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May 2009 | Dental Products Report
Clinical 360°: technology

Imaging the ideal implant

3D cone beam technology and imaging software bring new levels of accuracy and speed to planning implant procedures.

by Dr. Bill Busch

Photo courtesy of: E-Woo Technologies

 

The set-up

"After adding a cone beam unit to my office, I now see nuances and details I have never seen before. The images and software allow the ‘doctoring’ to be in the treatment planning. Using the technology lets you see everything you need to see before starting a case. Read Bill Busch’s article and get the ‘big picture’ on the ‘new picture’ we should all be using".”
—Dr. John Flucke, Team lead

Cone beam/3D imaging or CBCT, which stands for cone beam computerized tomography, has taken a mighty step forward in allowing general dentists and oral surgeons to completely and thoroughly plan predictable implant placements.

The rapid development of the software that transforms digital information captured by the CBCT machine to create an almost lifelike rendition of the patient’s anatomy in literally 1-2 minutes is driving the advancement of these systems. Cone beam technology is like having GPS for your surgical placement procedures. It tells you exactly where to go. You could perform these procedures without it, but you get faster and more predictable outcomes with it.

A versatile guide
I don’t think I could live without my GPS in my car, especially when I’m on the road in unfamiliar territory. You perform better as a driver when you know where you are going at all times. The same is true as a surgeon. It used to be a luxury to have this in your office. Now it is almost a necessity. With advancements in the software and hardware, it is easy for anyone who knows how to use a computer to learn to use CBCT technology, and the advantages of using it are noticeable immediately.

There are many uses for CBCT including orthodontics, endodontics, oral surgery, implant placement, diagnosis of oral pathology, periodontics, plastic surgery and TMJ surgery. When combined with CAD/CAM technology, a CBCT can be useful in creating orthodontic aligners, surgical stents and appliances. But while the range of uses is broad, for this article I will focus on the software used to help place predictable implants.

Enhanced software
When you buy a CBCT machine, it comes with its own software that allows you to view the patient’s digital image and manipulate it by performing functions like zooming in on specific areas, cropping the image to isolate a portion of the scan, or rotating the image for different views. The software also may have simple implant placement treatment planning functions built in. However, the CBCT data also can be sent to an external software application with even more robust treatment planning capabilities.

These programs include Nobel Biocare’s NobleGuide™, Dolphin Imaging’s Dolphin 3D, Materialise Dental’s SimPlant and Keystone Dental’s EasyGuide™.

These programs read the data from the CBCT in DICOM (Digital Imaging and Communications in Medicine) format and then create renderings of the object.

From this digital picture doctors can see the exact amount and quality of bone to guide them to the ideal implant placement. Prior to CBCT technology, the question of when and if to place a bone graft was always the most difficult part of implant placement procedures for me. Now the software can answer this question with confidence.

The process

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Implant options

Whether you are planning a single or a multiple implant case, the process always begins with great patient communication and effective treatment planning. Patient education software can be useful when explaining an overview of the proposed treatment. Even when using the latest technology to plan and explain a procedure it is critical to make sure you have a thorough dental-medical history because underlying patient conditions can make or break an implant case and can’t be understated.

After the patient and I have established the choice of a single implant or multiple implants, I create an initial treatment plan using 2D imaging with a digital panorex machine such as the Orthoralix 8500 from Gendex or simply digital periapicals from my DEXIS sensors. DEXIS has wonderful implant software built into its imaging suite.

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