CAD0110

20 I I case report _ CT-guided implant surgery _Way back in 2005, I was listening to a speaker discuss a new way of placing dental implants that would revolutionise the process. He showed a video ofanelderlySwedishmanstrollingintoadentalclinic with a bag full of ill-fitting dentures, and walking out laterthatsamedaywithfullyimplant-supportedfinal prostheses.Theprocessused3-Dcomputedtomogra- phy (CT) imaging to plan the implant placement, and thenacustomsurgicalguidewasmadethatfacilitated the flapless placement of a dozen or so implants so precisely that only minimal adjustments would be necessary to the prefabricated fixed bridges. The cost of this treatment was about US$100,000, rendering itbeyondreachforthemajorityofpatients. Thiswasanenlighteningmomentforme,asIsawthe potentialinthistechnique.Assoonasitwasavailablein the US and the cost became more reasonable, I vowed to bring this technology into my practice so that my patientscouldbenefitfromthisamazinginnovation. Earlyin2006,IflewtoChicagoandtooktheNobel- Guide training course, and within a short time I had halfadozencasesundermybelt.Iwasamazedbyhow quicklyandaccuratelyIcouldplacemultipleimplants, and that most patients needed only a few post-oper- ative ibuprofens and were back at work the next day. Soon thereafter, I acquired SimPlant software and began using both methods for treatment planning andplacingimplants. These two pioneering systems opened the door for the current tidal wave of CT-guided implant sur- geries. For those of you not familiar with the concept, CT-guided implant surgery uses 3-D CT imaging to evaluatethebonyanatomyoftheedentulousjaw,uses this for implant planning, and then accurately trans- fersthetreatmentplantothepatientatsurgeryusing acustomsurgicalguidethatcontrolstheposition,an- gle, and depth of each drill and implant fixture. It is so accuratethatacustomprovisionalorevenfinalpros- thesis can be made that is delivered with minimal, if any,adjustmentneeded.Itisapanaceafortherestora- tive dentist because implant placement is completely prosthetically driven, not dictated by the surgeon’s whimifthereareanatomicalsurpriseswhenthetissue isflappedopen.Theanatomyisknownwith3-Daccura- cybeforesurgery,andshouldboneortissueaugmen- tation be necessary to position the implants properly, thisinformationisknownaheadoftimeandadditional procedures are planned. The result is perfectly placed implants in ideal bone that are straightforward to re- storeandfunctionproperlynearlyallofthetime. Even though I did not use CT-guided surgery for every implant case, I probably completed a hundred cases or more in those first two years. It was a very time-consumingprocess.Ihadtohavethelaboratory makearadiographictemplate,arrangeforthepatient to have a CT scan, have the scan redone should the technician not have followed the protocol exactly, Fig. 1_Pre-op view of failing tooth #10 in a 70-year-old female patient. Fig. 2_Pre-op radiograph showing a horizontal fracture, root canal treatment and a cast post. Fig. 3_CEREC 3D virtual model with proposal of provisional restoration. CAD/CAM 1_2010 “Once you’ve tried it, you can’t drink anything else” Author_ Dr Jay B. Reznick, USA Fig. 1 Fig. 2 Fig. 3