Artifacts / / Read Article

CASE PRESENTATION: Virtual Implant Planning Using CBCT

Categories:

Author(s):

Date: 01-18-2021 10:45:25 am

  A 62-year-old male patient with poor oral hygiene habits presented with pain in all 4 molars. Additionally, he was dissatisfied with his chipped, discolored front teeth and “gap tooth smile” (Figure 1). His pain prevented him from eating the foods he liked and getting out and being social, and he feared that dentures were his only option. The patient also had severe anxiety about dental visits. A perio exam revealed a Type II classification, and all molars were found to be nonrestorable due to deep decay and multiple areas of abscess.
 

Treatment Plan

 

After discussing all options, a phased treatment plan was developed to allow the patient to budget:

  1. Removal of pain and infection through perio therapy, extracting hopeless teeth, and bone grafting of extraction sites
  2. Decay removal
  3. Cosmetic treatment to include wax-up of anterior teeth, whitening, and placement of anterior crowns
  4. Replacement of missing teeth using CBCT, virtual surgery, surgical guides, and implants

  Due to his treatment anxiety, the patient expressed interest in trying sedation for his initial treatment and was prepped following the Dental Organization for Conscious Sedation protocols. Periodontal therapy was completed using the NV Microlaser (DenMat), and molar teeth were extracted atraumatically using Physics Forceps (GoldenDent) (Figure 2). Socket preservation was completed using freeze-dried bone product (OsteoLife Biomedical). After this initial treatment, the patient said he felt as though he slept through the entire appointment was ready to continue treatment to replace his missing teeth and increase the esthetics of his smile.

  Six months later, a diagnostic wax-up was completed for his 4 front teeth (Glidewell Laboratories) (Figure 3), providing a blueprint to help simplify crown placement. The front teeth were prepped for BruxZir Anterior crowns (Glidewell Laboratories) using an ELECTROtorque handpiece (KaVo Kerr), and 2 weeks later, the crowns were cemented using RelyX luting cement (3M). The patient wanted his post-treatment smile to be whiter, so in-office whitening was also performed with Zoom QuickPro (Philips).
 


Image-Guided Implant Surgery


  A cone beam image was taken with the OP 3D Pro (KaVo Kerr) (Figure 4). Cone beam images—in addition to allowing me to actually see what I need to effectively and confidently come up with a plan and offer more predictable, safer, and efficient treatment—play a key role in implant surgery. Here, the high-quality cone beam image was used in the fabrication of surgical guides (Anatomage Labs) using Invivo software (Figures 5a and 5b), and I was able to virtually plan for implant placement. Virtual surgery allows me to perform prosthetically driven dentistry and increases patient safety by identifying and avoiding vital structures. Implants (OCO Biomedical) were placed using the surgical guides in the location of teeth Nos. 3, 14, 19, and 30 (Figure 6a and 6b).

  At his postoperative appointment, the patient reported only very minimal discomfort from his implant surgery. He was delighted with his temporary crowns, and he was even more thrilled when he saw the final crowns (Figure 7). The patient has his self-confidence back and advised that he is ready to get out there again and start dating.

Disclosure: The opinions expressed and procedures described are those of Dr. Ghaboussi. KaVo Kerr is a medical device manufacturer and does not dispense medical advice. Clinicians should use their own judgment in treating their patients.





GO-TO PRODUCT USED IN THIS CASE


OP 3RD PRO


  The ORTHOPANTOMOGRAPH OP 3D Pro, formerly the OP300, is a comprehensive 3-in-1 platform indicated to treat the entire maxillofacial region. Using the latest in 2D and 3D technologies, it offers a versatile selection of volumes and resolutions, intuitive patient positioning, and automatic dose control technology. A large, easy-to-use 10-inch user interface ensures easy capturing of high-quality images. The unit is designed as an expandable and upgradeable platform with a cephalometric option available.

Article 42 of 44

Online Continuing Education / Course Details

ADA Credits: 1 | AGD Credits: 1 | Cost: $19.00

A Paradigm Shift in Intraoral Scanning for Better Clinical Results

Categories:

Author(s):

Course Type: Self-instruction journal and web based activity

Target Audience: Dental Assistants, Dental Hygienist, Dentists from novice to advanced

View Video

Educational Objectives

• Determine if this technology is right for you and your practice
• Develop an understanding of intraoral scanners and their clinical applications
• Recognize that not all IOS scanners are equal

Abstract

Digitizing your impressions comes with amazing benefits for clinicians and patients. An intraoral scanner will not only simplify your current workflow, but also increase your overall production. It will provide you and your lab with more accurate information than traditional impressions, and give you the ability to design and manufacture: crowns, aligners, surgical guides, and a variety of other devices in office.

