Dental News - Intro to CBCT as it pertains to prevention of failures in oral implantology

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Intro to CBCT as it pertains to prevention of failures in oral implantology

Implant fracture. (DTI/Photo provided by Dr Dov M. Almog)
Dr Dov M. Almog, USA

Dr Dov M. Almog, USA

Wed. 30 March 2011

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Intraoral and panoramic imaging are not three-dimensional, and clinicians can obtain only vague measurements from them due to magnification changes as a result of positioning. They are not efficient for viewing certain pathologies and, because of the limitations, cone-beam computed tomography (CBCT) 3-D imaging technologies started to evolve.

CBCT 3-D captures a volume of data and, through a reconstruction process, it delivers images that do not contain magnification, distortion and/or overlap of anatomy.

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In recent years, CBCT 3-D started to make big inroads into every discipline in our dental profession, expanding the horizons of clinical dental practice by adding a third dimension to craniofacial treatment planning.

CBCT uses advanced 3-D technology to provide the most complete anatomical information on a patient’s mouth, face and jaws areas, leading to enhanced treatment planning and predictable treatment outcomes.

According to dental practitioners using this technology, it makes us more efficient. Essentially, this was a paradigm shift where measurements and anatomical relationships are precise and provide practitioners clear insight into the patient’s anatomical relationships.

As far as oral implantology, according to Kalorama Information (www.kaloramainformation.com/ pub/1099235.html), it is estimated that growth in implant-based dental reconstruction products will outstrip all other areas in dentistry.

The traditional method of replacing a tooth with a dental bridge has been shown to be problematic, and more permanent solutions are badly needed.

With a rapidly aging population trend in the developed world and the resulting enormous unmet need for teeth replacement, a large number of companies see the opportunity to move into these sophisticated dental techniques.

And indeed, as some have predicted, the growth in dental implantbased procedures increased considerably in recent years.

As a result, there has been a rapid increase in the number of practitioners involved in implant placement, including specialists and generalists, with different levels of expertise. At the same time, we are witnessing a diversity of unusual complications associated with these procedures.

A literature and web search revealed several published reports of such complications, which include: implant fractures (Fig. 1); impingement on adjacent teeth (Fig. 2); perforating the lingual undercut (Fig. 3); sinus perforations (Fig. 4); and displaced implants into the maxillary sinus (Fig. 5), to name a few.

The clinical management associated with some of these complications is difficult at times and considered very invasive.

Therefore, while the quantitative relationship between successful outcomes in dental implant treatment and CBCT-based dental imaging is unknown and awaits discovery through large prospective clinical trials, I strongly believe that using CBCT- and 3-D-based dental imaging is becoming a reliable procedure from a precautionary standpoint based on a series of recent preliminary clinical studies and case reports.

The author strongly believes that by taking a CBCT-, 3-D-based study prior to placing dental implants, many of the above mentioned complications can be circumvented.

About the author

Dov Almog, DMD, is a prosthodontist representing more than 30 years of diversified professional experience in clinical, academic and research environments. Currently, Almog is serving as the chief of the dental service for the U.S. Department of Veterans Affairs at the VA New Jersey Health Care System.

Dr Almog’s presentation, “Introduction to Cone Beam CT (CBCT), Especially as it Pertains to Prevention of Failures in Oral Implantology,” from the DTSC Symposia at the GNYDM, is available for viewing online at www.DTStudyClub.com.

Editorial note: This article was originally published in Implant Tribune Vol. 5 No. 12.

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