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How CBCT can improve your treatment plan

Imaging is a critically important aspect of diagnostics and treatment planning when placing dental implants. High-quality, accurate images collected at the presurgical stage can yield dividends both in implant outcomes and patient satisfaction.

Traditional radiographic methods are not ideal for planning implant placement because you are visualizing a three dimensional (3D) object in two dimensions and missing important information along the way.1, 2 The development of computed tomography (CT) allowed clinicians to take radiographic cross-sections, paving the way for 3D reconstructions of maxillofacial features, though this improvement came at the cost of higher radiation exposure.3, 4

CBCT is an advancement of the CT technology that uses a cone-shaped X-ray beam and a two-dimensional image receptor to generate high-quality 3D reconstructions with significantly lower radiation exposure.3, 5-11 Because of these features, the Academy of Oral and Maxillofacial Radiology recommends this technique for presurgical assessments of implant sites.5

This is in accordance with the ALARA (as low as reasonably achievable) principle, that radiation exposure should be minimized to produce an image of the required spatial resolution and diagnostic quality.12,13

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Add new dimensions to the planning process

Gone are the days when clinicians had to rely on 2D implant-placement planning. Advances in technology have revolutionized the treatment-planning workflow. Clinicians can use 3D reconstructions, such as those based on CBCT scans, to better understand the situation they are correcting and create a prosthetic-driven plan to optimize treatment for each individual patient.  

One recent study compared treatment planning using panoramic radiography with the combination of panoramic radiography and CBCT. In that study, performing a CBCT scan during the implant planning phase increased the agreement in predicting implant length considerably, from 40% after the initial 2D scan to 69.5%.1-4

Patient benefits of CBCT

An approach which comprises virtual treatment planning using CBCT followed by guided surgery has numerous benefits. In combination with the NobelClinician software and a guided surgery approach, CBCT allows clinicians to utilize flapless implant placement, which is less invasive and associated with high patient satisfaction,13-15 reduced patient discomfort16-18 and also improved soft tissue outcomes.19

One way to incorporate CBCT into guided surgery planning is using the NobelClinician Software as part of your treatment plan workflow. NobelClinician uses SmartFusion technology to combine CBCT reconstructions with scans of the intraoral situation to visualize the surgical area and tooth setup. This allows you to develop a treatment plan that maximizes the use of available bone at placement while also accounting for soft tissue features and prosthetic constraints, helping you produce the best possible results for every patient.

In summary, by incorporating CBCT into your workflow for planning guided surgeries, you can reduce the number of chairside decisions you have to make during surgery, improve your surgical outcomes and increase your patient satisfaction.

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1 Benavides E, Rios HF, Ganz SD, An CH, Resnik R, Reardon GT, et al. Use of cone beam computed tomography in implant dentistry: the International Congress of Oral Implantologists consensus report. Implant Dent. 2012;21(2):78-86.

2 Chan HL, Misch K, Wang HL. Dental imaging in implant treatment planning. Implant Dent. 2010;19(4):288-98.

3 Sukovic P. Cone beam computed tomography in craniofacial imaging. Orthodontics & craniofacial research. 2003;6 Suppl 1:31-6; discussion 179-82.

4 Tsiklakis K, Donta C, Gavala S, Karayianni K, Kamenopoulou V, Hourdakis CJ. Dose reduction in maxillofacial imaging using low dose Cone Beam CT. European journal of radiology. 2005;56(3):413-7.

5 Tyndall DA, Price JB, Tetradis S, Ganz SD, Hildebolt C, Scarfe WC. Position statement of the American Academy of Oral and Maxillofacial Radiology on selection criteria for the use of radiology in dental implantology with emphasis on cone beam computed tomography. Oral surgery, oral medicine, oral pathology and oral radiology. 2012;113(6):817-26.

6 Miracle AC, Mukherji SK. Conebeam CT of the head and neck, part 1: physical principles. AJNR American journal of neuroradiology. 2009;30(6):1088-95.

7 Mozzo P, Procacci C, Tacconi A, Martini PT, Andreis IA. A new volumetric CT machine for dental imaging based on the cone-beam technique: preliminary results. European radiology. 1998;8(9):1558-64.

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9 Kau CH, Bozic M, English J, Lee R, Bussa H, Ellis RK. Cone-beam computed tomography of the maxillofacial region--an update. The international journal of medical robotics + computer assisted surgery : MRCAS. 2009;5(4):366-80.

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11 Suetens P. Fundamentals of medical imaging. 2nd. ed. New York: Cambridge University Press; 2009. vii, 253 p. p.

12 Dula K, Bornstein MM, Buser D, Dagassan-Berndt D, Ettlin DA, Filippi A, et al. SADMFR guidelines for the use of Cone-Beam Computed Tomography/ Digital Volume Tomography. Swiss Dent J 2014;124(11):1169-83.

13 Farman AG. ALARA still applies. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100(4):395-7.

14 Mello LA, Garcia RR, Leles JL, Leles CR, Silva MA. Impact of cone-beam computed tomography on implant planning and on prediction of implant size. Brazilian oral research. 2014;28:46-53.

15 van Steenberghe D, Glauser R, Blomback U, Andersson M, Schutyser F, Pettersson A, et al. A computed tomographic scan-derived customized surgical template and fixed prosthesis for flapless surgery and immediate loading of implants in fully edentulous maxillae: a prospective multicenter study. Clin Implant Dent Relat Res. 2005;7 Suppl 1:S111-20.

16 Abad-Gallegos M, Gomez-Santos L, Sanchez-Garces MA, Pinera-Penalva M, Freixes-Gil J, Castro-Garcia A, et al. Complications of guided surgery and immediate loading in oral implantology: a report of 12 cases. Medicina oral, patologia oral y cirugia bucal. 2011;16(2):e220-4.

17 Yamada J, Kori H, Tsukiyama Y, Matsushita Y, Kamo M, Koyano K. Immediate loading of complete-arch fixed prostheses for edentulous maxillae after flapless guided implant placement: a 1-year prospective clinical study. Int J Oral Maxillofac Implants. 2015;30(1):184-93.

18 Pozzi A, Tallarico M, Marchetti M, Scarfo B, Esposito M. Computer-guided versus free-hand placement of immediately loaded dental implants: 1-year post-loading results of a multicentre randomised controlled trial. European journal of oral implantology. 2014;7(3):229-42.

19 Nkenke E, Eitner S, Radespiel-Troger M, Vairaktaris E, Neukam FW, Fenner M. Patient-centred outcomes comparing transmucosal implant placement with an open approach in the maxilla: a prospective, non-randomized pilot study. Clin Oral Implants Res. 2007;18(2):197-203.