CBCT and implants: a career-altering experience

A major concern during implant placement is the possibility of placing an implant too close to or penetrating the inferior alveolar nerve canal, likely resulting in injuries such as paresthesia, anesthesia or dysesthesia. In preparation for the insertion of fixtures, I wanted to be able to appropriately visualize important anatomic landmarks such as the inferior alveolar nerve canal, mental foramen, maxillary sinus, incisive canal, nasal floor, mylohyoid ridge and the location and morphologic variation of adjacent teeth. The data provided by the scan accurately locates such structures beforehand, so that they and potential iatrogenic injuries can be effectively avoided during surgery.

Obviously, with traditional two-dimensional radiographs, I could visualize the general location of these entities and approximate the height of the alveolus, but a 3-D scan provided more information about the morphology of that ridge — its height and width to within a hundredth of a millimeter as well as its angulation and variation of its form. Currently, I feel that the scope of data garnered from the CBCT is imperative to place implants safely and correctly for the best restorative options, and this technology has indeed, altered my approach to dentistry. I continue to learn from each case that I perform by acquiring low-radiation limited postoperative scans, which help me become a better surgeon.

The clear, virtual, revolving model of the dentition captured on the CBCT scan can be rotated, zoomed in on from any angle and viewed in 360 degrees to assist in the determination of the implant site as well as for the fixture’s proper inclination, length and diameter. As an added benefit, there are numerous CBCT-compatible, implant-positioning software programs available, such as SimPlant, NobelGuide, EasyGuide and Anatomage’s InVivo5.

Besides its usefulness for implant patients, my CBCT has a myriad of other benefits. I use it to gain information for many of the procedures performed in my practice: extractions, diagnosis and treatment of pathology, orthognathic surgery, airway studies, dental, oral and maxillofacial trauma, bone grafting, and evaluation of the paranasal sinuses.

For example, a cone-beam image can show the relationship of a tooth to vital structures, such as nerves, the sinus or other teeth, that could make an apparently simple extraction into a complicated one or provide one with information to treat complex extractions more easily. Using preoperative three-dimensional reconstructions, like those produced by InVivo5, has become indispensable preceding my treatment of jaw tumors, congenital and developmental deformities and maxillofacial trauma.

In addition to educating me regarding preoperative planning, the CBCT allows patients to better understand my reasons for the treatment that has been suggested, so they feel more involved in their own dental health planning decisions. When they must decide between an implant and other possible treatment options, the 3-D images illustrate and enhance my verbal explanation. Patients also enjoy the convenience of the in-office cone-beam examination, which eliminates the need for an extra trip to an imaging center and additional appointments at our office.

Also, during these times when financial considerations and radiation exposure are making headlines, patients appreciate that my CBCT machine exposes them to considerably less radiation and lower costs than the traditional medical CT scans taken elsewhere.

From a practice-building perspective, we have noted patients are appreciative of in-office CBCT technology that results in safer and easier treatment and they discuss their experience with family and friends, resulting in increased referrals.

Quite frankly, I can’t even imagine how I could practice oral and maxillofacial surgery without my i-CAT, and I would not want to place an implant without being aware of all the details that could affect its success or failure. The CBCT information helps me formulate the correct diagnosis, whether I am planning an implant, simple or complex dental procedure, or just consulting. For my practice, I consider it not only to be the standard of care, but the gold standard for dental practice.

About the author

Dr Steven A. Guttenberg, an oral and maxillofacial surgeon, practices in Washington, D.C., where he is director of the Washington Institute for Mouth, Face and Jaw Surgery. He is a diplomate of the American Board of Oral and Maxillofacial Surgery and a fellow of the American Association of Oral and Maxillofacial Surgeons and of the American College of Oral and Maxillofacial Surgeons, of which he is currently the immediate past-president. Guttenberg teaches at the Washington Hospital Center and is the chairman of its Oral and Maxillofacial Surgery Residency Training and Education Committee. He frequently lectures nationally and abroad. Guttenberg’s numerous scientific articles and book chapters have been published in dental and medical literature.