Really, only a dentist to whom you went to for a second opinion would be able to answer this question.

From the patient's view, we get that some services that are performed often seem just to be profit centers, or utilized just to help to pay for expensive equipment that has been purchased.

At the same time, the dentist no doubt wants everything about the procedure to be successful (and clearly 3D imaging does provide a higher level of information). And legally they are obligated to practice dentistry at the same level as other practitioners (so if most dentists would have used cone beam imaging for your case and your dentist didn't and a complication arose ...).

Per our AAOMR references above, theoretically it's expected that a dentist will initially evaluate their patient using more conventional types of radiographic exam (panoramic x-ray) and then make a decision for 3D imaging based on that.

It seems reasonable that a dentist would share with their patient what they see on that x-ray that suggests that CBCT imaging is indicated. (While we didn't mention and as you seem to suspect, yes many implants are placed without the assistance of CBCT radiography.)

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