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24 I I case report _ CT-guided implant surgery (Kettenbach) bite registration and the prosthetic pro- posal was created in CEREC (Fig. 3). The digital model and prosthetic proposal were then imported into GALILEOS. The ideal implant size and position were determined within the GALILEOS scan, based on the bony anatomy data, as well as the mucosal surface and prosthetic data from CEREC (Fig. 4). The treat- ment planning data, along with the stone model and a special scanning template were sent to siCAT, and acustomsurgicaltemplatewasreturned. This template was used in surgery once the tooth hadbeenatraumaticallyextractedinordertodirectthe placement of the implant fixture into the site of tooth #10. The position, angulation, and depth of implant placementwereallcontrolledbytheguide,sothatthe implantwasplacedexactlywhereithadbeenplanned inthe3-Dimagingsoftware(Fig.5).Aprovisionalabut- ment was placed (Fig. 6), and the patient was sent to her dentist for a digital impression and fabrication of a CEREC-produced provisional crown (Fig. 7). The procedure to remove the tooth and place the implant took under ten minutes. Post-operative GALILEOS scan images indicated accurate implant placement (Figs.8&9).Atthethree-monthfollow-upappointment, the provisional restoration was stable. The gingival architectureandtissuehealthwereexcellent(Fig.10). _Case II This second case illustrates the tremendous power of the integration of GALILEOS and CEREC for treating the partially edentulous patient. This patient was a 62- year-oldmanwithmoderatebonelossduetosmoking. He was otherwise healthy. He was missing teeth #2 to 5 and 15, and had undergone bilateral sinus-lift sur- gery to augment the bony deficiency in the posterior maxilla (Fig. 11). In preparation for implant placement, a GALILEOS CBCT scan was performed with a siCAT scanningtemplate.Afull-archdigitalimpressionwasac- quiredwiththeCERECACunit,andthenprostheticpro- posalsweredesignedforteeth#2to5and15.Thisdata wasthenimportedintoGALILEOSforimplantplanning (Figs.12&13).Thepositionoftheimplantswasverified (Fig.14)andthesurgicalguidewasorderedfromsiCAT (Fig. 15). This was used to place four Astra Tech dental implants accurately using the Facilitate Surgical Guide (AstraTech).Post-operativeradiographsdemonstrated that all four implants were accurately placed and in accordancewiththetreatmentplan(Figs.16&17).The patienthadanuneventfulpost-operativecourse. One of my favourite cocktails is the Vesper Martini, which was introduced to the world in the novel Casino Royale when James Bond asked the bartender to mix him this variation on his standard drink. Bond named thedrinkafterVesperLynd,hisloveinterestinthestory because,heconfessed,aswithher,onceyou'vetastedit, that's all you want to drink. CT-guided implant surgery isnodifferentforme.Afteryearsofplanningandplac- ing dental implants the old-fashioned way I learned in residency, I was given a taste of a new way to do so. It wasaradicalchangeatfirst,butonceIknewtherecipe, I realised that it was a faster, better and more accurate way to treat my patients. Now, I can’t drink anything else.Hopefully,youwillgiveitatastetooandagree._ Fig. 16_Post-op panoramic CBCT reconstruction showing position of placed implants. Fig. 17_3-D reconstruction of post-op CBCT showing placed implants in the right maxillary posterior region. CAD/CAM 1_2010 DrJayB.ReznickisaDiplomateoftheAmericanBoardofOraland MaxillofacialSurgery.HereceivedhisdentaldegreefromTuftsUniversity, andhisMDdegreefromtheUniversityofSouthernCalifornia,andtrained inOralandMaxillofacialSurgeryatLACounty-USCMedicalCenter.His specialclinicalinterestsareintheareasoffacialtrauma,jawandoral pathology,dentalimplantology,sleepdisordersmedicine,lasersurgery andjawdeformities.Healsohasexpertiseintheintegrationofdigitalphoto- graphy,3-Dimaging,andCT-guidedimplantsurgeryinclinicalpractice. Hefrequentlylecturesatcontinuingeducationmeetings,andhaspublishedarticlesinthe JournaloftheAmericanDentalAssociation;JournaloftheCaliforniaDentalAssociation;Oral Surgery,OralMedicine,OralPathology,OralRadiologyandEndodontology;Compendiumof ContinuingEducationinDentistry;DentalTownMagazine;CEDigest;andGastroenterology. DrReznickisafounderofOnlineOralSurgery.com,whicheducatespractisingdentistsinbasic andadvancedoralsurgerytechniques.Heservesontheeditorialandadvisoryboardsof anumberofjournalsandorganisations.HeistheDirectoroftheSouthernCaliforniaCenter forOralandFacialSurgery(www.sccofs.com)inTarzanainCalifornia,andaconsultant forvariousdentalandsurgicalmanufacturers.Hecanbecontactedatjreznick@sccofs.com. CAD/CAM_about the author Fig. 16 Fig. 17