IMPLANT PLANNING USING CT DATA

Cone Beam CT (CBCT) scans offer numerous advantages over conventional dental x-rays in implant planning. Most of these advantages stem from the fact that CBCTs are three-dimensional as opposed to conventional x-rays, which only offer a two-dimensional view. From a single CBCT study, limitless views may be generated with our software, capturing images from different angles, at different depths, and selective for different tissues. These images may be used to render 3-D views of the patient’s jaw to facilitate the treatment plan for all dentitions and implant planning, outlining the vital structures as true 1:1 views or enlarged for closer examination.

InPronto technicians manipulate the DICOM data received over the web to facilitate a complete review of an optimal   3-D visual plan for the proposed placement of dental implants. The benefits of DICOM data manipulation for the dentist are present throughout the continuum of care from diagnosis to treatment to post-op examinations and include:

• Locating and determining a linear measurement to vital anatomic structures
• Measurement of alveolar bone width
• Visualization of bone contours, dehiscences and fenestrations
• Determination of whether a bone graft or sinus lift is needed
• Selection of the most optimum implant size, length and type
• Biomechanical analysis of the implant location and angulations
• An increase in case acceptance by building patient confidence
• Reduction in surgery time

Guided implant placement based on 3-D CT scans is becoming the standard of care. Surgeons and restorative dentists can approach each case with the confidence that comes from knowing that the best available image data and technology have been used to complete the process in a minimally invasive fashion with optimum patient safety in mind.

SCANNING GUIDELINES

NobelGuide Protocols guidelines

Two CT scans are required:

1. Patient anatomy wearing a radiographic stent containing at least six radiopaque markers and a polyvinyl bite.

2. Patient’s radiographic stent containing radiopaque markers.

Note: each scan should be acquired using identical parameters. Image artifact caused by metallic fillings, bridges or implants can obscure anatomy of interest. Please take steps to minimize artifact by removing any metallic objects such as jewelry, retainers, partial dentures with metal frames or resin partial dentures containing wrought wire clasps, etc.

Fully Edentulous cases guidelines

A. Scanning the patient:

• Make sure that the denture is seated properly in the patient's mouth.
  
• In The area of the interest, the occlusal plane should be parallel to the gantry.
  
• Instruct the patient to bite firmly on the bite registration during the scan. If the patient has a surgical stent, it can be used in place of a patient's denture so long as a minimum of six radiopaque markers have been placed.
  
• Please avoid Image distortion from patient's motion. It can severely compromise the accuracy of the rendered 3-D model from the scan. Please ensure that scans are free from motion artifact.
  
• For traditional CT: Helical acquisition with a small FOV and the smallest available slice spacing, ideally less than .75 mm.
  
• For Cone Beam CT: Full field of view with .2-.5 mm slices and 40 - second exposure.
• For iCat CT: Full 13 cm, 40 second exposure at .25 Voxels.

B. Scanning the models:

• If the patient is edentulous, seat the denture on the patient's dental cast with the polyvinyl bite in place.
  
• Position the dental casts within the field of view on a flat surface. Make sure that the entire dental cast will be captured in the scan.

Transferring the Data

Archive the data in multi-file DICOM format including both the patient's file and the denture's file.