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

| cone beam supplement CBCT in everyday practice Fig. 7 Fig. 8 Day 3 Obtaining the correct position and trajectory of a retained upper canine has been traditionally dealt with by taking different 2-D images (periapicals) at different angles and possibly an occlusal film to Fig. 9 Fig. 10 Fig. 11 Fig. 12 Fig. 13 52 CAD/CAM 1 2017 determine the correct position in the bucco-palatal aspect together with some guessing work. 3-D imaging can be an invaluable tool for this mat- ter. The patient refused orthodontic extrusion of the upper left canine and wanted both the deciduous and permanent canines extracted in order to be replaced by an implant support crown. In planning the case, a CBCT scan was obtained to serve many purposes as to assessing the positions including any anatomy and bone surrounding these teeth. Since this image was taken, both teeth were ex- tracted and the socket was grafted fully to prepare the site for a later placement (Figs. 7 & 8). Day 4 Case 1 A lower molar case was in the planning stage, and the position of the mandibular canal was located. At this stage, different implant sizes were tested to check for best fit and maximum integration prog- nosis in the future. The AIS software indicated that the first implant was too long and there was a risk of nerve damage (Fig. 9), thus another implant size was chosen to al- low sufficient clearance above the nerve and the density of the bone was chosen at the same time, indicating good “green” values that the patient also could understand (Fig. 10). These tools as mentioned above can be quite an eye opener for patients and their engagement can affect the outcome positively. Case 2 A broken and lose bridge was planned to be re- moved. The lower left second molar which served as the most posterior bridge abutment tooth was beyond saving (visual inspection and probing). 3-D imaging helped with planning the case. It helped tracking the position of the mandibular canal in relation to the proposed implants (Figs. 11 & 12). In addition, the density of the bone was also checked (Fig. 13), indicating that a wider implant possibly is a better choice to improve integration rather than the current one used from the implant library. This will also allow us for deciding to perhaps perform an under preparation of the osteotomy site in order for the implant to engage in the bone better, this obvi- ously depends on the type of implant used and other factors that the expert clinician will be familiar with.

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