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f DT page 11A DENTAL TRIBUNE | March 2010 Clinical: Digital Perspective 13A The collected diagnostic CBCT and the added dimension of 3-D data will result in more predictable outcomes, increasing patient satis- faction and reduced risk of potential claims. If the patient declines the CBCT diagnostic data, the practition- er should obtain and document an informed refusal.2 In 1996, Quantitative Radiology (QR) from Verona, Italy, introduced the first dental CBCT machine called the Newtom into the Italian market. This ushered in the era of 3-D dental imaging, sparking a rapid develop- ment of dental CBCT scanners by a number of companies. To date, there are more than 30 such CBCT machines available on the market worldwide produced by a wide variety of companies.3 During the last decade, as rec- ognition in the concept of CBCT has matured, and with the wider availability of CBCT 3-D imaging in imaging centers, mobile scanning units and private offices, our profes- sion has been fueled further by the introduction of 3-D derived virtual planning software solutions.4 About a dozen of these virtual implant planning software solutions are used for general oral implantolo- gy treatment strategy, of which only eight are ultimately used to translate the treatment strategy into an actual physical surgical guidance drilling template, thus taking the guesswork out of oral implantology (Figs. 1, 2). Utilization of these adjunctive state-of-the-art technologies altered the manner in which we pull togeth- er diagnostic data, plan and execute both simple and complex implant cases. These surgical guidance sys- tems offer safer and more predict- able placement of dental implants, ensuring accurate transfer of critical restorative and anatomical informa- tion to the surgical site. Additionally, these surgical guid- ance systems offer an opportunity to maximize a team approach between surgeons, restorative dentists and the labs, creating greater under- standing, appreciation and profes- sional camaraderie. Of the eight 3-D derived virtual planning software solutions that are ultimately used to translate the treat- ment strategy into an actual physical surgical guidance drilling template, two systems differentiate themselves from all the other systems in that no physical shipment needs to be made to the guide manufacturer. Being fully automated, digitally manufactured solutions, only digi- tal data is transmitted, which is enough to manufacture the guid- ance drilling template using 3-D printing technologies. These two systems are: NobelGuide™ (Nobel Biocare, Yorba Linda, Calif.) and Scan2Guide™ (iDent Imaging, Foster City, Calif.). While NobelGuide can only be used in conjunction with Nobel implants, Scan2Guide is an open platform that can be used with most implant systems on the market. Because the iDent system is an open system, the company has developed a variety of metal sleeve sizes for placement in the surgical guidance drilling template and a series of tool inserts that accommo- date a diversity of systems out there, including the drilling sequence as required by each implant brand. Conclusion This report attempts to provide an argument in favor of the utility of CBCT-image-based 3-D-derived virtual implant planning software solutions in oral implantology that are ultimately used to translate the treatment strategy into an actual physical surgical guidance drilling template. Researchers studying these vir- tual surgical guidance technologies agree that the quantitative relation- ship between successful outcomes in oral implantology and CBCT- based dental imaging — coupled with virtual planning and, ultimate- ly, implant placement guided by sur- gical guidance templates — awaits discovery through large prospective clinical trials.5 Based on a series of case reports, it has been demonstrated that using CBCT-based dental imaging along with surgical guidance templates is, without a doubt, a reliable proce- dure, optimizing our patients’ safety and well being.6–8 DT A complete list of references is available from the publisher. (Photos/Provided by Dr. Dov Almog) AD Contact information Dov M. Almog, DMD, prosthodon- tist, Chief of the Dental Service VA New Jersey Health Care System 385 Tremont Avenue East Orange, NJ 07018 Tel.: (973) 676-1000, ext.1234 Fax:973-395-7019 E-mail: dov.almog@va.gov Michael Nawrocki, prosthodontist VA New Jersey Health Care System

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