CAD/CAM international magazine of digital dentistry No. 4, 2016

| cone beam supplement use of CBCT in dental implantology 32 CAD/CAM 4 2016 Diagnostic imaging in clinical practice Prosthetically driven implant placement planning requires images on which you can rely Author: Dr Bart Vandenberghe, Belgium A sequence of scientific papers has demonstrated the crucial role of cone beam computed tomography (CBCT) in the field of implant dentistry. In 2012, the American Academy of Oral and Maxillofacial Radiol- ogy recommended the application of this imaging technology as the preferred method of pre-surgical assessment of intraoral implant sites. The ability of CBCT imaging to visualize thesmallestbonyde- tailsmeansthatCBCT is superior to CT for evaluating the mor- phology of the re- sidual alveolar ridge and bone quantity in most cases, while emitting very low doses of radiation. The data can then be used in dedicated CAD/CAM software. Finally, the relatively low cost of CBCT systemsmakesthem economically viable —even more so than conventional CT—for use in everyday clinical practice. CBCT imaging as preferred method Until recently, radiographic modalities for diagnosis during implant treatment planning relied upon two-dimensional projections of three-dimensional anatomicalstructures.Withtheadventofcomputed tomography, cross-sectional imaging had evolved from simple, locally produced tomographic sections to more accurate, faster and more versatile 3-D re- constructionscomputedformaxillofacialdiagnostic tasks. However, this came at the cost of relatively high exposure doses. By the late 1990s, CBCT further advanced the field ofdentalandmaxillofacialradiologybyallowing3-D visualization of anatomical structures and their spa- tialrelationshipwithasignificantlyreducedradiation exposuretothepatient.Incontrasttothefan-shaped beams and multiple detectors used in multi-slice computed tomography (MSCT), CBCT uses a conical X-ray beam to acquire images. The entire volume is imaged in one single rotation using a flat two- dimensionalimagereceptor,thusmakingitthewidely accepted method of choice for the pre-surgical as- sessment of intraoral implant sites today. High accuracy and patient satisfaction The past decade witnessed a paradigm shift from surgically driven to prosthetically driven implant placementplanning.Nolongerjustanadd-ontothe process, CBCT scanning has become the cornerstone of an integrated treatment workflow, helping clini- cians better execute their treatment plans. With a single scan, practitioners are able to acquire much more—and more accurate—data at low effec- tive radiation doses that are nearly equivalent to the dose of panoramic exams. The superior radiographic visualization compared with 2-D radiography fa- cilitates better pre-surgical assessment and a better understanding of any oral pathologies. At the same time, the data can be used to optimize virtual treat- ment planning in 3-D and to prepare for guided surgery, which contributes to optimized treatment tailored for each patient. Furthermore,lessinvasiveproceduresreducepatient discomfort and result in high patient satisfaction, as shown in observational studies on guided flapless Fig. 1: CBCT scan imported into NobelClinician Software. CBCT scanning has become the cornerstone of an integrated treatment workflow helping clinicians better execute their treatment plans. 42016

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