Cone Beam CT for Implant Dentistry

Michael Tischler, DDS
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When you look at the many safety and planning advantages a CBCT scan offers—combined with its accessibility either through purchased equipment, mobile units, or local scan centers—it only makes sense to have a CBCT scan involved when treatment planning an implant and/or a bone graft.

This month’s Implants Today topic is cone beam CT for implant dentistry. CBCT technology has infiltrated many aspects of dentistry and implant dentistry. It can provide an invaluable source of data that allows clinicians a 3-D view of the jaws, with the ability to focus in on areas of concern in great detail to make the treatment-planning process easier and more accurate. There is a mixed consensus on whether a CBCT scan is the standard of care for implant treatment and bone grafting. In my opinion, it is! When you look at the many safety and planning advantages a CBCT scan offers—combined with its accessibility either through purchased equipment, mobile units, or local scan centers—it only makes sense to have a CBCT scan involved when treatment planning an implant and/or a bone graft. Furthermore, if our goal as clinicians is putting the patient’s safety and well-being first, then the extra cost of having a CBCT scan done is not a legitimate excuse not to have one. Would a general surgeon in medicine operate without an available MRI or CT scan?

When doing implants, CBCT scan information can offer many advantages to a clinician. In my practice, I rarely do guided surgery since I visually use the CBCT information, combined with the patient’s osseous anatomy, to place implants without a guide. The same CBCT information that I use for non-guided surgery can be used to create a guide for both tooth-borne and full-arch implant surgery. From a technological standpoint, it goes even further than that; for example, when the final prosthetic plan and guide is created, derived from a combination of a facial image and a CBCT scan. With that CBCT data, provisionals and other prosthetics can be created, and titanium housings can be milled. Currently, a few companies now have this combined digital technological workflow available. While this sounds great—and is great—there are some considerations to ponder with this highly digital route. In my opinion, the most important consideration is that the treating surgeon must have the skills to perform the procedure without relying on the guide. There are times that the guide may not fit for various reasons. An analogy for this can be found in the aviation industry. Before a pilot can fly with the autopilot, he/she must be able to manually fly the aircraft.

This month, Implants Today Advisory Board Member Dr. Justin Moody discusses the factors involved with starting and running an implant practice. In our cover-featured article, Dr. Todd Schoenbaum presents a scientific approach to the challenge of restoring implants in the aesthetic zone. And Dr. Eduardo Anitua presents a peer-reviewed CE article about a 9-year follow up on clinical successes using short implants.

If you have any questions or comments about this topic, or any other subject presented in Implants Today, feel free to contact Dr. Tischler at mt@tischlerdental.com.

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