Como a tomografia pode te ajudar a melhorar seus diagnósticos em Dentística

[00:00:06]Hail, hail, my Brazil. Greetings, greetings. I've missed you all so much. Hey everyone, can you hear me, Mateus? Is everyone listening to me? That's great, folks. I was already dying to say: "We're live for another straight talk with Barça. How cool, guys. A lot has been happening in my life. You remember, I was doing straight talk on Zoom and it was working great.

[00:00:40]Then a bunch of trips started popping up, a bunch of things, everything falling apart on Thursdays, planes, airports, I said: "Ah, I'm not going to suffer, I'm not going to suffer."

[00:00:48]Straight talk is something that has to help everyone, but above all it has to be possible for the average person. Anyway, problems solved, we're back and we're back at a very high level. We're back at a very high level. Why?

[00:01:14]Because today, based on some doubts, some direct messages I receive, questions I sometimes receive in the Nova Odontologia group, if you're not yet part of Nova Odontologia, don't miss this opportunity to participate. It's a free, 0800 community that we have on WhatsApp. We already have more than 100 members registered. A community that we meet every Thursday and Friday." It opens up, doesn't ask questions. It's crazy interactive. There's never a time when I can't keep up with everything that's happening. So if you're not already part of it, join the new dentistry, okay? If you're watching live, it's easy, just go to Marcos Parceleiro's Instagram, there's a link in his bio, boom, you're in the new dentistry, you're in, no need to ask for permission, you ask, you're in. If you're watching the recording, it's the same thing. And for those of you watching the recording, I'll ask you something. Why are you watching the recording and not live? It's just a matter of scheduling.

[00:02:33]But that's why I leave the classes we do on the straight talk here on YouTube so you have the opportunity to watch us.

[00:02:41]Remember, they are open for a short period of time, then we upload them to Newera and only Newera users will have access. If you're watching for the first time, arriving for the first time here on the Totom Faceleiro YouTube channel... Don't miss the opportunity, come down here. Here, where is it? Right here, down here. Come down here now, right? Like our channel, start following our channel and activate that bell. We already have almost 2000 subscribers, right? Soon we'll have 2200.

[00:03:20]2200. I was going to say that my goal was 2,000, now I'm going to raise the bar, I want to reach 2,500 subscribers here on YouTube. I want to show off here on YouTube, 2,500 for a channel that's free about dental education, from dentist to dentist. Look, I go one way, then I come another. That's how I am. Lots of questions happening, diagnoses, help me, planning, I don't know what and so on. And then I start talking to people, blah, blah, blah, send me this, send me that, send me, send me the tomography file. Oh, I don't have it. Send me the tomography file. Oh, I don't have it.

[00:04:01]Oh, I don't have it. Oh, I don't have it. And then I realized something, man. People still don't understand that CT scans aren't a luxury anymore?

[00:04:12]People don't understand that CT scans aren't like those years when you're going to ask for them and say, "Oh, I asked for the periapical scan, no, it wasn't clear enough to see what I wanted, I'm still undecided, I'm going to ask for the CT scan." No, it's not like that. Today, a CT scan is a routine exam that's part of any initial evaluation, especially for those who want to practice high- level dentistry. And that's why I invited a friend, a mentoring friend, she's part of the same mentoring program I'm in, okay? Which is Doc Evolution. Cláudia Coscarelli, a mega ultra expert on the subject. She has a WhatsApp community about it, she has courses about it, she knows everything about CT scans, and then I said: "Claguinha, let's have a straight talk?" She agreed, and I know she's already here because I saw her down here. Right? I'm going, right? Then I have to put on my glasses, there's no way around it. I'm going to bring Claudinha to the stage. Let's see.

[00:05:18]There, you see, Claudinha?

[00:05:20]Hey, I'm here loving it, having fun. You 're a successful YouTuber. I'm a chatterbox, man. I'm a chatterbox. I like this, you know? I find fulfillment in this. I'll tell you something. Tired all day, a bunch of headaches. Today, just today, was one of those days when you say: "My God, why did I get out of bed?" I was all warm and cozy with a nice blanket, but all I got was trouble, just problems, just problems.

[00:05:55]Tired. Then I turn on the camera here, boom!

[00:05:59]I'll get better, everything will pass. I don't know.

[00:06:01]My wife says I'm wasting my time and that I should be going to Globo.

[00:06:05]I'm starting to agree [laughs] that YouTube is the new Globo.

[00:06:12][snoring] Love, welcome. Thank you so much for your generosity, for your donation to come here and help the dentists.

[00:06:30]On a subject I don't know about. Were you listening to me? Were you listening to me?

[00:06:37]Well, what I said was very wrong, Claudio. That's very wrong. CT scans are still something we only request very occasionally, when we have a lot of doubts. Either I'm on the right track. Goodnight darling. Thank you so much for your generosity. It's an honor to be in the bag with Barça, right? It even has such an emblematic name.

[00:07:03]Straight talk with B. And here it's straight talk. Don't try to fool my audience here, they like straight talk.

[00:07:11]Can I be so direct? When you ask me if, when you say things like, " CT scans are only for surgical procedures," that kind of straightforward talk stopped being true a long time ago, right? It's been a long time, hasn't it? A very long time, a very long time.

