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ePaper created 2015-05-29, 13:18:43 | version 1.38.0
I technique _ virtual planning _“Pre-surgical prosthetic planning” can be defined as the process of accumulating diagnostic informationtodeterminewhichcourseoftreatment shouldbeconsideredforthefullyedentatepatient. The first step in patient evaluation should include conventional periapical radiographs, panoramic radiographs,oralexamination,andmounted,artic- ulated study casts. In the completely edentulous patient it is essential for the clinician to assess sev- eralimportantaspectsoftheindividualanatomical presentation including vertical dimension of oc- clusion, lip support, phonetics, smile line, over-jet, overbite,ridgecontours,andabasicunderstanding of the underlying bone structures. The accumula- tion of preliminary data afforded by conventional diagnostics provides a foundation to prepare a course of treatment for the patient. However, if the reviewoffindingsisbaseduponatwo-dimensional panoramic radiograph, it may not be accurate in appreciating the true spatial positioning of vital structures such as the incisal canal, the floor of the nose, or the maxillary sinus. To fully understand each individual patient’s actual bone anatomy, it is essentialthatcliniciansadoptan innovative set of virtual, three- dimensional tools. Through the useofadvancedimagingmodal- ities new paradigms have been established that in the author’s opinion will continue to redefine the process of diagnosis and treatment planning dental im- plant procedures for years to come. Without the application of computed tomography (CT) orlowerradiationdosagecone beam computed tomography (CBCT), an understanding of the three-dimensional anatomic re- ality cannot be accurately de- termined,potentiallyincreasing surgical and restorative com- plications. Theutilizationof3-Dimaging modalities as part of pre-surgi- cal prosthetic planning can take several paths. The first involves acquiring a three-dimensional scan directly, without any prior planning or ancillary appliances. The scan process can be accomplished at a local radiology centre, mobile imaging company, or via an in-office CBCT device.Thescanitselfcanbecompletedwithinsev- eral minutes. Once the data is processed, it can be viewedonthenativesoftwareoftheCBCTmachine itself, evaluated for potential implant receptor sites, followed by the surgical intervention, or with a third party interactive treatment planning soft- ware. A second path requires the fabrication of a radiopaque “scannographic” appliance that incor- Fig. 1_The axial view provides insight into the global topography of the maxilla. Fig. 2_The volumetric rendering aids in the inspection of the bone but does not the desired restorative position. Figs. 3a & b_A radiopaque scanning appliance fabricated from a duplicate of a patient’s existing well-fitting denture (a) allows inspection of tooth position in relation to the underlying bone (b). 3-D Virtual Planning Concepts: Maxillary Implant Supported Removable or Fixed Prostheses Author_ Dr Scott D. Ganz, USA 06 I cone beam2_2015 Fig. 1 Fig. 2 Fig. 3a Fig. 3b