Posted by in Blog, Featured Articles | 5 comments

I believe Cone Beam-CT technology and treatment planning software have the greatest potential for helping doctors avoid or reduce the frequency of implant complications. Our in office I-Cat cone beam CT (Imaging Sciences International) scanner allows us to evaluate the patient’s anatomy in 3D and accurately identify the location and course of vital structures such as the inferior alveolar nerve. In addition, dental pathology not seen on plain films occasionally becomes readily apparent with this technology.

When combined with a scan guide derived from a diagnostic wax up that duplicates the proposed final implant restoration, we are able to perform 3D treatment planning as we evaluate all of the restorative and surgical information on the screen. We can then convert the scan guide into a conventional surgical guide to prepare our sites for implant placement or to guide our 3D hard tissue site development procedures.

The 3D diagnostics provides greater information, allowing us to make better treatment planning and intra-operative decisions. Taking it a step further, we can order a computer generated surgical guide that incorporates a master cylinder and drill sleeves to allow precise 3D osteotomy preparation or even guided implant placement.

As with any technology, there is a learning curve and nuances which must be understood in order to avoid complications related to the technology itself. Some examples include misinterpretation of CT data or misfit or movement of a guide during surgery which can lead to irreversible complications. The bottom line for doctors is to make a commitment to learn all that they can about the technology and apply it at an entry level before proceeding into advanced applications such as guided surgery.

One of this blog’s readers, Dr. Charles L. Ross, recently asked me, “Do your recommend cone bean CT scans to be routine for most if not all implant therapy procedures?” The concise answer is that we recommend a diagnostic Cone Beam CT dental scan for the majority, but not all, of the patients that we see for implant consultation in our practice, as the majority of these patients present with advanced and complex case scenarios.

I would estimate that 65% of the patients require a 3D anatomical evaluation for implant planning due to complex anatomy related to vital structures or for pre-surgical evaluation when alveolar ridge or sinus lift bone grafting is indicated. Of the remaining 35%, standard dental radiographs are all that are required as they may have presented to our office with a very straight forward case with little risk for damage to vital structures or they may have already had a scan performed by their dentist or another dental specialist.

Many of these cases are previous patients who present for implant consultation for a new site due to impending loss of another tooth. When these patients already have a scan on file, we are able to use this scan to evaluate the anatomy at the site in question, thereby avoiding the need for a follow up scan.

All of the scans taken in our practice are sent to a maxillofacial radiologist for a comprehensive evaluation and report. 

NOTE: We’ve just announced the dates for a one-day seminar that focuses on Avoiding and Managing Dental Implant Complication. We’ll be taking the seminar to four cities in the eastern U.S. For more information, click here.

 

5 Comments

  1. July 31, 2012

    Excellent

  2. August 1, 2012

    Excellent post.
    I would like to emphasize the importance of having all CB-CT images evaluated and reported by a maxillofacial radiologist. It is Dr responsibility to diagnose pathology in the entire image area and not only the area we are familiar with.

  3. August 4, 2012

    Dr. Sclar great blog, I agree with your comment about the reading and understanding of your CBCT scans. Ideally, interactive treatment planning of cases is recommneded as well, it will give a global view and understanding of the cases even if a surgical guide is not fabricated. Patients love to understand the process and this is a great tool for it.

  4. August 15, 2012

    I think it is also interesting to report that ADA just released new guidelines on the use of CBCT technology.
    Available free of charge @ http://jada.ada.org/content/143/8/899.full.pdf+html

  5. June 13, 2013

    This type of technology helps dentist to diagnose the critical anatomical features of teeth or teeth roots. It helps implant dentist a lot. With the help of this technology implant dentist can get periodontal status much sooner. Dentist can work out on dental implants treatment planning before Implant surgery too.

Leave a Comment

Your email address will not be published. Required fields are marked *

*

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>