[00:07:27]Claudinha, I, I, oh, let's do a, let's do a historical account here. You and me, you complete me. It's very wrong to say that tomography came to dentistry with such importance thanks to implantology. They were the ones who brought to the forefront of tomography, in a more popular way, understanding the importance of this exam in almost any planning process. I think it was the Implanto team that made that first move, wasn't it? Okay, it was the implant team. Give it that initial push.

[00:08:09]I've been talking [clearing throat] about tomography for 25 years, since 2001.

[00:08:14]And back in 2001, when tomography started arriving in radiology clinics, the first dentist to start adopting tomography was a surgeon who used to operate with panoramic X-rays. There was that CT scan there, it was just a blurry 2D slice. I don't know if you remember this.

[00:08:43]Hmm. But the dentist used it, it wasn't a Comibin, right?

[00:08:47]Yes, the dentist was using tomography, which was done in medical settings. And that's where a part of the interaction was missing, because the dentist knew little about medical equipment, the doctor knew little about anatomy, and the terminology wasn't very clear.

[00:09:13]Besides the part about measuring the implant bed, right, and installing the implant. We didn't have it, it wasn't a Conibin lens, and I couldn't see the dental part with the resolution I have now; the tooth came out kind of blurry.

[00:09:28]Yeah, I could see the bone clearly, but the tooth wasn't very well resolved, okay? Let's go. That was a moment in my life in dentistry, okay? I am not an implantologist, but I have always been very close to implantologists. So I lived through that moment, right?

[00:09:54]Leaving that point aside, I'm not sure about the exact timeline, but I'm starting to see a very strong trend towards the use of computed tomography in foot care, also considering surgical planning and endodontics, for diagnosis, looking for fissures, fractures, and everything else. No, I 'm not going to start building guide rails just yet, like we know they have today. I'm talking, right?

[00:10:30]Eh, eh, eh, eh, a come a péo and I think they're going more or less uh walking there seeing uh the possibilities.

[00:10:43]But, well, it did n't quite reach the restoration area. The time has come for the restoration sector, hasn't it? It's time for me to arrive, right?

[00:10:57]Tell me, Claudia, how is the situation today? Well, without even mentioning the guide yet, we'll talk about the guide in a moment so as not to confuse things, thinking of tomography as an instrument for diagnosis, evaluation, and so on. Give me an overview. Where do you think it's worthwhile to consider tomography for diagnosis and treatment planning in dentistry today? Tell me.

[00:11:37]I'm going to give a retrospective overview of what you said, right?

[00:11:41]Implantology emerged as the flagship service.

[00:11:43]Some surgeons use it, who likes extractions, right? Third molars, although at that time we had surgeons who had a very high level of skill, because they had poor eyesight and they developed that skill.

[00:11:58]And periodontics comes along somewhat because of the pink aesthetic issue. And back in 2009 we have an important article, by Barriviera and Januário, which defended the separation of soft tissues in computed tomography. This brings benefits to periodontics.

[00:12:26]If you talk about it enough. In parallel with this, there was the development of tomography equipment. In this first generation of equipment, we only had large FOV equipment, equipment that acquired the volume of the entire face or a whole marked area, with a very low resolution, a very low capacity to see details.

[00:12:55]So, we would try to see something endodontic, but we ended up making mistakes because, well, the equipment didn't yet have the ability to see small details.

[00:13:11]Starting around 2012, dedicated equipment began to arrive on the market; this equipment is exclusively for tomography and features a small FOV and high resolution. From then on, I'll help you, man. What is fovio? I'm asking because I know that people are going to ask what "fóvil" means.

[00:13:37]Hold on, I'm going to grab something here to show you.

[00:13:44]Oh, ah, those who know how, do it; those who know how, do the same.

[00:13:52]F is a volume, a quantity acquired that has a height and a diameter, okay? A small FOV looks like this. And I'll mention, for example, coffee, you know, that little cup of coffee, okay?

[00:14:11]a height. The smaller the FOV, the higher the resolution.

[00:14:17]Then I can see more detail. At this point, from 2012 onwards, we have high-resolution CT scanners, and endodontics is exploding not only in awareness but also in the use of tomography, although not yet as a preventive diagnostic tool.

[00:14:38]Endodontics involves extensive procedures to try and find cracks, fractures, and any suspicious signs that are completely invisible in 2D imaging. AND.

[00:14:50]And then they'll say, there must be a fracture, there's an injury here. Then we start exploding around here. Let me just show you what a large FOV is. FV is large, look, we're talking about a larger volume. Get the whole face, okay? So, the larger the volume purchased, the lower the resolution, okay?

[00:15:13]That's why we needed the equipment to come in a small FVE (fiber veneer) so we could see the endodontic details in this case.

[00:15:25]And that helped a lot too, right?

[00:15:29]It helps a lot. What primarily helps with foot problems is the technique using spandex. The patient uses spandex during the CT scan or a cotton roll inserted into the vestibule to retract the gums.

[00:15:46]Incredible investigative information. You've probably seen many times when biological spaces are invaded by veneers or restorations where the gum tissue, you see, is squashed by the excess, right?

[00:16:06]I hardly see a problem with facets anymore [laughs] I hardly see one.

[00:16:15]Hey, Claudinha, let's go. Let's go.

[00:16:19]Well, it's logical that I have an audience today that follows me, which is more geared towards restoration and all that. I have my own recommendations, my own uses, and I know where I'm using it, but I don't want to influence you.

