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I 25 digital dentistry _ CT-guided implant surgery I cosmeticdentistry 1_2010 therearesomesmartpeopleatsiCAT,Sirona’ssoftware subsidiary in Germany, whose mandate was to do just that. Their efforts have changed implant dentistry forever. With the integration of CEREC and GALILEOS, we now have the opportunity to practise real digital implantology. The restoration of a patient’s missing dentition can be treatment planned in virtual reality, without the need for physical impressions, pour-up studymodelsorwax-upprostheses.Theabilitytovisu- alisethepatient’sbony-andsoft-tissueanatomyinre- lationship to the proposed prosthesis is a tremendous advantage in attempting to follow the principles of prosthetically driven implant dentistry. This facilitates restoration,optimisesfunctionalforcesontheimplant fixture,andimproveslong-termimplantsuccess. AnotherbenefitofCT-guidedimplantsurgeryisthe abilitytoperformtheprocedurethroughaminimalin- cision.Thisispossiblebecausetheunderlying3-Dbony anatomy is known preoperatively. Also, since the sur- gical guide directs the position, angulation and depth ofeachdrill,thesurgicaltimeissignificantlyreduced. This translates to an easier post-operative course for the patient. Because the implant is placed in the ideal position, functional loads on the implant fixture are more ideal. This helps maintain optimal peri-implant bone levels and reduces the failure rate. The resulting time saved can be used by the surgeon to schedule anotherconsultation,surgery,orrecreationalactivity. The following cases demonstrate the types of implant treatment plans that can be treated using 3-D CT-guided surgical techniques through the inte- grationofGALILEOSandCEREC. _Case I This first patient was a 70-year-old woman with a failingmaxillaryleftlateralincisor.Thetoothhadbeen treated endodontically many years before and had a post-retained fixed prosthesis that was subject to repeatedfailures(Fig.1).Thetoothwasnotrestorable and a decision was made to remove the tooth and re- placeitwithanimmediatelyplaceddentalimplantand provisional prosthesis (Fig. 2). The patient understood and agreed that the immediate implant and prosthe- sis would not be placed in function for three months afterplacement. A stone study model was made, and the crown of tooth #10 was removed. This modified model was captured by CEREC in order to create a digital model that represented the site after tooth extraction. The opposing dentition was captured in a Futar D Fig. 12_3-D image reconstruction from GALILEOS Implant software showing implant planning for tooth #15, based on imported CEREC virtual model and prosthetic proposal. Fig. 13_3-D image reconstruction from GALILEOS Implant software showing implant planning for teeth #2 to 5, based on imported CEREC virtual model and prosthetic proposal. Fig. 14_Panoramic reconstruction of CBCT showing proposed implant positions and abutment screw paths. Fig. 15_Prepared siCAT surgical guide for Facilitate Surgical Guide. Fig. 14 Fig. 15 Fig. 12 Fig. 13