Dental News - Avoiding the pitfalls of implants with 3-D imaging

Dr Terry Myers, USA

Mon. 19 October 2009

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Once only a solution for the rich and famous, dental implants have become a popular option for people across all economic categories. Along with the popularization of this procedure, while implants were usually delegated to specialists, technology, such as in-office cone-beam scans and digital imaging allow general practitioners to offer this type of service while also avoiding the pitfalls that result from a lack of precise information.

Research illustrates both the growing popularity of implants and the increasing desire of general dentists to provide their patients with this procedure. A recent survey cites that 19 per cent of general dentists have placed implants for three years or less. Many practitioners want to add this procedure as a response to requests from their patients. The study also showed that 77 per cent of general practitioners said the number of patient inquiries about implants in their practice has increased during the last three years.

For the general dentist, the proper technology can reduce stress and expand the comfort zone, as well as increase the safety and comfort of the patient during implant planning and surgery.

A successful implant surgery is dependent upon many details, a majority of which are hidden beneath the gingiva. A 2-D X-ray or pan cannot discern certain anatomical conditions of the dentition that may determine the direction and scope of the treatment plan. Without a 3-D scan, the dentist needs to devise several “just-in-case” options, to provide for the various possible scenarios taking place under the gum tissue. While this may seem to you like “covering all bases,” it may decrease the patient’s confidence in your diagnostic ability.

3-D reveals narrow ridges and provides precise measurements for safer placement.

A comfortable and positive experience will determine whether you retain a loyal patient or get bad press among his/her friends.

Beginning an implant without a 3-D scan is like trying to navigate through a dark room without a flashlight. You are sure to bump into something that will stop your progress. A 2-D pan alone cannot clearly establish the dimensional shape of the bone. Without the exact measurements of the width and height of the bone provided by the cone-beam image, it is likely that you may flap back the tissue only to find insufficient bone to support an implant. The patient ends up with pain, stitches, and an additional appointment to complete the next stage.

Besides the amount of bone, the 3-D scan avoids other possible obstacles to a successful implant. The ability to view abnormalities of the roots, the tooth’s proximity to adjacent teeth, supernumerary teeth and the proximity to the nerves and sinus provides valuable insight, avoiding surprises once the surgery is underway.

The undercut mandible as seen in 3-D prior to surgery.

The cone-beam scan improves patient communication, avoiding misunderstandings and improving patient acceptance. Back to the survey scene, more than 98 per cent of those surveyed were involved in patient education on implants. Education is easy with a 3-D image. The dentist can point out the possible trouble spots on the 3-D model, slicing, rotating, enlarging and exploring the patient’s dental anatomy from all angles.

Whether you are a general dentist or a specialist, no one wants the stress of a possible failed implant, or a disappointed patient.

In conjunction with 3-D imaging, many surgical guides are available that provide even more direction during the surgery, and 2-D digital images taken during the surgery can offer a quick check of drill lengths and placements.

While success in any surgical endeavor cannot be totally guaranteed, having all of the facts beforehand does stack the odds in your favor. With cone-beam technology, general dentists can keep their existing patients in-house, attract new patients and expand their dental horizons. There’s no need to do surgery in the dark because 3-D imaging is available to shed light on all the pertinent facts.

About the author

Dr Terry Myers completed his residency in advanced general dentistry and served as an instructor in the advanced education in general dentistry residency program and as director of the faculty practice at the University of Missouri-Kansas City School of Dentistry. He is a fellow in the Academy of General Dentistry and a member of the Academy of Cosmetic Dentistry and the Dental Sleep Disorder Society. Myers is on the board of directors at Research Belton Foundation and is a participating provider for the dental care program to improve children’s dental care. His private practice, where he utilizes the Gendex GXCB-500 and DEXIS, is in Belton, Mo. Myers can be reached by e-mail at office@keystone-dentistry.com.

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