[00:16:39]Imagine a professional today, let's say you're teaching a class for a specialization in restorative dentistry or prosthodontics, where will that professional gain if they start using tomography as an aid? Tell me.

[00:17:01]There are three main indications, I would say, for example, if a tooth is very damaged, right? Even though he hasn't had endodontic treatment yet, he has a small remaining tooth structure, and we need to evaluate not only the crown-to- root ratio, but also the implantation of that root in the bone and the phenotype in that region to adjust the entire process and actually achieve an aesthetic result within the biological framework of that tooth's implantation in the ridge, in the alveolus, and so on.

[00:17:44]The other is an indication, and often the endodontist performs the root canal, but this relationship depends a lot on the conversation between professionals, right? I see colleagues, you know, that we know, very, very good endodontists, who say that the one who has to prepare the canal for the post, you know, is the endodontist.

[00:18:13]It's the endodontist, I think so too.

[00:18:16]I think so too.

[00:18:17]I am unique. My dream is to train endodontists so that they understand the correct indication for an intraradicular retainer. The correct way to perform adhesive cementation of an intra-articular retainer. And from there I already received the tooth with a root canal, eh eh eh eh eh eh eh with a cemented post, because today in any more up-to-date endodontics, the endodontic treatment is considered finished when the restoration is positioned, whether it's a retainer or not, if you want to do a direct restoration, a block, a crown or a retainer. So, personally, I think that's what happens, but we know that's not what's going on. There's a crazy market reserve there, anyway.

[00:19:19]Well, and a lot of it is not felt, it's very redundant, it also doesn't feel confident enough to put the pin on it. He's not, he's not that up-to-date on adhesion, on, on, on, on cement and all that, but then we're stuck in this limbo, right?

[00:19:36]Because we have ultra- niche specialties, right? And that's where the endodontist works; the one who knows anatomy best, right, intraorally, is the endodontist, without a doubt. For that reason, he should be the one to prepare it. However, it may be that the endodontist is not up-to-date on adhesive systems, right, on the photopolymerization process with a photopolymerizer that has, right, the amount of energy that reaches that region and also what will be done afterwards.

[00:20:13]In fact, he needs to seal the canal and create space for you, the restorative dentist, to do your work. But we have this procedure, and I think we have a very significant loss, and the patient is the one who loses, because an endodontic treatment that isn't completed with immediate restoration ends up being wasted.

[00:20:34]Yes, perfect. But let's go back to tomography because otherwise we 'll start teaching about pins, and I already know my audience.

[00:20:45]Let's go back to the CT scan.

[00:20:46]No, but why am I talking about this, Barça?

[00:20:50]Because often the restorative dentist—and I'll consider the clinical and restorative dentist, I'm not talking about dental specialties, I'm talking about what they do in the clinic.

[00:21:03]Often, especially professionals like you, who already receive patients with issues that no one has resolved or more complex cases, receive patients for crown replacements, veneer replacements, for extensive rehabilitations on top of endodontic treatments done in the distant past or in the recent past, where they don't know the origin of that endodontic treatment.

[00:21:35]And what we see most often, and you'll probably agree with me, is a festival of unblocked conduits. Yes, very much so that if the general dentist doesn't have the tomography, he will do a technically very good job based on an imperfect diagnosis.

[00:21:59]And in my opinion, since we're talking frankly with Barça, you could be the best technically gifted player in the world. If you get the diagnosis wrong, you 're not a good dentist. It's not over. The diagnosis was wrong. He got everything that came after wrong. Claudio.

[00:22:16]He got everything that came after wrong.

[00:22:17]You were wrong. He made a wrong diagnosis.

[00:22:21]Everything that comes after that is wrong. That's wrong. This applies to any field. This applies to any field. I'm telling you that this world of tomography, I think it still has something, in my opinion, okay? There are still many dentists who think like this: "I'm not managing to sell the treatment, I'm not managing to close deals, right? Let's use their terminology, I'm not managing to close budgets, to prove budgets. It's difficult to get patients. Then the patient arrives in my chair and I don't have [the equipment]. And then I think, 'That's normal.'

[00:23:09]I don't even have a CT scanner here in our clinic, and that's fine. It's not necessary, of course. No, we don't have one. I think, well, if you want one, great, you can have one. I don't have one here.

[00:23:24]Oh, but then I'll send the patient for a CT scan. Well, well. R$250, R$300 for a scan. I'm not wrong, I am. It's an average, it's a reasonable average price at the time of this recording.

[00:23:44]Yes. Today, today, June 17, 2026.

[00:23:48][laughs] Eh, it's because it used to be more expensive. Yes, it used to be more expensive, it's getting cheaper, but for many dentists it remains so." I'm afraid to send the patient for a CT scan, and then the patient says, "Oh, I don't have that kind of money, it's too expensive," and so on. Then, sorry, dear. And you already know me, I'm like this. If you want to like me, fine. If you don't, learn to like me, because I'll still love you.

[00:24:22]Honey, a patient who doesn't have R$250 to pay for a CT scan, sorry, I don't want them in my office because they won't pay for my treatment.

[00:24:34]I want them. Oh, my patients with insurance.

[00:24:38]So, people, that's wrong. They're trying to get insurance. That's wrong. That's wrong. On Monday I was discussing this with the people in my mentorship program.

[00:24:47]An insurance company is paying R$27 for a posterior resin restoration. Are you kidding me? They don't pay anything anymore. Before I said they don't pay for the time, no. They don't pay anything. R$27 doesn't even cover any materials anymore.

