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ePaper created 2017-01-24, 10:47:27 | version 1.38.0
I 21 CAD/CAM 3_2016 clinical_ simplifying dentistry I Sensor-based digital X-rays and digital panorex radiographs are often the first digital diagnostic in- struments used for a patient during a routine, emer- gency or need-based examination. The resulting im- agesgivetheproviderasenseoftheareaofconcern, showing surrounding hard-tissue structures and anatomy and an overview of the areas in question. When combined with a physical visual examina- tion,muchinformationisrevealed.Upuntilapproxi- mately a decade ago, two-dimensional images such as these were the only imagery available to achieve a diagnosis. The diagnostic and treatment workflow could be described as in figure 1. With the introduction, and now routine use, of cone-beam imaging in dentistry, the workflow has dramatically changed. In addition to traditional two-dimensional PA, bitewing and panographic images, three-dimen- sional cone-beam images can safely and effectively be used to yield exponentially higher amounts of diagnostic information. Planmeca’s ProMax® 3D technologycandeliverhighlyaccurateanddiagnos- tic images using proprietary Planmeca Ultra-Low Dose™ Imaging protocols (Fig. 2) with comparable radiation yields to conventional digital PA, BW and panoramic studies. The impact of Planmeca’s Ultra-Low Dose 3-D imagingisthatpractitionerscanchoosetoutilize3-D cone-beam studies without concern for excessive radiation exposure to the patient. The 3-D images allowforvisualizationofstructuresinalldimensions, showing height and width of hard tissue structures as well as a clear 1:1 view of all pertinent anatomy. These images can be used for the virtual placement ofimplants,planningtheprostheticendresultwitha library of abutments and correlating images derived fromCAD/CAMdesignstooverlayimplantprosthesis that are in proper occlusal form. An example of the superior diagnostic ability of 3-D over 2-D is shown in Fig. 3. The workflow for the diagnosis and treatment planning of implants today begins with digital 3-D CBCT imaging (Fig. 4). Once imaged, implants may be placed virtually in the exact position desired, with full awareness of anatomicalstructuressuchasthemandibularnerve, the mental foramina, maxillary sinuses and lingual mandibular concavities, to name a few. With the implant placed virtually, the study can be emailed in a secure and compliant fashion to a laboratory for the production of a surgical guide, if desired. This same 3-D image can be correlated or matchedtoaCAD/CAMscanofthesamearea,allow- ing the dentist to properly plan the restoration while (Photos/Provided by Dr. Eugene Antenucci) Fig. 1 Fig. 2 Fig. 4 Fig. 3