Using CBCT to Place Implants in a Knife Edge Ridge

This is Part III of our three-part series on interesting topics covered at the 1st International Congress on 3-Dimensional Dental Imaging held in New York City. The meeting was hosted by Imaging Sciences International and i-dontics. Missed Part I? Read it here. Part II, which discusses the Triangle of Bone concept, is available here.

Introduction: Surgical Guide Stents

At the 1st International Congress on 3-Dimensional Dental Imaging in New York City, many new applications for CBCT scans were unveiled. For treatment planning for the surgical placement of dental implants, highly accurate surgical guides can now be constructed that enable the dentist to place implants without laying a flap. These surgical guided stents are generated from the CBCT scan and provide for site, inclination and depth guides. In conjunction with visualization of the 3-dimensional anatomy of the proposed sites, accuracy and predictably are a given.

Application: Placing Implants in a Knife Edge Ridge
When the dentist is confronted with the problem of placing implants in a knife edge ridge, the CBCT scan and software enable the dentist to visualize the anatomy of the ridge in 3-dimensions. Using the software program, the dentist can transect the knife edge ridge to establish a wider alveolar ridge table for placement of the implants.

A surgical reduction stent can be generated to enable the dentist to remove exactly the amount of bone needed to establish a favorable implant site. The stent is inserted over the surgically exposed ridge. Bone is removed in a horizontal plane to establish the ideal contours of a flatter alveolar ridge. A second surgical guide stent can then be inserted over the transected ridge to accurately guide the placement of dental implants.

In one visit, the knife edge ridge, unsuitable for implant placement, is removed in a manner that creates ideal ridge morphology for implant placement. At that same visit, the second guide stent is used to guide dental implant placement. The procedure is fast and seamless. Reduction of bone is precise. Placement of implants is highly accurate. In some cases that can lead to immediate loading as well, based on prosthetics generated by CBCT scans.

This eliminates the problem of having to make decisions at the time of surgery. This approach using CBCT scan generated guide stents is far more accurate. The dentist can plan in detail prior to the surgery. This greatly expedites these procedures burning up far less chair time.

Nobody wants surprises at the time of surgical placement of implants. This is one way to keep that to a minimum because of the extreme accuracy with which treatment planning can be accomplished.
Application: Growing the Face

One other major use for CBCT scans and software programs is in orthodontics. The CBCT scans accurately depict the teeth and anatomy and can be used to generate orthodontic appliances for use in therapy. One of the great strengths of this kind of analysis is that the dentist can actually see the face grow over time in accurate visual illustrations. This is a great aid to treatment planning in orthodontic therapy.

Application: Oral Pathology

The new generation of CBCT scans yields highly accurate visualization of the internal anatomy of the head and neck. These views of the internal anatomy yield a vast amount of information not previously available. This leap in technology enables the dentist or physician to view the internal anatomy almost as clearly as if a dissection had been performed. This unparalleled opportunity to view the internal anatomy in such clarity and detail facilitates the early diagnosis of pathoses that might otherwise not be diagnosed until a much later stage in the pathogenesis. This is represents a a major enhancement of diagnostic capabilities.
Summary Prepared By:
Gary J. Kaplowitz, DDS, MA, M Ed, ABGD
Editor, www.osseonews.com