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cone beam – international magazine of cone beam dentistry

technique _ CBCT diagnostic I _Conclusion The application of three-dimensional imaging has been greatly enhanced through the continued evolution and adoption of lower dosage CBCT de- vices. The image resolution and image quality have benefitted from improvements in sensors, graphics processors, increased computing power, and soft- wareapplications.CBCThasbecomeanessentialtool forpre-operativeassessmentofpotentialdentalim- plant receptor sites, bone grafting procedures, and otheroralsurgeryapplications.Thediagnosticpower oftheimagingmodalityhasbeengreatlyaugmented by newer and upgraded tools included in interactive treatment planning software applications. The important tools include (but are not limited to): _availability of realistic virtual implants _library of abutment components _advanced software segmentation/thresholding _clipping functionality _'selective transparency’ as defined by the author _and calculation of bone graft volumes. Despite all of these improvements, diagnostic ac- curacy can also be greatly enhanced if certain steps are taken prior to the CBCT scan. The use of a radio- paque scanning template helps to provide a concrete relationship between the desired tooth position and the underlying bone, allowing for true restoratively drivenplanning.Throughspecificcaseexamples,this article demonstrated important concepts of using interactive treatment planning that can increase di- agnostic acuity. When it is important to understand the soft tissue biotype, soft tissue thickness, emer- genceprofile,facialorbuccalplatethickness,enhanced implantand/orabutmentplanning,andextentofthe labialvestibule,acottonrollplacedwithinthevestibule priortothescanacquisitioncanprovideasimpleand effective solution._ Fig.8_Placingacottonrollunderthe lip,asseeninthecross-sectionalslice, bringsthelipawayfromthetooth, root,andalveolus(yellowarrows);and definesthevestibule(redarrow). Fig. 9a_An implant simulated with an abutment trajectory projecting through the clinical crown (green), perforating into the incisal canal. Fig. 9b_For a screw-retained crown, the screw-access hole would need to project through the lingual/palatal aspect of the crown, dictating bone grafting to cover the exposed threads. Fig. 10a_Another clinical case which utilised the ‘lip-lift’ clearly illustrates the advantages of placing a cotton roll in the labial vestibule (yellow arrows). The alveolus curves superiorlytothenasalfloor(redarrow), and the soft tissue thickness revealed (pink arrow). Fig. 10b_The outline of the simulated implant (green) and the yellow outline of the virtual tooth allows further inspection of the implant within the desired receptor site, and the thick- ness of the soft tissue (pink arrow). Fig. 11_The ‘lip-lift’ technique helps to define the volume of bone required to fill the defect to achieve optimal results (yellow outline). I 09cone beam1_2015 Dr Scott D.Ganz maintains a private practice for prosthodontics, maxillofacial prosthetics,and implant dentistry in Fort Lee,New Jersey,USA.He has served as President of the NJ Section of theAmerican College of Prosthodontists and the ComputerAided Implan- tologyAcademy (CAI).He has served as President of the New Jersey Section of theAmerican College of Prosthodontists and of the ComputerAided ImplantologyAcademy. Dr Ganz delivers presentations worldwide on both the surgical and restorative phases of implant dentistry,and has published extensively on these topics.He is considered one ofAmerica’s leading experts in the evolution of computer utilisation and interactive software for diagnostic and treatment planning applications using CT and newer- generation CBCT imaging modalities. cone beam_about the author Fig. 8 Fig. 9a Fig. 9b Fig. 10a Fig. 10b Fig. 11

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