Please activate JavaScript!
Please install Adobe Flash Player, click here for download

CAD/CAM International magazineof digital dentistry No. 1, 2017

the radiation significantly, individual assessment of every case is still very important to get the most of the 3-D image without exposing the patient to extra radiation. In many cases, a small FoV that is enough for one to several teeth could be equal to a few periapical ra- diographs but with a much higher diagnostic value. In order to show how a CBCT scanning machine can affect the day-to-day dentistry in a small family practice, it would be beneficial to share a week’s diary, bearing in mind each practice’s needs are different, but one thing should be common above all, and that is to assess every case individually and never take 3-D scans routinely, even despite their clear benefits. When a 3-D image is necessary, patients appreciate the information and education they get by discuss- ing the case with them while pointing to vital struc- tures and solutions in 3-D versus an old fashioned 2-D image that did not make sense to the untrained eye in most cases. So here are a small selection from a week’s diary utilising the X-Mind Trium 3D CBCT scan in the clinic. More CBCT scans were probably obtained on any one day depending on the cases on that day, however, due to space limitations in this article, only one to two cases per day were selected. Day 1 The patient had all his lower teeth extracted many months ago, due to mobility and infections and preferred to have a fixed solution through implant therapy. Patient currently is wearing a well-fitted temporary lower denture. Initially the idea was to take a scan of the existing denture with radiopaque markers (gutta-percha in 6–8 holes made in the denture) to plan for the placement stage. However, a decision was made to duplicate the existing den- ture using a Lang duplication flask in order to fabri- cate a clear acrylic radiographic guide (Figs. 1 & 2). A 3-D scan was obtained using the X-Mind Trium 3D CBCT scanner to be utilised as an invaluable re- source in the treatment planning of the case. Through the scan, the type and position of the im- plants in relation to the density of the surrounding bone were checked. The AIS 3-D Software that comes with the device, includes a library of most current implants on the market, allowing to place the right implant in the right angulation plus abutments and crowns in order to maximise the predictability of positioning the implants, thus improving its success. CBCT in everyday practice cone beam supplement | Fig. 3 Fig. 4 Fig. 5 For clinicians who use more than one implant system, to change the implant model that was inserted from the library, we simply click in the middle of the implant and the implant library is opened again and it is pos- sible to choose another implant model, the software will keep the same insertion point and direction of the previous one. In addition, the software will easily evaluate the bone density around the implant. The aim is to show, both through colour maps and numer- ically (Figs. 3 & 4) the values before commencing sur- gery (green if the values are acceptable and high and red if the values are low—Fig. 5), allowing the clinician to make the right decision. This can also be a very good educational tool to show patients how their bone density potentially is around the implants. In our experience, patients like this feature once shown what they mean. Day 2 An implant is planned to replace a missing lower molar, and the position of the mandibular canal is not very clear on a 2-D image anyway, and even on the 3-D image the position is still a little confusing. Here we decided to use the AIS software’s FlyMode option, which is like a virtual endoscope that follows the mandibular canal tract from within, and aids to clarify the path and double check if our nerve tracking was correct (Fig 6). This is one of the unique features of the software that can help clarifying and controlling nerve-tracking. Fig. 6 CAD/CAM 1 2017 51

Pages Overview