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Kevin Martin, D.D.S.
Dentistry today has witnessed the introduction and universal acceptance of implants. A 2007 survey of general dentists reported that more than half of general dentists offer their patients some form of dental implant surgery, and the vast majority of general dentists restore dental implants.
With so many general dentists both placing and restoring implants, the progression to affordable and practical "in-house" 3-D radiology services has allowed dentists the added benefits of significantly lowering patient radiation doses, greatly increased patient convenience, lowering patient cost, and giving complete control over implant diagnosis and treatment planning.
The state-of-the-art in implant treatment planning and placement now involves the use of three-dimensional imaging. We now have in-office an imaging machine that allow us to take a three-dimensional image at a lower cost and a lower radiation exposure yet provide an image very similar or superior to a medical CT scan.
Cone-beam computerized tomography (CBCT) is quickly becoming the standard maxillofacial imaging technology for diagnosis, surgical and implant-treatment planning.
CBCT is a computer-generated three-dimensional image of oral structures that is similar to a CT scan obtained at a medical imaging center. Cone beam images are acquired in the dental office in a manner similar to taking a digital panoramic image, which most patients have had since youth. Once generated, they allow a dentist to manipulate the image on a computer in order to plan implant surgery prior to the actual procedure. It allows the dentist to see how certain implants will "fit" in certain areas of the jaw and what the potential complications might be.
In essence, the dentist can perform the surgery before ever touching the patient or making surgical recommendations. This takes an amazing amount of the guesswork out of the surgery and vastly improves the outcome and safety to the patient.
Conventional two-dimensional periapical and panoramic imaging in general dentistry form the backbone of everyday clinical diagnosis and treatment planning. Every patient has seen a set of two-dimensional radiographs and has listened to the dentist explain what the image reveals. We have moved, just like everyday cameras, from film-based images to digitally captured images. The levels of acceptance and utilization of digitally created and rendered images is high, and dentists have successfully integrated digital imaging in dentistry.
But two-dimensional images have their limitations. From a single film it is impossible to determine where structures lie within that image in relation to other structures since all the contents lie within a single plane and depth cannot be distinguished. Two things may look like they are sitting right next to each other when in reality they are behind or in front of each other.
I have found in my practice that 3-D imaging has become indispensable in a wide range of dental diagnosis and treatment planning, to the point that there are many cases today where I cannot imagine attempting to treat a patient without the use of 3-dimensional images.
The utility in everyday dental practice is extensive, with applications in many areas of diagnosis and treatment planning, including endodontics, periodontics, orthodontics, implantology, dental and maxillofacial surgery, and TMJ analysis.
After its successful integration, it becomes evident that there are many cases where the lack of the third dimension actually diminishes the level of care being rendered. In endodontics, fractured roots, periapical pathology and accessory canals can be visualized. In treatment planning for the extraction of third molars the proximity to the mandibular nerve becomes plainly evident.
In the diagnosis of all types of pathology, visualizing the third dimension allows for a thorough understanding of the pathology's actual extent, position and relationship to adjacent anatomic structures. The third dimension is indispensable in understanding the cause of previously undiagnosed pain; in visualizing sinus pathology; in understanding the etiology of temporomandibular joint dysfunctions; in diagnosing the true extent of periodontal pathology and disease in localized areas.
In implant treatment planning, the standard of care today for many practitioners is to recommend 3-D imaging for implants for nearly every patient. The implication is not that 3-D images are required for all patients, but rather that there are cases where two dimensions are simply insufficient, and the additional third dimension becomes the only means of providing an accurate diagnosis. The presence of this technology has forever altered dental diagnosis and treatment planning, and Cone Beam Imaging has raised the bar and re-defined the standards for many areas of dentistry.
Above all, patient well-being and safety must be kept in mind. While cone beam does emit much lower levels of radiation than a CT scan, it does yield higher doses of radiation than a digital full mouth series or panoramic image.
Cone-beam is not intended to replace 2-D imaging, but to serve as invaluable adjunct in achieving the highest possible levels of care when needed. In implant treatment planning, I have come to hold the strong opinion that the best treatment option today in implant dentistry is to recommend 3-D imaging for nearly every patient I treat.
Kevin Martin, D.D.S., is a family and cosmetic dentist in Kingsport. He practices at Martin Dentistry with his father, Dr. Tim Martin. E-mail questions or topics of interest to firstname.lastname@example.org, visit www.martindentistry.net or call 247-8172.