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ePaper created 2017-08-25, 17:58:13 | version 1.38.0
| case report guided implant reconstruction Brain-guided implant reconstruction: Who makes the decisions? Author: Dr Scott D. Ganz, USA It appears that there is still a great divide between those who utilise 3-D technology for dental implant planning and surgical placement of dental implants and those who do not. Clearly, decisions as to how to diagnose and treatment plan our patients may be the difference between success and failure. Recently an in- ternet advertisement promoting an educational pro- gramme stated that ‘Implant surgery is not compli- cated, easier than most other dentistry, and every dentist has the skills to surgically place implants. If you can take teeth out, you can put a dental implant in! You don’t need expensive equipment for brain-guided sur- gery, you can learn it with no initial investment!’ Im- plant dentistry has become one of the most predictable and successful treatment modalities in all of dentistry. If the only imaging modality utilised is a two-dimen- sional panoramic or periapical radiograph how can a clinician really know if a procedure will be complicated? Figure 1 represents a beautifully rendered 3-D max- illa and mandible with the cross-sectional imaging showing the existing teeth and roots in both arches as Fig. 2 processed within the interactive treatment planning software (NobelClinician, Nobel Biocare). This vital in- formation allows for a complete understanding that each patient's anatomy is individual and unique, and that each patient’s bony anatomy, root positions within the bone, and tooth trajectories may not coin- cide with the alveolar process. Therefore without this information, the placement of implants may be com- promised, resulting in complications. Therefore it is imperative that clinicians utilise the most up-to-date 3-D CBCT imaging and interactive treatment planning software to fully appreciate the individual nature of each patient’s unique anatomy. When evaluating potential implant receptor sites, it is not just the available bone that should be consid- ered, as our patients are in need of teeth, not implants. Clinicians must learn to practice ‘restoratively driven implant reconstruction’—knowing where the tooth position should be in relation to the bone and poten- tial implant. This process can be accomplished with greater accuracy with the use of 3-D imaging and software applications that have the tools to provide clinicians with this valuable diagnostic information. Fig. 1: Three-dimensional volumetric rendering of the maxilla-mandibular relationship (r), and a sagittal section (l) of this region of interest. Fig. 2: Frontal view of reconstructed volume from CBCT dataset allows for total inspection of the patient’s anatomy. Fig. 1 26 CAD/CAM 3 2017