[00:25:02]And you still have to pay tax on that. And what if you're a dentist working in a clinic where you earn a percentage on that? Value, God knows how much you're going to earn from that resin. So it's a joke.

[00:25:15]So, stop saying that I'm not going to send the patient for a CT scan because it's expensive. Stop that.

[00:25:23]It's the opposite. You're protecting yourself legally.

[00:25:27]Look, look. You're protecting yourself legally, you're putting together a much more precise diagnosis, and you're doing the opposite. You're showing your patient a different level of authority. No, look, I need this exam because I want to give you a correct diagnosis. That's the gist, or the old-timer is talking nonsense.

[00:25:53]You translated exactly the dentist's belief. The dentist, in fact, the dentist himself suffers from a still scarce mentality, and he thinks R$ 300 is expensive.

[00:26:07]So, the moment he thinks it's expensive, he thinks, look, if I ask the patient, he'll spend the money on the exam, it will be R$300 less for him to spend with me.

[00:26:20]And then, uh, it's a mistake, because we know that whoever takes a stand, it happens, and the issue of defense... The legal aspect, I'm going to tell you, is that it's about diagnosis, it's about 3D imaging, because it's about diagnosis, correct clinical decision-making, and professional defense.

[00:26:50]Of course.

[00:26:51]If he makes a mistake in the diagnosis, he makes a mistake going forward. If he makes a wrong clinical decision, he won't deliver what the patient needs. And if he doesn't have an exam that protects him legally, he's in trouble later on.

[00:27:11]The difficulty dentists have in requesting this is because, deep down, maybe they haven't seen certain cases, because their mistake won't stop with them, it will stop with you.

[00:27:26]Yes. Yes. So sometimes they don't see the rework, but the patient pays for that rework. And I created a metaphor, Bársa, to explain this to the dentist, which I think is an excellent metaphor to explain to the patient, for the dentist to explain to the patient, which is the 2D exam, the complete periapical. Pay attention, everyone, a complete periapical always includes bite. A complete periapical without bite is called an incomplete periapical, okay? Complete periapical [laughs]. He said it was the The point was, you said the conversation was straightforward.

[00:28:09]Yes. Yes, it really is.

[00:28:12]The complete periapical ultrasound and the panoramic x-ray function like a paper map.

[00:28:18]It's flat. You're seeing the terrain, you're seeing the streets, but you don't see what's inside the terrain. So what the dentist will explain to the patient is: "Look, up to this point I've asked you for exams that function like a map.

[00:28:36]From now on, I need the best strategy to carry out your treatment.

[00:28:42]For that, I need to turn on my GPS, because the GPS will show me the best route, it will show me where I have obstacles, it will show me the best strategy.

[00:28:55]Unlike what the dentist might think, ordering a CT scan isn't because he's technically unprofessional; quite the opposite, because I'm a good driver and every time I go somewhere, even on a route I know, I turn on the GPS because I want predictability, I want to know what time I'll arrive, I want to know the best route.

[00:29:19]Nowadays, GPS can even show you the most unsafe areas.

[00:29:25]So, if the dentist explains it to the patient like this, he'll say: "Look, up to this point I've used a map, from here on I need GPS.

[00:29:35]You, the patient, right?" The dentist interacting with the patient, would you go to a place you don't know, or even on a trip to a place you know, without turning on GPS?

[00:29:48]The patient will say no, because it's over, over, over, the objection, right?

[00:29:58]The objection is over.

[00:30:00]The patient is the one who will decide; they will say, "I want to go by GPS." It 's OK.

[00:30:06]Ready.

[00:30:08]Ready. But there are more obstacles along the way, right, Barça? The next obstacle is that he mustered the courage and requested the CT scan.

[00:30:16]The next obstacle is how to make a really good order.

[00:30:21]Hmm.

[00:30:22]Because the request, I compare it to the prompt we make in Intelp, in artificial intelligence it will generate a good result from the question we asked. However, if I give a generic prompt, the artificial intelligence will give me a more or less accurate answer, okay? It's the same thing with a request for an examination.

[00:30:47]When you place an order with the radiology clinic, just checking the little "x" on that form, your order is like a bad prompt. Your report, your diagnosis, will be generic, which makes perfect sense.

[00:31:05]And then the dentist loses another point of interaction with the clinic and gets stuck on the obstacle of not knowing how to place the order.

[00:31:17]The more details you provide, the better, right?

[00:31:20]What is your suspicion?

[00:31:22]What are you trying to imagine? What are you looking for? That's about right. That's about right.

[00:31:27]If you want it to be done, if you want it to be done or not to perform soft tissue retraction, that 's the question. That's about right.

[00:31:37]Come on, come on, come on, let's move forward a little further here. Come on, let's go further.

[00:31:43]I, I, I have three or four cases here that I want to discuss with you, but first I want to talk about something that fascinates me a lot, you know?

[00:31:53]These days, guys, you know, implant surgery without a guide, they do n't want to do it anymore. My wife, after discovering this guided surgery thing, doesn't want any other life for herself. I just said, "Wow, this is getting easier, isn't it?

[00:32:14]Endodontics can already be done with guidance.

[00:32:18]How difficult.