When purchasing an intraoral scanner there are many things to consider, and with the growing number of products on the market, making a decision can become a daunting task.

Dr. Justin Moody will walk you through a typical day in his practice and show how this technology has changed the way he practices and the impact it has had on his patients and staff.

ADA Credits: 1 | AGD Credits: 1 | Cost: $19.00

Course 126 of 128

Online Continuing Education / Course Details

ADA Credits: 1 | AGD Credits: 1 | Cost: $19.00

Aesthetic Natural Teeth and Implant Cases using 3D Face Scanning and Smile Design

Categories:

Author(s):

Course Type: Self-instruction journal and web based activity

Target Audience: Dental Assistants, Dental Hygienist, Dentists from novice to advanced

View Video

Educational Objectives

After completing this webinar, participants will be able to:

•Compare and contrast conventional and digital impressions 
 
•Determine what digital treatment planning is and why it is essential
 
•Comprehend digital dentistry workflow and the critical steps in the treatment process
 
•Discover the tools available that make dentistry more accurate, more predictable, and more fun 

Abstract

As technology has evolved, there is no exception in dentistry. The digital impression is not just taking an imprint, but rather is a transformation in the way we treat our patients. This session will discuss the many essential tools for the dental practice of today and tomorrow. Come see simple tools that will improve communication between clinicians, patients, and the dental lab and how these important elements significantly enhance patient understanding, resulting in increased case acceptance. Move more of your patients from consults to action.

ADA Credits: 1 | AGD Credits: 1 | Cost: $19.00

Course 125 of 128

Artifacts / / Read Article

CBCT: Guiding Clinicians to Informed Decisions with PERRY E. JONES, DDS, MAGD, IADFE

Categories:

Author(s):

Date: 09-21-2020 08:06:32 am



Q: How has CBCT changed your practice?
A: CBCT can be compared to a Swiss army knife in that it is a multipurpose tool. Using CBCT, I’m able to collect general diagnostic data, evaluate implant sites, plan implant surgeries, fabricate surgical guides, generate radiology reports, evaluate sites for endodontic treatment, diagnose TMD, evaluate and make critical measurements related to airway and sleep studies, and evaluate patients for orthodontic treatment. The accuracy, quality, and versatility of CBCT has allowed me to provide a higher level of care to my patients. To put it simply, CBCT provides me with better data. The end result is informed clinical decision-making.

Q: What is a good example of a case where CBCT saved the day?
A: I have a specific case where I was planning an implant surgery for a patient, and was in the process of designing a surgical guide using CBCT and intraoral scan data. While virtually planning the case, I found a periapical lesion at the root of an adjacent tooth. If I had placed the implant without knowledge of this lesion, the implant would have certainly failed. The ability to evaluate bone accurately using CBCT allowed me to treat the tooth in question before the implant was placed. Without CBCT, this surgery would not have been successful.

Q: Can you tell us about the study you conducted?
A: I did a study of 100 CBCT scans taken for “routine” diagnosis, and I compared them to commonly used 2D panoramic images. Out of the 100 cases, 36 presented with pathology that was not identified using conventional 2D imaging. So, we missed diagnostic data about one-third of the time! That finding has been repeated in the dental and medical literature in multiple studies. And that is because, in 2D, we see 2 dimensions: height and width. With 3D data, we see all 3 dimensions: height, width, and depth.

Q: What does having CBCT in your practice do for ROI?
A: CBCT drives income into my office daily. Every periapical lesion I find using CBCT data results in endodontic treatment followed by crown placement. CBCT is also an integral part of my implant service. I use CBCT data to plan implant placement and fabricate surgical guides. CBCT allows doctors to plan implant restorations prior to placement. This cuts down on unnecessary costs and adjustments related to improperly placed implants. CBCT has many uses that allow practices to better serve their patients.
Article 37 of 44

Online Continuing Education / Course Details

ADA Credits: 2 | AGD Credits: 2 | Cost: $29.00

2D vs 3D Imaging in Endodontics: CBCT Application in Modern Endodontic Treatment

Categories:

Author(s):

Course Type: Self-instruction journal and web based activity

Target Audience: Dental Assistants, Dental Hygienist, Dentists from novice to advanced

Educational Objectives

After completing this course, the reader should be able to:

1. Discuss the American Association of Endodontists and American Academy of Oral and Maxillofacial Radiology joint position statement on the use of CBCT in endodontics.

