CDEN0310

I 19 clinical report _ imaging I cosmeticdentistry 3_2010 _Consultative and treatment planning Once the examination and diagnostic records have been collected, the process of interpretation, diagnosis, treatment planning and consultation come into play, with a myriad of applications to facilitate those processes. Current state-of-the-art systems are based on 3-D applications, but there are systems even for those who have been most conservative with technology applications. With a minimum investment in a laptop computer, a dig- ital camera and software, a dentist can incorporate digital treatment planning and interactive con- sultation by using XCPT (XCPT, LLC). XCPT provides visuals of proposed treatment, such as crowns, bridges and implants on the patient’s X-rays, CT scans, or photographs. The software saves time, reduces paperwork, streamlines workflow in the office and allows patients to grasp treatment con- cepts quickly and intuitively (Fig. 5). When it comes to working in 3-D, there are a number of software applications that import DICOMfilesfromanyCTorCBCTunit,andthenallow you to plan your case more accurately and many of these programs will also allow you to have a sur- gical guide made for guided implant surgery and immediate prosthetic restoration. ProgramssuchasInVivo(Anatomage,Inc.),Dolphin Imaging and Management Solutions, NobelGuide (Nobel Biocare) and SimPlant (Materialise Dental, Inc.) will all help you analyse your CT or CBCT scan and plan your implant treatments, but surgical guide construction can be influenced by which im- plant system you choose to work with. If you work primarily with Nobel Biocare im- plants, NobelGuide—their proprietary software appli- cation—will allow you to format the DICOM data file from any CT or CBCT unit, design the case and directly order the surgical guide along with all the implant surgical, prosthetic hardware needed to complete the case. By working with a laboratory that has the NobelGuide software, your provisional prosthesis can also be constructed from the CT or CBCT data set (Figs. 6a–d). Thereisagrowingtrendtowardsguidedimplant surgery. The benefit for the patient is that the sur- gical placement of implants and the insertion of the prosthesis can be done during the same visit. This is more costly but there is always a premium for the convenience. The challenge is that there is no room for error, so the dentist has to be prepared with a back-up plan, should there be complications during surgery. _Cosmetic imaging Cosmetic imaging has been around for over 20 years, but recently a company has taken this ap- plication to the next level. Dental GPS (Dental GPS, Inc.) can simulate anything, from whitening to full- mouth reconstruction, with the subtle twist that it can morph the teeth into the existing soft-tissue envelope.Whatthismeansisthatitcanfacilitatethe predictabilityofyourprovisionalandfinalprosthesis from the photographic simulation. By using the Kois Dento-Facial Analyzer System (Panadent) with face bow, the simulation can give the laboratory a guide to waxing up the case for provisionals (Figs. 7a–d). _Imaging communication Oneofthemostsignificantadvantagesofdigital imaging is the ability to share images with col- leagues for referral or second opinions. It facilitates interdisciplinary care and can save patients signifi- cant time and money. In today’s fast-paced society, time is becoming a very limited commodity. Once youhaveexaminedthepatientandhaveuncovered conditions that require other input, you can upload any kind of digital file and send it to any number of colleagues for input. We have been using an appli- cation called Transnet (Transcend) since 2000, which has significantly reduced the need for spe- cialty consultation prior to treatment. We have been using the same network of spe- cialists for years and know the information they Fig. 8_Multiple open windows of different file types in Transnet. Figs. 9a & b_Example of radiographic report and report images returned by radiologist. Fig. 9a Fig. 9b Fig. 8