[00:32:22]Uh, one day, not long ago, I was watching Thiago Ottobone teaching how to do resin restorations with layer guidance. Layer guidance. So you have a guide to glue up to here, you're going to put the resin of such and such color. The resin. I said, "My God, periodontal surgery today is all with guidance."

[00:32:43]With guidance, right? The more aesthetic involvement, everything with guidance. So, and you can't do the guidance without tomography, right?

[00:32:53]No, that doesn't exist, right? It's not possible, Barça. I think guided surgery is incredible. I think it's supreme because it's even more predictable. And for those who think there's no work involved, the work is before, it's in the prior planning.

[00:33:10]The work is done without the patient, it's in the software with all the information, running here and there, measuring, merging with the STL of the scan.

[00:33:20]So there's a lot The work is done beforehand so that the surgical moment is very simple and predictable.

[00:33:30]But guided surgery is for those who are already at the highest level, not only in three-dimensional diagnosis with tomography, but also in digital dentistry. My purpose, Barça, is to talk about tomography for everyone.

[00:33:51]My purpose is that the everyday clinical dentist, when faced with clinical information and radiographic information that don't match, as if a piece of the puzzle is missing, that information is missing at this moment, the real dentist, from any neighborhood, any city, any service, should raise their hand and say to the patient: "Up to this point I've been using a map, now from here on I'll only use GPS."

[00:34:29]So, without fear, without fear, without fear, without fear. Do you know why? Let's draw a parallel. Come on, come on, come on. I'll bring it for myself. I go to a doctor because I have a health problem, and there's a medical exam that will show my problem to the doctor in three dimensions.

[00:34:51]This doctor didn't order that test for me.

[00:34:55]Maybe it's because that day I looked poor, my hair was a mess, and I was wearing a really ugly blouse. He said: "Look, I'm not even going to order that exam for Claudia because she's not going to do it.

[00:35:09]The doctor doesn't have the right to do that to me.

[00:35:14]Just like the dentist doesn't have the right to do that to the patient. He has to know that the exam exists and he's going to order it. The decision to do the exam or not is the patient's and the dentist's position. If this patient comes without the exam, that's what has to be correct.

[00:35:34]Yesterday I was giving an in-person class and I said: 'Try to imagine this scene.'" "I'm going to have knee surgery, I'm going to the orthopedist, the orthopedist orders an MRI of my knee, and on the day of admission I arrive there for the surgery." The doctor says, "Give me the exams." Then I'll say, "Oh, I didn't do them."

[00:35:54]He'll say, "Then there's no surgery."

[00:35:59]And there really isn't.

[00:36:01]And why does the dentist allow it? It's a matter of positioning, it's a matter of mentality.

[00:36:08]Yes. I agree. I agree. You're absolutely right. But that's what I'm discussing most in this straightforward conversation. It's dentistry. As long as dentists don't change their own mindset, dentistry will remain exactly as it is.

[00:36:25]The change has to start here. That's very clear to me. There's a question I'm going to put on the screen that Taiana sent when we were still in that discussion about large, small, and so on, right? Then she asked if there's still an indication for it within dentistry.

[00:36:45]I think not, right? There is. So tell me.

[00:36:50]There is a large FOV, it This will be for orthognathic surgery, for planning, right, maxillofacial surgery, the whole process. And today, more and more, and I hope so, okay? I'm also going to advocate for this with invisible aligners. When you acquire aligners, look, it's like this, because it has to cover from the glabella to the sternocleidomastoid process. Look there. This is the scan. This is the scan that you put into the planning software to fuse with STL and create a real three-dimensional plan for the invisible aligners. Because when we move the crown in the aligner planning, you're not seeing what's happening with the root. And then, as PV says, in the case of gingival recession, the teeth, the dental roots are being pushed out of the alveolar ridge. If there's no bone, the gum won't stay, there will be gingival recession.

[00:38:06]Yes, looking at it this way, really, the way they're using aligners, without doing much, right? Because without even doing much... X-rays sometimes, okay?

[00:38:20]Yeah, it's going down a dangerous path. The aligner business is going down a dangerous path, but I don't want to pick another fight.

[00:38:28]I've already picked enough fights. I'll pass on this one, I'll leave this one for you to fight. I'll leave this one for you to fight. Actually, I don't want to fight. I want to educate these people, because what's going to happen in the orthodontics market, with aligners, is going to be a festival of rework, and the patient is the one who pays the price.

[00:38:55]Okay, okay.

[00:38:59]Oh, oh, oh, oh, Claudia, if I get into this, if I get into this line of talking about dentistry, about changing mindsets and everything else, then I don't even discuss anymore, how do you say it?

[00:39:12]I don't even discuss tomography with you anymore. We're going to go down another path, and I want to take some of your experience in some situations that I'm going to tell you. I'll present it here. I'll project it first, while I'm opening my files here, do me a favor and leave it recorded, while I open the files here to leave it recorded for everyone, tell me who wants to follow Cláudia Coscarelli today, who wants to have a little more contact with Cláudia Coscarelli, who wants to take a digital course, a face-to-face course. Give me an overview while I'm opening the files, give people an overview of where they can find you. Mateus, you can even take me off the screen and project the QR code of her community so that while she speaks, the community is already open. Do me that favor. But I 'm here, I'm listening, okay? Folks, while Barça finds the case we're going to talk about, it's an invitation on the screen for you, a free community on WhatsApp, Tips and Tricks on 3D Onto. I even put the invitation there today, right, for people to come here and so much other content. What we talk about there are real-life, everyday cases where tomography has completely changed the game.