2. Explain how to use CBCT 3D imaging to evaluate unusual or complex anatomy of root canal systems, calci­ ed canals, and periapical pathosis.

3. Describe how to assess sinusitis of endodontic origin using CBCT imaging.

4. List other documented advantages of the routine use of CBCT in endodontics.

5. Discuss the impact of 3D imaging in decision-making in endodontics.


Download this course PDF

________________________

Abstract

The use of cone beam computed tomography (CBCT) in endodontics has expanded in recent years. 3D imaging adequately supports the interpretation of dental anatomy and surrounding areas during root canal therapy. To assist decision making in endodontic cases, experts recommend small field-of-view (FOV), high-resolution CBCT imaging for diagnostic and treatment planning as well as for intraoperative procedures and managing cases post-treatment. This article presents some examples of everyday clinical cases to illustrate how CBCT images can help diagnose, treat, and solve endodontic problems.

ADA Credits: 2 | AGD Credits: 2 | Cost: $29.00

Course 113 of 128

Online Continuing Education / Course Details

ADA Credits: 1 | AGD Credits: 1 | Cost: $19.00

The Power of Chairside Milling: An Overview of Scanning, Designing and Milling for Single Visit Restorations

Categories:

Author(s):

Course Type: Self-instruction journal and web based activity

Target Audience: Dental Assistants, Dental Hygienist, Dentists from novice to advanced

View Video

Educational Objectives

After completing this webinar, participants will be able to:
-Learn the advantages of intraoral scanning how digital impression workflows differ from traditional impression-taking methods
-Examine the importance of capturing a clear and accurate digital impression that fully captures the patient’s dentition
-Review the clinical implications of digital impressions and how they can be used to facilitate single-visit restorations
-Explore the chairside milling workflow as a completely digital CAD/CAM solution
-Gain an understanding of the adhesive ceramic materials available for chairside milling
-Study the benefits of using 3D printing technology to fabricate surgical guides

Abstract

Take a deep dive into the clinical workflows of digital impressions. Explore milling, conservative ceramics, digital smile design and 3D printed surgical guides. Participants will understand the how to leverage a completely digital CAD/CAM solution for greater efficiency, increased quality control and exceptional restorative outcomes.

ADA Credits: 1 | AGD Credits: 1 | Cost: $19.00

Course 100 of 128

Online Continuing Education / Course Details

ADA Credits: 1 | AGD Credits: 1 | Cost: $19.00

The Power of 3D Imaging: Transitioning from 2D to 3D in Private Practice

Categories:

Author(s):

Course Type: Self-instruction journal and web based activity

Target Audience: Dental Assistants, Dental Hygienist, Dentists from novice to advanced

View Video

Educational Objectives

Learning Objectives
After completing this webinar, participants will:
»     Learn how 3D Imaging leads to faster, more accurate diagnosis.

»     Understand how 3D Imaging simultaneously expands your knowledge, increases the enthusiasm of your team, and adds to the scope of procedures you can provide. 

»     Understand how 2D/3D imaging will immediately bring new revenue into your office 

»     Recognize the multiple avenues to ROI when investing in 3D Imaging.

Abstract

Making the transition from 2D to 3D is like stepping into a whole new world. In this webinar, Dr. Daron Clark will illustrate the differences in workflow and diagnostic protocols offices experience when implementing CBCT technology. He’ll also shed light on some strategies he used to prepare himself and his staff for working with CBCT images, the training necessary to harness the full potential of CBCT and how to leverage it for practice growth.

