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opinion _ 3-D technology I officeandhewasawarethatweareaproponentof performing flapless guided implant surgery when possible. I explained the benefits and risks associ- ated with this type of implant surgery. The advan- tages include fast, safe, accurate implant place- ment with a minimally complicated post-op heal- ing period. Digital 2-D periapical X-rays taken were limited in their diagnostic value. There was no way to be certain as to the exact location of the inferior alveolar nerve or the lingual concavity in the molar area.Withthatinmindwediscussed,andheagreed to accept a CBCT scan to fully evaluate his current condition and determine if enough bone volume existed to perform a guided implant surgery. This is where my in office CBCT unit becomes invaluable as the information cannot be obtained by any other in office radiographic modality. A medical CT could be requested which exposes the patient to a much larger dose of radiation and could only be taken at a different imaging center. Obviously I could not treat the patient if the ex- isting bone anatomy was deficient and could not accept a properly positioned root form dental im- plant in solid bone. He was thinking that he could replace four teeth with two implants and a bridge. Butthatwasnotappropriateduetothelargemesial distal edentulous span of missing teeth. The crest in the area of tooth #29 and #30 exhibited height and labial bone loss. Due to his occlusion, number of missing teeth and the position in the lower right dental arch, I felt it would be necessary to place a minimum of three fixtures to retain a 4-unit fixed bridge. Capturing3-Danatomy Sirona’s GALILEOS scan travels around the patients’ head in a single revolution that takes 14secondstocompletethecaptureofthemaxillo- facial anatomy and a full volume of data is recon- structed and becomes available to assess within minutes.MypatientandIreviewedthe3-Dimages together on a large computer monitor in my con- ference room. I was able to place three virtual implants into the residual bone avoiding the IAN, mental foramen and lingual concavity. Patient could clearly visualise this procedure being per- formed in his jaw. In this case the bone appeared adequate to receive 3 endosseous implants that could be restored with a 4 unit fixed bridge (Figs. 4–7). So to recap, this patient was reluctant to be treatedwithconventionalflappedimplantsurgery and declined additional bone grafting to improve any bone volume, but was a candidate for flap- less or minimally flapped guided implant surgery which gave him the confidence to accept treat- ment based upon our initial consultation and treatment plan which was developed during this visit. This first step is essential to gain the patient’s trust and gain acceptance to the treatment plan at his initial visit as he would not return to us if he wasn’t convinced that I could perform his treat- mentasIdescribedandunderlocalanesthesiaand without further bone grafting. In preparation for guided implant surgery it is necessary to fabricate a computer generated surgical guide based upon the restoratively driven I 09CAD/CAM 1_2016 Fig. 14 Fig. 12Fig. 11 Fig. 13 CAD0116_06-18_Ramirez 21.01.16 11:02 Seite 4 CAD0116_06-18_Ramirez 21.01.1611:02 Seite 4