[00:40:49]Besides that, I'm on Instagram @cláudia.coscarelli, on TikTok with the same username @cláudia.coscarelli, here on YouTube, Cláudia Coscarelli, 3D dentist, on LinkedIn, and all the other networks to talk about this shift in mindset from 2D to 3D. I know it's difficult because I, like Barça, didn't learn tomography in college. I can't say it's a recent exam, because I've been talking about tomography for 25 years and I graduated this year. It's not a new exam, but it's an exam that many people still haven't learned. And what I'd like to leave you with is that if we make a mistake in the diagnosis, you're making absolutely every mistake going forward.

[00:41:50]Not making mistakes in what you're doing will be pure luck.

[00:41:55]Some of the cases that Barça will be projecting are cases where there was a need for restoration, for rehabilitation on top of teeth.

[00:42:04]Endodontically treated patients who lacked the periodontal and periapical health necessary for any type of treatment. And so I wanted you to reflect on whether, if I'm not making a complete and correct diagnosis, I'm a good dentist. And so, folks, I'm not. I know this is blunt, but I don't mean to be rude to you. But if we draw a parallel to when we go to a doctor, if the doctor gets our diagnosis wrong, they've got everything wrong. The person sitting in your chair is someone's loved one. The person sitting in your chair is someone who has no idea if you can do a beautiful resin restoration, a ceramic laminate, or a veneer, because they trusted your diagnosis. They didn't trust your hand, because technically the patient isn't able to evaluate us technically; they can't see that. And that's why we have to explain to the patient what makes them agree to the treatment, as Barça said, or understand the proposed treatment you're making—it's them understanding what they have.

[00:43:29]And nothing... Better than a clinical exam, the anamnesis you do with this combination of imaging exams. And Barça, I believe what you said, the 2D exam is the first step, but there's a next one. Yes.

[00:43:47]And the next step is to complement what the 2D doesn't show. And complementing what the 2D doesn't show, we have the 3D, okay? Ana Cristina. Ana Cristina, so come with me, right? I also have a paid community, which is a course, a recorded course within the community, where you'll find all the concepts of tomography and a year of follow-up with me.

[00:44:14]This year of follow-up allows you to ask questions, learn how to use the software, and go through this whole process of becoming literate in tomography. I'm sure, Ana Cristina, that you and other dentists feel illiterate when it comes to 3D exams. And my purpose, and what makes my eyes light up, is exactly to teach you all.

[00:44:39]Look here, let me show you just one more.

[00:44:43]See if you recognize this, see if you recognize this mass.

[00:44:46]Ah, who Is this the girl?

[00:44:49][laughs] Adriana, bye, darling. Here. Pay attention. Let's go. I'm going to take her thing off now, Mateus, and put mine on the stage.

[00:45:01]Uh-huh.

[00:45:02]Do me a favor.

[00:45:03]Switch it, okay?

[00:45:06]Just go to the other one.

[00:45:09]Hey, Massa, you know what I wanted you to tell me?

[00:45:12]Where was your turning point in dentistry?

[00:45:17]Since many dentists say: "I did n't learn it in college, neither you nor I."

[00:45:26]I've been using tomography for so long that I don't even remember anymore. I really don't remember anymore. I'll tell you that it increased a lot as more and more cases of poorly done veneers started coming into my life, you know? So, that's when things exploded. So today it's basic. It's basic in my life. And it's difficult for me to get a case where, and it's like this, just sharing this with everyone, this is the periapical, right?

[00:46:06]Then you look at the periapical. Of course, when we look Okay, so I'll zoom in for everyone. When you look at, for example, this region here, uh, 14, 15, it's obvious that the absence of obturation material catches your attention. It's obvious that this patient needed a rework.

[00:46:34]The problem, can I give you some data? Can I give you some data from the literature?

[00:46:39]The literature says that we can only see a periapical lesion in the periapical examination if we already have 30 to 50% bone destruction or the loss of one of the cortical bones.

[00:46:53]That's crazy.

[00:46:54]This means, the literature also tells us in another article that 50% of existing periapical lesions are not visible in the 2D examination.

[00:47:06]In other words, if you're not careful, there's a lesion here and the periapical isn't showing it. At 15 you can't see it. At 15 you can't see it.

[00:47:13]Exactly.

[00:47:16]Now, this means that the dentist is 50% worse than he thinks he is. He's not seeing it now. Now, now pay attention.

[00:47:28]Pay attention. I'm going to close the periapical scan here and open the CT scan of this same patient.

[00:47:40]Where's 17? Look here. Remember 15, right? And 14. Look here now. There.

[00:47:50]Here.

[00:47:52]Zoom in on this image for us.

[00:47:53]That's it. Look there.

[00:47:56]It's 15, folks. Look there, with the material below the apex [clearing throat] with a lesion. It's gone. It's already gone. This is a huge periapical lesion.

[00:48:09]Here.

[00:48:09]The arrow in the drawing is right on top.

[00:48:12]Now look at 14.

[00:48:13]It's on top. It's on top. Arrow. Now look at this.

[00:48:16]Now I can be mean.

[00:48:22]Can I be mean? Because we end up focusing our vision here. Wait, look, look at 15. You're going to focus your vision here, right? Because the periapical scan had already shown this problem. Look at the amount of excess of this "What a mess here! Look, exactly.

