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ePaper created 2017-08-25, 17:58:13 | version 1.38.0
guided implant reconstruction case report | Fig. 4 Fig. 3 Fig. 5 Fig. 6 There are advertisements that promote concepts such as: ‘Brain-guided surgery vs cone beam-guided surgery—which works better’, leading clinicians to believe that it is the computer that makes the deci- sions, and not the clinicians who use the technology properly to improve their diagnostic abilities. The diagnostic and treatment planning process using CBCT imaging provides for a variety of views including the axial, cross-sectional, panoramic, 3-D reconstructed volume (Fig. 2), and much more af- forded with the use of interactive software as an aid to evaluating the thickness of the buccal plate, to as- sess the bone density, to visualise the trajectory of the tooth vs the bone, and then if a receptor site is found to be appropriate the clinician can position the im- plant to best support the desired restoration (Fig. 3). Therefore it is the clinician who will decide on the available treatment options based on the enhanced diagnostic information provided by the technology. 3-D imaging technologies helps clinicians diagnose more accurately and more consistently, than any two-dimensional modality—there is just no compar- ison. Diagnosis is the key element of implant success, and should not be minimised. To diagnose properly, clinicians need to use our brains—it is not the com- puter that makes the decisions. Case presentation A 74-year-old male presented to the clinic with a chief complaint of pain in the edentulous lower jaw, especially on the right side when trying to masticate using an existing complete denture (Fig. 4). The den- ture had little or no retention due to the resorbed con- dition of the mandibular arch, and was almost impos- sible to wear without denture adhesive applied many times during the day. The patient had been seen by a local dentist with the concept of managing his man- dible with the placement of dental implants. The initial treatment options that could be consid- ered for this patient included: · · · · · · Four/five standard diameter implants supporting a fixed hybrid restoration. Immediate loading of implants with a fixed resto- ration. Two standard diameter implants supporting an overdenture. Four standard diameter implants supporting an overdenture. Narrow-diameter implants supporting an over- denture. Flapless surgical approach or a flap procedure to expose the underlying bone. Fig. 7 Fig. 3: Cross-sectional slice revealing the trajectory of the maxillary alveolus vs the trajectory of the root when planning for an implant. Fig. 4: Edentulous resorbed mandibular ridge. Fig. 5: Panoramic reconstruction from CBCT dataset. Fig. 6: Reveals the broken pilot drill ‘in the bone’. Fig. 7: 3-D volumetric reconstruction from CBCT data. Fig. 8: The need for bone reduction to flatten the ridge for implant place- ment (red arrows). Fig. 9: The axial and 3-D reconstructed views revealing the IAN’s, and four proposed implants in the symphysis. Fig. 8 Fig. 9 CAD/CAM 3 2017 27