With over 40 years of clinical development, dental implants have clearly been positioned as the treatment of choice today for the replacement of missing teeth. Successful results can be predictable with careful analysis of the anatomy of the region, and appropriate planning. New technology has made dental implant therapy safer and more predictable than ever before. The most dramatic example is the use of three-dimensional imaging in the planning of individual patient cases.
We have utilized computerized tomography (CT Scans) for our patients over the past 12 years. For the appropriate cases, we would have local hospitals and radiologists provide medical grade CT scans to help us in proper diagnosis of these cases. Radiation exposure, additional costs to the patient and the inconvenience of additional procedures made the use of CT scans limited to the most demanding cases. However, the development of in-office scanning technology, called Cone Beam Computerized Tomography (CBCT), has overcome these challenges, and has brought this wonderful technology to the convenience of our private practice environment. Our practice, Shoreline Periodontics, was only the second private office to receive approval from the State of Connecticut, for installation of this technology this past summer.
Historically, implant diagnosis was limited to a two dimensional x-ray and a clinical exam (Fig. 1). This information provided an “idea” of what the surgeon may encounter during the surgical placement of the implant. However, the true anatomy of the bone and how it might impact the surgical procedure was not known until the time of surgery. Many times, this resulted in additional procedures the patient was not aware of, or compromises with the ultimate outcome of the case. In addition, there are certainly risks of surgically entering the bone without knowing the exact location of all critical structures.
3-D CBCT imaging can provide important information regarding the width, shape, quality and volume of bone in cross-section (Fig.2). Once the scan is obtained, this information can be immediately reviewed with our patient to discuss the findings of the scan. The shape of the bone can be clearly seen and a discussion can be conducted of whether procedures such as bone grafting will be required. Other important anatomic landmarks can also be identified such as critical nerve structures, and bony undercuts that can not be seen with traditional x-rays (Fig. 3).
3-D imaging has quickly become the standard of practice in our office, as we have seen the benefits to the patient and the treatment team. Some technologies can dramatically impact the delivery of care, and this is especially true when it involves the improvement in diagnostic knowledge and therefore increases in patient safety. CBCT improves treatment outcomes and this equates to patient benefits all around.
This article first appeared in the 2010 November / December edition of the The New London Women’s Journal