[00:48:42]Look, look at the size of the excess tooth in this mess here.

[00:48:52]Just compare the vestibular with the palatal, for those who can't see it. Look at the palatal contour and look at the vestibular contour.

[00:49:00]Palatal, look at the vestibular. The image, the tooth is here. Look at all the excess, people. This much excess. So, this is just an example for you of a situation where tomography helped me. For example, look here. Look.

[00:49:21]This needs it. Look here, here, look there. Poor thing. Look at the gum.

[00:49:26]Where is it, people? Biological space there. It's gone.

[00:49:34]I'm going to bring another situation, Cláudio.

[00:49:37]I'm going to bring another situation. This here.

[00:49:40]I'm leaving this cream of the cream here for the end. Look here, people.

[00:49:49]This is a joke.

[00:49:52]This is a joke.

[00:49:54]Think about the endodontist now to work on this. An endodontist who plays around.

[00:50:03]Now, how are you going to..." "Doing a rehabilitation and you're not going to have this image here to help you?

[00:50:14]Here are all the measurements, everything you need, it's not a whim.

[00:50:21]You can speak.

[00:50:22]And so, Barça, what I think is this, we value good dentistry, which is a good dentist, but if you continue doing dentistry like the colleague who did n't do this root canal, it's the same thing.

[00:50:38]Yes, yes. I have no doubt. Look here, look. Oh, Claudia, look, look at this case.

[00:50:45]Panoramic.

[00:50:47]Panoramic.

[00:50:50]Panoramic. It draws attention here. Tooth 11.

[00:50:55]Significant bone loss, right?

[00:50:58]Significant bone loss.

[00:51:00][clearing throat] 12. 12. 12, 12, 12 has an incredible case where the root ends here, look.

[00:51:07]Look, the root, the root is just this here, look. It ends here. But what I want, what I want to discuss is this. If I have periapical, if..." I'm looking at the panoramic x-ray, and at most I would see a problem in teeth 11 and 12. Do you agree with me?

[00:51:22]Exactly.

[00:51:24]At most. At most.

[00:51:26]Let's close this up.

[00:51:29]Look at teeth 11 and 12 of this patient.

[00:51:35]Where are they?

[00:51:37]Look.

[00:51:38]Tooth 21.

[00:51:39]Yes. I wanted to get to this point, look. We had already seen teeth 11 and 12 there.

[00:51:43]Problem here, look. 21. Look at this.

[00:51:47]21. Look, everyone. Look at this.

[00:51:51]Look at the periapical lesion in tooth 21.

[00:51:56]Oh, to do a veneer, damn it.

[00:52:00][laughs] Look at tooth 22. Look at the facet of [snoring] Oh Cláudio, this is a crime.

[00:52:10]The person who does a veneer and leaves this step, this here, this looks like a gym step where we're going to do the step exercise, I don't know, look at the size of this. You're a criminal, the person who does this. The worst part is, you couldn't see it in the panoramic x-ray.

[00:52:29]No It's possible to do this here. I'm corroborating what you're saying. CT scans aren't a luxury anymore. CT scans will help you.

[00:52:41]Going back to image 21, there was no lesion on the panoramic x-ray, and here it is.

[00:52:49]Just like the article I mentioned.

[00:52:51]It's here. Here. Here. Look at the size of the lesion.

[00:52:57]The next step is rupturing this cortex and having a fistula, right? So you didn't do the panoramic x-ray, the CT scan, you only made your diagnosis based on the panoramic x-ray.

[00:53:08]Eventually, you discovered there's a little step here, you're going to replace the facet. You're going to mess around. I'm going to replace this, I'm going to replace it. And here's the... and the... and the bomb exploding down here, look. And the bomb... And what's worse? The bomb is exploding down here. When it explodes, it's your fault, because you're the one who did this new work.

[00:53:29]You're the one who did this new work. The bomb was already here, baby. You just didn't see it.

[00:53:35]You just didn't see it.

[00:53:37]But then you intervened. You didn't... This thing exploded after you did it. This work on my mouth. Look, a process in my head to stop being silly. To stop being silly.

[00:53:47]Doctor, after you did this veneer again, a little bump appeared here, doctor. Look, a little bump here.

[00:53:55]Now, Claudia, this here for me today, I don't know if you agree with me, there are many dentists who take this image from the tomography, they even show it to the patient, so the patient has an idea, so they have an idea of ​​what it is, right? Ah, you see here, look, there's a little hole, look.

[00:54:16]There's a little hole. Your root is even showing here, look. Your root here, look.

[00:54:22]This is a little lesion, right? Let's see what we're going to do about it. Then he shows here, look, the image, right, the image, a transparency, a transparency. Okay, folks, pay attention. If you want, I can share this prompt with everyone later, right? This here, you take this image of... To scan a CT scan, use a prompt in the GPT chat and it will create this for you with the CT scan image.

[00:55:00]This shows everything you see here: perap lesion, everything written here, see: root, middle, vestibular, 46, lesion, inferior alveolar nerve. All of this here. It even makes mistakes, see? It put 44, 45 here, see? It makes mistakes, the chat makes mistakes. Now, my friend, with this you can finalize the treatment plan you want, because the patient will see an image like this. They don't want this in their mouth anymore, they want you to solve this problem no matter what. So here's another functionality of the CT scan: it generates a file that you can take to the GPT chat and the GPT chat will create this for you, so you can discuss and sell your treatment plan. If after this your patient really doesn't want to do the treatment, I don't know what else will convince them, because this is transformative for me.

