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| EDITORIAL |
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| Year : 2012 | Volume
: 2
| Issue : 1 | Page : 1 |
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From the Editor's desk
Rajiv S Khosla
Editor, Journal of Dental Implants, Diplomate, International Congress of Oral Implantologists, Mumbai, India
| Date of Web Publication | 24-May-2012 |
Correspondence Address:
Rajiv S Khosla
Editor, Journal of Dental Implants, Diplomate, International Congress of Oral Implantologists, Mumbai
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0974-6781.96554
How to cite this article:
Khosla RS. From the Editor's desk. J Dent Implant 2012;2:1 |
 From 2-D to 3-D - The Missing Dimension II | |  |
Comprehensive diagnosis and treatment planning is the cornerstone of all that we do in dentistry. While there can be more than one treatment plan for a given case, there is but one diagnosis, and cone beam computed tomography (CBCT) has had a dramatic impact on this critical process, according to Dr. Michael Pikos, the keynote speaker at Osteogenics' 2010. CBCT, also called "volumetric tomography," represents the latest generation in medical imaging scanning machines ascending from conventional X-ray to panoramic and cephalometric X-ray to medical spiral CT. It is a tomographic scanning technology that can scan and acquire a specified volume of the patient head and generate 3-D data. Available in Europe since 1999 and introduced in the United States in 2001, CBCT is a relatively new imaging technology and arrived in India in the year 2010 in Mumbai. Now, we have between 12 and 15 such scanners in the country. We are currently enjoying the 2 nd and 3 rd generation CBCT scanners.
As we strive to meet the growing demand for implants, the value of computer-assisted, 3-D analysis has now become inseparable with treatment planning and the delivery of dental implants as well as post-procedure monitoring. The clear, virtual, revolving model of the dentition captured on the CBCT scan can be rotated, zoomed in on from any angle, and viewed in 360° to assist in the determination of the implant site as well as for the fixture's proper inclination, length, and diameter. As an added benefit, there are numerous CBCT-compatible, implant positioning software programs available, such as SimPlant, EasyGuide, InVivo5, and NobelGuide. CBCT technology allows us to avoid restricted visualization and errors, including non-uniform magnification, diagnostic restrictions in the anterior areas, missing cross-sectional information, superimpositions, cephalometric orientation, and problems of geometric distortion. In these areas, CBCT has become the leading method for evaluating dentofacial structures related to implant planning because it ensures safe and accurate implant positioning (Lucia Cevidanes et al.).
Countless clinicians have successfully placed implants using only 2-D imaging. As a result of significant information received from 3-D studies, however, practitioners can decrease potential risks and dramatically enhance predictability in results due to thorough analysis and preplanning. CBCT imaging provides important information about the 3-D structure of nerve paths, soft tissue, and bone. 3-D software can shade images to differentiate varying densities of facial structures. Grayscale shading provides the ability to view the relationships of common internal anatomy. Present-day scanners render images in 14-bit grayscale, providing 16,384 shades. Color coding the image by density further distinguishes anatomical structures. CBCT slices are as thin as 0.1mm, compared to 1mm for a conventional fan CT scan.
Generally, the 3-D rendering of bone is used to determine the proper placement and size of dental implants and to create computer-generated drill guides with stereolithography. In addition to planning the implants, it is also possible to plan for the actual restoration prior to implant placement. This provides the benefit of knowing how much space is available for restorative materials and the proper contours that are needed for esthetics and hygiene. Virtual treatment planning can determine the ideal position for restorative components, and by using computer-generated drill guides it is possible to create an ideal environment for the manufacture of the final restoration using advanced techniques. The tissue and implants can be scanned to create a virtual model of the planned final restoration. The actual casting can then be produced using a technique called layered manufacturing. Software is used to display and visualize the anatomy in a way that allows for multiplanar reformation and display. The reconstructions can occur in the axial, coronal, sagittal, curved, and oblique planes. The location, dimensions, and thickness of the reconstructions can be varied to achieve the desired results.
Current trends in software and technology development suggest that in the near future, CBCT scans will be used to develop a patient-specific 3-D model that will be used for implant diagnosis, treatment planning and simulation, implant placement and tooth replacement, thus providing us, clinicians, the missing "third dimension."
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