Every dentist eventually encounters the word DICOM. First it's an abbreviation on a flash drive with a CBCT scan from the diagnostic center. Then — a folder with thousands of files that refuses to open in any regular program. Then — turning away a patient because "I don't have software for those files". Let's break down what DICOM actually is and why it's worth getting comfortable with as a dentist.
What is DICOM
DICOM stands for Digital Imaging and Communications in Medicine. The standard was developed in the 1980s for exchanging medical images between equipment from different manufacturers.
The main thing to understand: DICOM isn't an image. It's a **container**. Inside is the image itself (or a series of slice images), plus metadata: patient name, date of birth, study date, machine model, acquisition parameters, voxel size, and much more. A single DICOM file can contain either one image or hundreds of slices from one study.
Where DICOM comes from in dentistry
The main source for a dentist is Cone Beam Computed Tomography (CBCT). When you send a patient for a 3D jaw scan, the diagnostic center delivers the result in DICOM format. Usually this is a folder with 200-600 files with the .dcm extension, plus a DICOMDIR file (the index).
DICOM also includes: panoramic images from digital machines, cephalometric images, periapical X-rays from modern digital sensors. Old film X-rays don't exist as DICOM unless they've been digitized.
What's inside a CBCT study folder
Typical folder structure from a diagnostic center: a main folder with a cryptic name (often a patient ID or date), inside either all files dumped together, or subfolders IMAGES, DICOM, STUDY. Files may have .dcm extension, no extension at all, or numeric names like IM0001, IM0002 and so on.
Each file is one slice of the study. Slices come at intervals of typically 0.15-0.4 mm. A complete jaw study contains 300-600 slices, giving data volumes from 80 to 500 MB. Viewing slices one image at a time is meaningless — you need software that combines them into a three-dimensional volume.
DICOM viewers for dentistry
OnDemand3D — a powerful universal viewer from Cybermed. Works with DICOM from any CBCT manufacturer. Handles volume reconstruction, multi-planar reformatting, measurements. Has a Lite version and a paid Pro.
Sante DICOM Viewer Pro — European developer from Greece. Very detailed metadata handling, intuitive interface, PACS support. Used in radiology centers. Paid.
Inobitec DICOM Viewer — Russian development. Full dental functionality plus a PACS server version.
eFilm Workstation — classic American product from Merge Healthcare. Strong on stable handling of large datasets.
Sidexis 4 — proprietary software from Sirona/Dentsply for their own Orthophos and Galileos CBCT machines. If you have a Sirona unit — this is the right choice.
On Mac there's Horos — a fork of paid OsiriX, free for non-commercial use.
DICOM-based implant planning software
Viewing is one thing, actual implant planning is another. For virtual implant placement and creating surgical guides, you need specialized programs:
coDiagnostiX — Straumann's flagship. Premium solution, used in major clinics.
RealGUIDE — program from Italian 3DIEMME. Good balance of price and functionality.
Blue Sky Plan — program from Blue Sky Bio. Simple, intuitive, widely used.
Nobel Clinician — proprietary software from Nobel Biocare for their NobelGuide implant system.
All these programs import the DICOM study, overlay an STL scan of teeth from an intraoral scanner on top, and allow virtual implant placement in the desired position. Output is an STL file of the surgical guide for 3D printing.
DICOM to STL conversion
Sometimes you need to turn a CBCT study into a three-dimensional polygon model — for example, to print on a 3D printer, use in a CAD system, or show to a patient. This process is called **segmentation**.
In implant planning programs (coDiagnostiX, RealGUIDE, Blue Sky Plan) segmentation is built in and happens automatically. In universal viewers (OnDemand3D, Sante) it's also available but requires manual threshold configuration.
A powerful free tool — 3D Slicer with the SlicerDental extension. Professional — Materialise Mimics. Simple for quick tasks — InVesalius.
Typical DICOM problems
"DICOM won't open" — usually the problem is that you're opening a single file instead of the whole folder. The program should import the entire series of slices in one operation: File → Open Folder → select the folder, not an individual file.
"Program asks for a license" — Lite versions of many programs have limits on number of patients per month or functionality. If you've hit a limit — you need the full version.
"Gray mush instead of bones" — wrong windowing settings (contrast and brightness for CT). Need the "Bone" preset or manual setting Window Width around 2500 and Window Center around 400.
"Can't find DICOMDIR" — the DICOMDIR index file is sometimes missing from certain centers. Most modern programs work without it — you need to import the entire folder directly.
Security and privacy
DICOM contains **complete personal patient data**: name, date of birth, sometimes address. This is medical privacy. When forwarding files to colleagues, for consultation, or to a dental lab — always anonymize the files. All professional DICOM viewers have an anonymize function: replaces the name with neutral "Anonymous", zeroes out the date of birth, removes identifiers.
In most countries, transferring non-anonymized DICOM files without patient consent violates personal data protection laws (GDPR in Europe, HIPAA in the USA).
Installing and configuring DICOM software
Installing a viewer like OnDemand3D is relatively simple. Installing an implant planning program (coDiagnostiX, RealGUIDE) is more complex: licensing, activating implant libraries separately for each brand (Straumann, Nobel, Astra, MegaGen, etc.), configuring surgical guide export to 3D printer.
We install all dental DICOM software remotely in 60-90 minutes. We connect the implant libraries you need, verify import of your CBCT data, configure surgical guide export. Message us on Telegram @keys_helper or WhatsApp — we'll install in under an hour.
More on which programs you need at each stage of digital workflow — article «Dental 3D printing: which software at each stage». On the remote installation process — article «How remote installation works».