Supported through an unrestricted educational grant from Planmeca

ADA Credits: 1 | AGD Credits: 1 | Cost: $19.00

Course 97 of 128

Artifacts / / Read Article

CASE PRESENTATION: Stabilizing a Maxillary Denture With Narrow-Diameter Overdenture Implants

Categories:

Author(s):

Date: 05-13-2020 08:00:19 am


A healthy 75-year-old female presented with a loose maxillary complete denture and the desire to place implants to assist the denture to remain in place. Approximately 20 years ago, she had implants placed on her mandibular arch and an implant overdenture fabricated. She was always told, however, that her bone was insufficient in her maxillary arch for implants. She was referred to the author’s practice for evaluation for narrow-diameter implant placement.

A CBCT scan of the patient was made using cotton rolls for occlusal and soft-tissue separation in combination with a radiopaque PVS impression liner placed on the intaglio of her maxillary denture to enhance the radiographic visualization. A second CBCT scan of the denture was made and an extraoral digital impression was used with an intraoral scanner (3M True Definition Scanner, 3M). Six 2.4 mm x 12 mm Zest LOCATOR Overdenture Implants (LODI, Zest Dental Solutions) were planned in the computer software (Invivo, Anatomage). A computerized surgical guide was planned and fabricated (Anatomage Guide, Anatomage).

The patient was anesthetized, complete adaptation of the surgical guide confirmed, osteotomies prepared, and implants were placed using a minimally invasive technique. Recesses in the denture were prepared using specialized burs specifically designed for overdentures (Denture Prep & Polish Kit, Zest Dental Solutions). LOCATOR abutments (Zest Dental Solutions) were attached to the implants and connected the denture the same day using an overdenture attachment material (CHAIRSIDE, Zest Dental Solutions). The LOCATOR Black Processing Male inserts were kept inside the denture, and the patient was seen for recall 8 weeks later, when the tissues were fully healed. At the recall appointment, the inserts were changed from the processing males to the light, standard-range retentive male inserts. The patient was followed up over the course of several years and has continued to report a high degree of satisfaction.

Figure 1
Fig 2- 10
Article 20 of 44

Artifacts / / View Webinar

The Power of 3D Imaging: Transitioning from 2D to 3D in Private Practice

Categories:

Target Audience: Dental Assistants, Dental Hygienist, Dentists

Duration: 1 hour 9 minutes

Synopsis

Making the transition from 2D to 3D is like stepping into a whole new world. In this webinar, Dr. Daron Clark will illustrate the differences in workflow and diagnostic protocols offices experience when implementing CBCT technology. He’ll also shed light on some strategies he used to prepare himself and his staff for working with CBCT images, the training necessary to harness the full potential of CBCT and how to leverage it for practice growth.


 

Dr. Daron Clark received his Bachelor of Science degree in biology from Mississippi College. He went to receive his DMD from University of Mississippi Medical Center, School of Dentistry in 2007. He is a member of the American Dental Association, the Tennessee Dental Association, the American Academy of Cosmetic Dentistry, and the Academy of Laser Dentistry. His passion for continuing his education and. His continual search for more advanced dental technologies has led him to progressive training in laser dentistry and an associate fellowship with the World Clinical Laser Institute

Webinars 6 of 7

Online Continuing Education / Course Details

ADA Credits: 2 | AGD Credits: 2 | Cost: $29.00

Impacted Canines: Etiology, Diagnosis, and Management

Categories:

Author(s):

Course Type: Self-instruction journal and web based activity

Target Audience: Dental Assistants, Dental Hygienist, Dentists from novice to advanced

Educational Objectives

The overall goal of this article is to provide the reader with information on impacted canines. After completing this article, the reader will be able to:

1. Describe the radiographic investigations that may be required to assess impacted canines
2. List etiological factors for impacted canines
3. Review the rationale for interceptive orthodontics and methods used in intercepting impacted canines
4. List and describe treatment options and considerations involved in the treatment of impacted canines.

Download this course PDF
_________________________________________

Abstract

Impacted canines are frequently encountered in clinical practice and a common obstacle during routine orthodontic care. While canine impaction is multifactorial, the exact etiology is not always known. Impacted canines should be identified and diagnosed as early as possible to determine and permit the best path of treatment. In some cases, interceptive orthodontics at a young age can resolve canine impaction; for example, by extracting the primary canine and/or the primary first molar. Treatment options for impacted canines include extraction of primary canines and molars, rapid maxillary expansion, canine substitution, autotransplantation, surgical exposure, and orthodontic extrusion, and for those with a poor prognosis, extraction.

ADA Credits: 2 | AGD Credits: 2 | Cost: $29.00

Course 45 of 128