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CBCT in everyday practice cone beam supplement | Day 5 This case was performed by another clinician who was hoping to achieve good integration after plac- ing two anterior implants with grafting material. According to the colleague, primary stability was good at the time of placement and the implants were ‘buried’ in the bone with some buccal fenestra- tions, hence the grafting. So everything indicated success. After the patient complaining about some threads showing through the soft tissue, the colleague suggested further grafting to ‘secure’ the implants. A CBCT scan was obtained (Fig. 14) as part of case planning, and clearly the scan shows that, this may prove difficult or at least very challenging. In addition, on the 3-D image we noted that the tip of the implant on the left side might be colliding with the root of the adjacent tooth, with long-term uncertainty as a result (Fig. 15). In this scanning slice (Fig. 16) we also noted the challenge ahead for grafting this implant suc- cessfully, which indicated that a lot of consideration has to be given and careful planning has to be em- ployed in order to make the case successful. However and despite the outcome so far with these two implants, the patient appreciated the high value of the 3-D technology and being able to see the prob- lem clearly and from different perspectives, elimi- nating any guesswork that might affect the final outcome, and guiding the treatment in the right di- rection. Conclusion These cases and many more every week pass through any dental clinic, with patients hoping for best available treatment under best circumstances (clinical, timescale, financial etc). We know that 3-D imaging is here to stay and in order to make treatments safer and more predict- able for our patients, we have to engage in these technologies and involve the patients more in showing them their clinical conditions and per- haps the limitations (anatomical, structural etc.) together with other factors that may affect treat- ment planning and outcome, hopefully for the bet- ter. We hope to be able to use our CBCT scan for more indications, especially in endodontics as few times we have seen amazingly positive results in using a CBCT scan in some difficult endodontic cases since we acquired this 3-D technology. It is the way forward and we wish we had the X-Mind Trium 3D Scanner earlier._ Fig. 14 Fig. 15 Fig. 16 References Ludlow JB, Laster WS, See M, Bailey LJ, Hershey HG. Accuracy of measurements of mandibular anatomy in cone-beam comput- ed images. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:534–542. Farman GA, Scarfe WC. The basics of maxillofacial cone beam computed tomography. Semin Orthod 2009;15:2–13. Holroyd JR, Gulson AD. The radiation protection implicatios of the use of cone beam computed tomography (CBCT) in Dentistry— What you need to know. SEDENTEXCT 2009. Harris D, Horner K, Grondahl K, et al. E.A.O Guidelines for the use of diagnostic imaging in implant dentistry 2011. A consensus workshop organised by the European Association for Osseo- integration at the Medical University of Warsaw. Clin Oral Implants Res 2012;23:1243–1253. Hultin M, Svensson KG, Trulsson M. Clinical advantages of com- puter-guided implant placement: A systematic review. Clin Oral Implants Res 2012;23(Suppl 6):124–135. contact Dr Diyari Abdah DDS DDS MSc ImpDent, is a cosmetic and implant expert in private practice in Cambridge, UK. Passionate about research and innovations, especially in the fields of implantology and 3-D imaging. He deals with all aspects of implantology and grafting techniques, and has been actively promoting and teaching implantology to GDPs worldwide for over 15 years through lecturing, workshops, articles and mentoring pro- grammes. He is a visiting academic at the University of Warwick Medical School (UK) and runs a successful mentoring programme on avoiding and solving problems in implantolo- gy. Currently on the editorial board of several dental publications. He is a two times best-selling author and an Emmy Award nominee for his humanitarian documentary. Dr Abdah can be reached through: www.dentalCBCTtraining.com CAD/CAM 1 2017 53