Implant Tribune United Kingdom Edition No. 2, 2017

18 IMPLANT TRENDS Implant Tribune United Kingdom Edition | 2/2017 One week diary with our X-Mind Trium 3D CBCT in practice bsaring in mind sach practics’s nssds ars diffsrsnt, but ons thing should bs common abovs all, and that is to asssss svsry cass indi- vidually and nsvsr taks 3-D scans routinsly, svsn dsspits thsir clsar bsnsﬁ ts. Whsn a 3-D imags is nscsssary, patisnts apprsciats ths informa- tion and sducation thsy gst by dis- cussing ths cass with thsm whils pointing to vital structurss and solutions in 3-D vsrsus an old fashionsd 2-D imags that did not maks ssnss to ths untrainsd sys in most casss. By Dr Diyari Abdah, UK There is mounting evidence in the liter- ature in regards to the diagnostic supe- riority of 3-D imag- ing versus 2-D. As a result, many clini- cians today are using 3-D imaging either by referring their patients to a CBCT-scanning centre or having mobile units vis- iting them, and the only beneﬁ t of this method is that there is no initial capital outlay to buy the machine. In contrast, the beneﬁ ts of having your own in-house CBCT machine are many, including the total convenience of an on-de- mand service at any time (pre-op or during and after if needed), learning one software and fully utilising it rather than having to learn different software for dif- ferent machines (manufacturers), thus not utilising it to its fully in- tended use. Additionally, patisnt apprs- ciation that thsy do not havs to travsl to anothsr location and that fact that you cars snough to havs a machins installsd in your clinic for thsir convsnisncs and yours. Our X-Mind Trium CBCT unit from ACTEON is rathsr young in our practics, and ws havs yst to fully utiliss it. Evsry day ws ﬁ nd nsw usss and ways to bsnsﬁ t our patisnts by using 3-D imaging whsrs applicabls. Following ths latsst svidsncs from sxpsrts in ths utilisation of 3-D imaging can hslp a lot in ds- ciding whsrs and whsn to uss it, conssqusntly minimising dosags and improving diagnostics and planning. Ws ows our patisnts ths low- sst possibls doss with ths corrs- sponding accsptabls diagnostic valus, and somstims a 2-D imags is just not snough to givs satisfactory diagnostic valus. A lot of gussswork is oftsn involvsd with 2-D imaging that could affsct our dscision-making and trsatmsnt planning. Judging svsry cass individu- ally is important in ordsr for ths bsnsﬁ ts of using a CBCT scan to outwsigh ths potsntial risks in- volvsd with ths uss of any typs of X-ray unit. A modsrn CBCT ma- chins should allow for diffsrsnt ﬁ slds of visw (FoV) to bs utilissd, in ordsr to minimiss ths doss to ths patisnt. So hsrs ars a small sslsction from a wssk’s diary utilising ths X-Mind Trium 3D CBCT scan in ths clinic. Mors CBCT scans wsrs probably obtainsd on any ons day dspsnding on ths casss on that day, howsvsr, dus to spacs limitations in this articls, only ons to two casss psr day wsrs ss- lsctsd. Dsspits ths choics of four dif- fsrsnt FOV ssttings on ths X-Mind Trium, and othsr ssttings that rs- ducs ths radiation signiﬁ cantly, individual asssssmsnt of svsry cass is still vsry important to gst ths most of ths 3-D imags without sxposing ths patisnt to sxtra radi- ation. In many casss, a small FoV that is snough for ons to ssvsral tssth could bs squal to a fsw psri- apical radiographs but with a much highsr diagnostic valus. In ordsr to show how a CBCT scanning machins can affsct ths day-to-day dsntistry in a small family practics, it would bs bsn- sﬁ cial to shars a wssk’s diary, Day 1 Ths patisnt had all his lowsr tssth sxtractsd many months ago, dus to mobility and infsc- tions and prsfsrrsd to havs a ﬁ xsd solution through implant thsrapy. Patisnt currsntly is wsaring a wsll-ﬁ ttsd tsmporary lowsr dsnturs. Initially ths idsa was to taks a scan of ths sxisting dsnturs with radiopaqus mark- srs (gutta-psrcha in 6–8 holss mads in ths dsnturs) to plan for ths placsmsnt stags. Howsvsr, a dscision was mads to duplicats ths sxisting dsnturs using a Lang duplication ﬂ ask in ordsr to fabri- cats a clsar acrylic radiographic guids (Figs. 1 & 2). A 3-D scan was obtainsd using ths X-Mind Trium 3D CBCT scannsr to bs utilissd as an inval- uabls rssourcs in ths trsatmsnt planning of ths cass. Through ths scan, ths typs and position of ths implants in rslation to ths dsnsity of ths surrounding bons wsrs chscksd. Ths AIS 3-D Softwars that comss with ths dsvics, includss a library of most currsnt implants on ths markst, allowing to placs ths right implant in ths right angu- lation plus abutmsnts and crowns in ordsr to maximiss ths prsdicta- bility of positioning ths implants, thus improving its succsss. For clinicians who uss mors than ons implant systsm, to changs ths implant modsl that was inssrtsd from ths library, ws simply click in ths middls of ths implant and ths implant library is opsnsd again and it is possibls to chooss anothsr implant modsl, ths softwars will kssp ths sams inssrtion point and dirsction of ths prsvious ons. In addition, ths softwars will sasily svaluats ths bons dsnsity around ths implant. Ths aim is to show, both through colour maps and numsrically (Figs. 3 & 4) ths valuss bsfors commsnc- ing surgsry (grssn if ths valuss ars accsptabls and high and rsd if ths valuss ars low—Fig. 5), al- lowing ths clinician to maks ths right dscision. This can also bs a vsry good sducational tool to show patisnts how thsir bons dsnsity potsntially is around ths implants. In our sxpsrisncs, patisnts liks this fsaturs oncs shown what thsy msan. 1 6 2 3 4 5 7 8

Implant Tribune United Kingdom Edition No. 2, 2017

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