Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2014-10-07, 09:31:41 | version 1.30.01
special _ 3-D planning for implants I incisive canal, the inferior alveolar nerve, or the maxillary sinus. In order to under- stand each individual patient’s presen - tation fully, it is essential that clinicians adoptaninnovativesetofvirtual3-Dtools. Through the use of advanced imaging modalities, new paradigms have been es- tablished that, in the author’s opinion, will continue to redefine the process of diag- nosis and treatment planning for dental implant procedures for years to come. Without the application of computed to- mography (CT) or lower radiation dosage cone beam computed tomography (CBCT), an understanding of the 3-D anatomical reality cannot be accurately determined, potentially increasing surgical and resto- rative complications. The utilisation of 3-D imaging modali- tiesaspartofpre-surgicalprostheticplan- ningcantakeseveralpathsasdemonstratedinthe flow chart. The first involves acquiring a 3-D scan directly, without any prior planning or ancillary appliances. The scan process can be accomplished at a local radiology centre or via an in-office CBCT machine, now widely available. The scan itself can be completed within several minutes. Once the data has been processed, it can be viewed via the native software of the CBCT machine used and evaluated for potential implant recipient sites, fol- lowed by the surgical intervention. A second path requires the fabrication of a radiopaque scanno- graphic appliance that incorporates vital restora- tive information and will be worn by the patient during the acquisition of the scan. In this manner, the tooth position can be evaluated in relation to the underlying bone and other important anatomical structures, such as the maxil- larysinusortheinferioralveolarnerve.The scan data can again be visualised via the CBCTmachine’snativesoftwareandaplan can be determined based directly upon the restorative needs of the patient. The scan data is formatted into a non- proprietary data interchange protocol re- ferred to as DICOM (Digital Imaging and Communications in Medicine). The DICOM data can be exported for use in third-party software applications that incorporate additional tools to aid clinicians in the di- agnosisandtreatmentplanningfunctions. The use of interactive treatment plan- ning has expanded dramatically in the past ten years as computing power has increased exponentially. There are at least two paths that can be taken once a virtual plan has been established. The first allows the data to be assessed, providing important information to the clinician who will perform the surgical interven- tion free-hand based upon the software plan. This has been termed CT-assisted intervention by the author. The second path involves the fabrica- tion of a surgical guide or template that is re- motely constructed from the digital plan usually through rapid prototyping or stereolithography. ThismethodhasbeendescribedasCT-derivedtem- plate-assisted intervention and is considered to be more predictable than any previous methods. The use of advanced imaging modalities for pre- surgical prosthetic planning is essential for any type of implant surgical and restorative interven- I 35cone beam3_2014 Fig. 4bFig. 4a Fig. 3bFig. 3a Fig. 6bFig. 6a Fig. 5bFig. 5a CBE0314_34-39_Ganz 30.09.14 14:17 Seite 2