Predictable, safe implant placement aided by CBCT

Dr. Justin Moody writes that even when using BioHorizons implants, it’s best not to discover the presence of three mental foramens and a canal traveling forward from the mental foramen during surgery. Thanks to the benefits of CBCT, this surgery proceeded smoothly.

Dr. Justin D. Moody discusses 3D imaging and its profound impact on implant decisions

Implant dentistry has been changed forever by the development of cone beam CT for the diagnosis and treatment planning of dental implants. From the introduction of this technology, we began to view implant surgery differently. No longer did we have to reflect large flaps to visualize the mental foramen or use calipers to acquire the width of the ridge. Today we use this technology to visualize the anatomy, making surgery more predictable and safer. This imaging modality offers the ability to create surgical guides, which are so prosthetically driven that temporary restorations and, even in certain situations, the final prosthetic can be delivered at the time of surgery.

Today in my practice, the CBCT unit is the patient’s first stop, as there is no need to enter into a consultation without this information. Imagine the time you can save during your initial exam when you have already seen the anatomy, nerve, and virtual implant placement positions. Knowing this information allows you to concentrate on the patient’s health history, chief complaint, and desired prosthetic outcome.

Recently, I was reviewing the CBCT from a new patient who was here for full-arch restorations. In reviewing the 3D rendering, I noticed that there were three openings on the patient’s left mandible. I had not seen this before, so it had my full attention. Upon mapping out the nerve in the ACTEON® AIS software, I discovered that the patient actually had three mental foramens on the left side. My review of the left side showed that there was a distinct incisal canal traveling forward from the mental foreman as well. These are all very important discoveries in the treatment planning of an all-on-X; implant positions are critical in maintaining proper A-P spread as well as screw-access openings. The ability to use the manufacturer’s virtual implant is important in the process. In this case, I have six BioHorizons® Tapered Pro line implants planned. Virtually planning and reviewing make the surgery go more smoothly, eliminating as many of the unknowns as possible, and making implant placement a “non-event” in your practice.

Figures 1 and 2 (left & Center): 1. 3D rendering of the mandible done with ACTEON AIS software. 2.Cross section of CBCT showing bifurcation of the mental foramen; Figure 3 (right): ACTEON AIS software makes it easy to draw the IA nerve on the mandible; it even allows for interesting anatomy such as this case with three foramens
Figures 4-6: 4. 3D rendering showing the three exits of the nerve in the case. 5. Virtual placement of the this BioHorizons 4.6 mm x 12 mm Tapered Pro implant. Measurements can be made to determine the restorative space needed and to estimate how much alveoloplasty this ridge will need. 6.The entire mandible plan is made possible by ACTEON’s extensive library in cooperation with companies like BioHorizons that give them the files to allow for such precise placement
Figure 7: Trajectory of the implants can be seen here. This allows us to see where the screw-access holes could be and the positions

If you are placing dental implants and have not embraced this technology, what are you waiting for?  My first CBCT in 2006 was nearly $225,000; recently, we upgraded this machine with the ACTEON Prime CBCT for only $50,000. You can’t afford to not have this in your practice.

Besides BioHorizons implants, Dr. Moody appreciates when technology plays well together. Read his thoughts on this topic here: https://implantpracticeus.com/when-technology-plays-well-together/.

Justin D. Moody, DDS, DABOI, DICOI, is a Diplomate in the American Board of Oral Implantology, Diplomate in the International Congress of Oral Implantologists, Honored Fellow, Fellow and Associate Fellow in the American Academy of Implant Dentistry, and Adjunct Faculty at the University of Nebraska Medical Center. He is an internationally known speaker, founder of the New Horizon Dental Center (nonprofit clinic), and Director of Implant Education for Implant Pathway. You can reach him at justin@justinmoodydds.com.

 

Disclosure: Dr. Moody is a paid consultant for BioHorizons®. Dr. Moody has no contract or financial interest in Acteon®.

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