[00:56:04]Here we use it every day when we have to deal with a more complicated case, when we have to explain it to the patient. We use this today; the prompt is already ready here at the clinic. So it's another functionality that I see today, right, tomography helping us. I don't know, I don't know if, let me, let me take myself out of here.

[00:56:27]Take it out, removed it, I removed myself.

[00:56:30]But the realistic image is incredible; it's extremely didactic in showing the patient what they have difficulty seeing in a technical exam, okay? I'm just going to make a point regarding the realistic image. The diagnosis isn't given in the real image.

[00:56:54]I know you don't say "recorded here" for the people watching us. The diagnosis is made through the slices.

[00:57:02]This [clearing throat] goes through the slices, through the images. And the realistic image generated by AI is a communication and illustration image so that the patient understands the size and reality of the disease they have.

[00:57:28]That's it, that's it, that's it. [snoring] It's more realistic, it's communication, it's sales, it's presenting treatment, facilitating the exchange between you and The patient, the diagnosis, the planning, everything's perfect in the tomographic slices, just right, pretty, as it should be. Fantastic.

[00:57:48]Exactly. Exactly. Perfect.

[00:57:50]Very. Am I going down the wrong path or do I have a future? You're so modern.

[00:57:57][laughs] Up to date with the latest trend in three-dimensional diagnosis.

[00:58:03]That's it, my daughter. Now the man is a YouTuber and a specialist in childcare. What's that? Take care of him.

[00:58:12]Get out of the way, I'm coming through.

[00:58:15]Claudinha, my love, I'm so happy. So good.

[00:58:19]I talked to you. You were worried.

[00:58:22]Oh, do we have anything to talk about? I said, we do. There's not enough time, son. There's enough to talk about for more than an hour, it passes by so quickly we don't even notice.

[00:58:32]But, look, I'm so happy. I think we are... and... it's a lesson to open our minds, it's a lesson to change... the way we act, the way we think.

[00:58:49]Oh, I want to learn how to do it. Then you go there, you follow the... Claudia, you join her community. We've already put the link here. If you're watching the recording, it's open, so turn on what you haven't seen yet, go there, right? Get the QR code, get it here, go there and follow Claudia. Then you'll learn how to do it, how not to do it, and so on. Pi pi pi pi pi pá, right? Barça will continue with his summaries, which is already a lot for me to argue about, right? It's already a lot for me to keep picking fights. If I were to, but I'm itching to talk about this aligner thing, you have no idea. But never mind, there are good people to do that. I think veneers are already giving me a lot of work.

[00:59:46]But surely you'll also get it, right? What isn't a criticism, but there are many people who aren't orthodontists doing small movements. It's all good if the diagnosis is well done.

[01:00:04]Yes, yes. Diagnosis. Once again, Small movements generate less damage than large movements. But where is the diagnosis?

[01:00:18]Perfect. Perfect. It started wrong.

[01:00:23]Go on, go on. You're just going to get everything wrong from now on. You're going to get everything wrong.

[01:00:27]Just go on.

[01:00:28]Honey, honey, how can I thank you?

[01:00:31]Where do I send the Pix payment? Tell me.

[01:00:34]Tell me so I can send it here. Thank you for your... I'm at your disposal, okay? For whatever you need for your community, for whatever you need, count on me.

[01:00:46]I'm going to invite you to give a technical lesson, not this chat format. I'm going to invite you to give a technical lesson to the Newera people. Are you in? It has to be on a Monday night. Fit it into your schedule.

[01:01:00]Monday night? Fit it in, fit it in.

[01:01:03]Then we'll give a technical lesson. Then you take a PowerPoint, the screen is yours and you can do your thing.

[01:01:12]Okay.

[01:01:13]There, look. Helio, Helio, look at Helio.

[01:01:15]Helio, want to see? I'll put it here, Oh.

[01:01:17]Oh, Hélio from New already gave it a thumbs up here because he already felt it was worth it, that it's worthwhile, right? And, and, and, and, and, oh, and then it's going to help here, look, Ana Cristina is also there, look. Look, what did she add? She started to brighten what was totally dark. Okay, I'm going to call you to give this class for us, Claudinha. I think it's going to be great. And then the New Era team is only going to grow more and more, okay? Oh, thank you. God bless you.

[01:01:49]Thank you. Thank you for everything. Thank you for everything. Guys, you who are watching this live video now, for the love of God, you haven't given it a thumbs up yet, you haven't given it a like here. Give it a like, give it a like, for the love of God, so the YouTube algorithm will deliver this video to more people.

[01:02:09]You who are watching the recorded video too, go ahead. Here, give it a like. You watched, you liked it, share the link to our class with other people. Free and quality information. Dentist helping dentist. That's what the chat with Barça is for. Cool.

[01:02:29]And to finish, #pediat omo.

[01:02:33]Pediatom. There's still some, oh, there's still some, there's still some #pediatom. I liked this one.

[01:02:39]Awesome, my loves. Tomorrow is Thursday and Friday, oh. Tomorrow is Thursday.

[01:02:44]Thursday and Friday are for answering open questions. I'm waiting for everyone's participation. May God be with you.

[01:02:53]Big kiss.