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22 I I feature _ interview _Imagine a technology that brings the most de- tailedknowledgeofthepatient’sdentalanatomyand greater treatment predictability right into the dental office. A good imagination is no longer necessary to achieve this goal. That technology, CBCT imaging, is notjustadentaldaydreambutalsoarealityeveryday inmanydentalofficesnationallyandinternationally. Three-dimensional technology is already rede- fining dental outcomes across a broad spectrum of treatment options, including implants, bone grafting, oral surgery,orthodonticsandendo- dontics. The ability to capture a 3-D image of the mouth and to view it from all angles, together with the capability of rotating that 3-D mode and zooming in on details, can only result in moreeffectivedentaltreatment. With cone beam, all of the information can be coordinat- ed for integration with other applications, such as guided implant placement software or CAD/CAM.Sincethei-CATandtheGXCB-500capture scans in DICOM format, clinicians can combine this high-resolution data with digital 3-D impression scan data to perform restorative-driven implant planning and take advantage of CAD/CAM milling (Fig. 1). Software navigates the clinician through the planning process using virtual implants. CAD/CAM yields a surgical guide that ensures the plan trans- lates into precise placement of the actual implants and facilitates final implant restoration milling. Par- ing these two technologies ultimately reduces the risk of poorly placed implants. Dentists who have already implemented 3-D technology are seeing results, from more proficient diagnosis to more defined treatment planning and increased case acceptance. CAD/CAM spoke to Dr Steven Guttenberg, owner of i-CAT, and Dr John Flucke, owner of GXCB-500 HD, who share their experiences on how CBCT is helping to change the face of dentistry across a wide range of procedures. _CAD/CAM: Howisdentalimagingbroadening thescopeofdentalproceduresforthegeneraldentist aswellasspecialists? Dr Guttenberg: With 3-D imaging, the dental profession is experiencing a real paradigm shift. Dental radiography has come a long way from the first X-ray taken by Wilhelm Roentgen of his wife’s handinDecemberof1895.However,evenwithapan- oramic radiograph, we are getting a 2-D representa- tion and making diagnostic and treatment decisions for a 3-D object. CBCT imaging gives dentists the opportunity to diagnose and plan treatment more efficiently. While I thought that I would use my i-CAT primarily just for implant procedures, I now use it for everything— takingoutatooththatisclosetothenerve,exposing atoothfororthodontics,forimplants,TMJtreatment and trauma. Three-dimensional imaging touches all aspects of dentistry, from endodontics looking at teeth cross-sectionally, to orthodontics for non- surgical treatment or for integration for SureSmile robotic archwire technology. When I think about the many ways that scans canbeviewedandthescopeofinformationthateach scanprovides(Fig.2),thelistofproceduresthatcanben- efit from this technology just keeps getting longer— Iuseitforextraction,pathology,orthognathicsurgery, airway studies, dento-maxillofacial trauma, implants, bonegraftsandevaluationoftheparanasalsinuses. _Whattypeofdentistreallyneeds3-Dimaging? DrGuttenberg:BeingattheInternationalCongress on 3-D Dental Imaging last year was an eye-opening experience. I witnessed how doctors of different specialties and general dentists use this innovation. For any practice to expand and improve, a dentist must embrace change. Physicist Thomas Kuhn, who firstcoinedthetermparadigmshiftin1962,notedthat scientific advancement is not evolutionary, but is rather “a series of peaceful interludes punctuated by intellectually violent revolutions. In those revolutions oneconceptualworldisreplacedbyanother.” Cone beam, to me, represents a revolutionary conceptinimaging.Sixorsevenyearsago,itwasjust CAD/CAM 2_2010 “Three-dimensional imaging touches all aspects of dentistry” An interview with Dr Steven Guttenberg & Dr John Flucke, USA Fig. 1 Fig. 1_Proficient technology: Restorative-driven implant planning.