How Do I Make the Transition to Cone Beam Volumetric Tomography?

Anon. asks:
I have begun to place my own dental implants. I started in the mandibular anterior area because this seems like the easiest area to treatment plan and the area with the least potential for complications and the greatest chance of success. So far so good. I have been using diagnostic casts and a panoramic radiograph to treatment plan the placement of the implant fixtures. After reading the many posts on OsseoNews.com about the use of Cone Beam Volumetric Tomography (CBVT) to treatment plan implant placement, I feel that I may not be doing all that I can to insure the best implant placement. How do I make the transition to using CBVT?

8 Comments on How Do I Make the Transition to Cone Beam Volumetric Tomography?

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Brian James
11/4/2008
I would suggest simply find a CBCT provider near to you, go and see how the machine works and get some instruction on manipulation of the interpretive software. iCAT provides iCAT vision as free ware, and this is an extremely effective and versatile program, letting you manipulate the images, make measurements and have a look at volumetric rendered images. Imaging sciences can even provide a tutorial disk for instruction. Once you know how to use this, you can get some education in interpretation of CT images at somewhere such as http://www.onderwijs.acta.nl/cbct/index_redirect.html . If, on the other hand, you are considering purchasing a machine, I would suggest you would need to justify the expense in terms of how often you would actually use it. There is no doubt it is an incredibly handy machine to have in your rooms, and I use mine daily, but I am in restricted practice (Perio/Implant). my only comment would be "what are you waiting for?"
steve c
11/5/2008
I would suggest finding a dental radiologist in your community with whom you can work. I find it much easier to refer my patients to another competent specialist who provides an excellent report that is not necessarily limited to the area of interest. I am able to view hard copies of the implant sites with all pertinent anatomy marked by the radiologist, or the more extensive study is available to me on disc. This prevents me from having to purchase an expensive unit or employ extra staff to use and maintain the equipment. Its hassle free and it doesn't matter if you use it once a month, once a week, or a few times a day because you've got no financial obligation.
dbe
11/5/2008
fantastic information is now readily available in your practice, you cannot believe what you see that you never saw before. very unnerving how much existing adjacent pathology you are missing with 2d imaging. invaluable in my omfs/ implant practice.
Kaz Z
11/6/2008
I believe the best way to start would be to get yourself some software. Simplant is an excellent software that is quite user friendly. Like all new programs, it takes a little effort to learn but after you understand how to manipulate the images it is quite simple and fun. My routine for just about all cases is to get accurate study models. Implantology is prosthetic driven. You need to get an accurate wax up of the sites where you plan on placing implants. The wax up is duplicated in stone and a suckdown with .020 material is made. You trim the suckdown and add 15-20%barium to acrylic and flow the mixture into the sites to be restored. This is placed over the original model that has had the wax removed, undercuts blocked out and lubricated. After the acrylic is set, slightly adjust for flash. I drill through the guide in the angle of trajectory that I believe I will use surgically and the hole is in the middle of the tooth. The patient comes back and you try the radiographic stent in the patients mouth for fit. I then use a radiolucent putty to index the opposing dentition with the guide in place. The patient closes down within 1.5 mm in the anterior in CO (or CR if doing a full mouth rehab) on the putty until set. The patient is instructed in how to place the guide and index. The patient goes to a conventional scanning center or to a cone beam facility. My scanning center charges me $300.00 for a scan and the conversion of the software into Simplant format. I find it hard to believe that anyone would work without this information for such a cheap price to truly understand what the 3rd dimension has in store for you. The scanning center sends me the disc within a day and I then load up the info into my Simplant software and go to work planning.
a r ilker cebeci
11/10/2008
Dear dr brian james you can use cone beam ct for implant treatment planning and other dental procedures. for examples are unerupted mandibuler 3. molar teeth, sinus pathologies, orthodontic anomalies, cysts, odontojenic tumours. cone beam ct makes comfartable ambience for us.if you want few case I can sent it to you. you can my web site, because I am a dental radiologist. ( soory for my bad english)
Dr. Bill Woods
11/14/2008
I would love a CBCT but I cant justify the expense. I have Simplant, but I certainly can see the benefit of what CBCT offers in terms of detail.I hear they are coming dowm. I would like to know what they are costing at the moment. Kodak has the 9000 but it isnt an entire arch. They still want too much for an "almost" CBCT scan. Bill
Daniellase
11/15/2008
T%hese are all good comments & i agree with most. Yes CBCT devices are expensive and one must weight teh cost/benefit for your patients. There is a new movement towards Mobile CBCT units that will come to your office and scan your patients,provide you with a report by a Dental Radiologist and give you teh images iin print and on a CD. I believe that this service is beneficial for your patients as well as your practice
Sameh
11/16/2008
Quoting: "You trim the suckdown and add 15-20%barium to acrylic and flow the mixture into the sites to be restored. After the acrylic is set, slightly adjust for flash. I drill through the guide in the angle of trajectory that I believe I will use surgically and the hole is in the middle of the tooth. " so you end up with a scan where the wax up shows as lightly radiopaque with radiolucent channels corresponding to your drilling channels Would you be so kind to confirm

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