is to get ahead of problems before we go in there and do that. So here's an example of a patient that had a very deep bite, very horizontal bxism, a lot of breakdown occurring at the level of her dician and she needed to be restored. But what we want to do is you look up here, you see this first mer asymptomatic active infection occurring on these. And you know the funny thing is you know when this starts to hurt as soon as we put a bur to the tooth and then the patients are like well geez you know Dr. has this tooth wasn't hurting me before you started to work on it. And by utilizing this technology, it just helps us to stay ahead of problems. Orthodontic considerations before we want to go in there and start to move teeth. You see this patient here already been through ortho multiple times in her life. And when we image, we can see that on the facial aspect here, she had almost no buckle bone remaining. She just had this little island of buckle bone and the rest of the teeth are almost floating in bone. And you can imagine the complication that this can lead if we want to go in and start doing Invisalign and start moving teeth and not recognizing maybe she we want to move those teeth to the facial or we want to change the inclination of the anterior teeth and unless we're able to visualize what are we working with we could create major problems. Sinus implications and considerations. Remember your maxillary sinuses are such an important part of supporting your patients airways. And when we start to visualize and image the sinuses, we see so many people that have massive problems in their sinuses, which creates secondary airway problems. You can look at how obliterated this patient's right maxillary sinus is with fungus and with inflammation and bacteria. And we see these peoples everywhere. And then we want to move them towards the ENTs to help to support their breathing and their airway as well. Plain old diagnosis looking for abscesses, infections. Had a new patient come in that wanted to be restored, was complaining about sensitivity on the lower left quadrant. You look at this periapical radioraph and you don't really see a lot going on down here. You don't see really any abscess at all. But when we look at this three-dimensionally, you can see the magnitude of the infection that was occurring on that primo or let me back it up one more time. You see a little bit of a radolucency here, but you aren't seeing almost anything at the apex of this tooth, but it can't hide three-dimensionally. That's because a periapical radioraph or a bitewing is a two-dimensional picture of a three-dimensional object. And that means you have 33% availability for things to hide in plain sight. And I, you know, I've showed this to numerous dentists over the years and they always say, well, maybe that's the mental fammen. And no, you don't see the root in a mental fam. And this is the mental fammen down here. And then when we break it up into its individual components in the diccom, you can see the magnitude of the infection that is just hiding in plain sight. and the infection is not really focalized at the apex and that's how it oftentimes hides from us. Same thing here. You look at these massive asymptomatic infections that we see so many times with root canals that have been failing in patients everywhere. They're hiding everywhere. They can't hide three-dimensionally, but so oftentimes you look up at this panorex. It doesn't look like there's a lot of problems in there, but they're so clear and easy to visualize when we can look at things three-dimensionally. Another example of a patient having uncomfortable um chewing pressure. And you look here and you don't see a lot on a PA, but and you look at it in the in real life in three dimensions, there's just simply decay everywhere, hiding in plain sight. Another example of a periapical infection that we don't necessarily realize how severe it is. And this is ready. This is breaking through that lingual cortical plate. And this patient was probably about 10 days away from developing Lwood's angina as that infection would have spread into the sublingual and sublymphatic spaces down there. So again, here's another that same patient I showed you that had that tumor growing in her neck. I had another patient that had severe um sclerosis that was occurring in the corroted artery. Again, these are all things that my radiologist finding. I'm not I'm not trained to look for these things. Another patient that had a litic lesion growing in their cervical spine. Again, these are the all the reasons why we want to make sure that we are sending this big fieldof view scans to a radiologist. So the thing that's being missed in most dental practice is that the CBC can help us is number one, most of us weren't trained to look for problems beyond things related to bacteria, periodonal disease, and decay. That's what we give people the ability to do at the Dawson Academy is do a complete examination, make a differential diagnosis, and then we can prescribe the appropriate treatment restoratively or medically if necessary. And the reason why this is so important, which is another great quote from Dr. Dawson, the point that should not be missed is that masctory system disorders are rarely ever confined to a single structure. There will almost always be collateral effects from disorders in the joints, the teeth, or the muscles. These will be evident as signs or symptoms and careful observation will usually show that there is a chain of cause and effect reactions as one disorder leads to another. And so what I encourage all of you to do is we have so many patients that have horrible wear dentition open wounds I like to call them. When dentin is exposed in the mouth, that is an open wound. And there is a reason why there's an open wound because the inner layer is not supposed to be the outer layer. So we all need to be concerned about this and bring this to our patients and start to have compassion. And if we can combine those two, a lot of times we have the ability to provide this complicated restorative care. If you like what you are learning about today and if you want to learn more, I've got some recommendations of books you can read. I recommend these books right here. I recommend these books right here. I'll leave this up here for a few seconds. I'm kidding. If you want to learn more, then I would encourage you to come to the Dawson Academy. Our foundational class of our seven course core curriculum is called occlusion and smile design. And it is a 2-day course that if you want to learn to become a physician of the mascatory system, if you want to be able to do predictable and profitable fullmouth rehabilitations, if you want to learn how to manage vertical dimensional occlusion, if you want to be able to diagnose the health of the temporal mandibular joints, if you would like to be able to properly prescribe proper splint and orthotic therapy, if you want to have a better understanding of the function of the system overall and how you can make teeth look beautiful but also make them functionally correct. This is the course for you. And I would love to invite all of you to join me at our next live location coming up. We have one coming up in New Jersey actually in a few weeks. And that would be my invitation to you is if you've been stimulated by what you've learned, please join me at this