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ePaper created 2016-03-24, 17:16:09 | version 1.38.0
| research 24 implants 1 2016 Maxillary implant supported removable or fixed prostheses Author: Dr Scott D. Ganz, USA “Pre-surgical prosthetic planning” can be defined as the process of accumulating diagnostic infor- mation to determine which course of treatment should be considered for the fully edentate patient. The first step in patient evaluation should include conventional periapical radiographs, panoramic radiographs, oral examination, and mounted, artic- ulated study casts. In the completely edentulous patient it is essential for the clinician to assess sev- eral important aspects of the individual anatomical presentation including vertical dimension of occlu- sion, lip support, phonetics, smile line, over-jet, overbite, ridge contours, and a basic understanding 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 review of findings is based upon a two-dimen- sional panoramic radiograph, it may not be accu- rate 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 under- stand each individual patient’s actual bone anat- omy, it is essential that clinicians adopt an innova- tivesetofvirtual,three-dimensionaltools.Through the use of advanced imaging modalities new par- adigms have been established that in the author’s opinion will continue to redefine the process of di- agnosis and treatment planning dental implant procedures for years to come. Without the appli- cation of computed tomography (CT) or lower ra- diation dosage cone beam computed tomography (CBCT), an understanding of the three-dimen- sional anatomic reality cannot be accurately deter- mined, potentially increasing surgical and restorative complications. The utilization of 3-D imaging modali- ties as part of pre-surgical prosthetic plan- ning can take several paths. The first in- volves acquiring a three-dimensional scan directly, without any prior planning or an- cillary appliances. The scan process can be accomplished at a local radiology centre, mobile imaging company, or via an in- office CBCT device. The scan itself can be completed within several minutes. Once the data is processed, it can be viewed on the native software of the CBCT machine itself, evaluated for potential implant receptor sites, followed by the surgical intervention, or with a third party inter active treatment planning software. A second path requires the fabrication of a radiopaque “scannographic” appliance that incorporates vital restorative infor-Fig. 3a Fig. 1 Fig. 3b Fig. 2 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). 12016