Dr. Richard Sable - April 24, 2009

American Dental Implant Association
The Miami Implant Update
Dr. Richard P. Sable – April 24, 2009
Current Concepts and Access to Care Issues for CBCT (Cone Beam Computerized Tomography) Scanning

· Mobile CT Scan Center
· Quality of bone, shape of bone, dentsity of bone
· Tx planning software
· What is a CT?
o Come Beam Computerized Tomogram
· Why do we use them?
o Evaluate max and mand
o Extent of alveolar ridge resorption
o Location of Mandibular nerve
o Invagination of Maxillary sinuses
o Evaluate undercuts and anomalies
o Evaluate anomalies (Pathology)
o Evaluate bone density
o Implant tx planning software
· Other uses
o TMJ Evaluation
o Airway space
· When to order it?
o Diagnostic purposes
o In every implant case?
§ Yes
o Pre-tx planning
o Post-implant placement
· Distortion… or the lack thereof
o Periapicals: 1.5-3.5mm
o Panoramic: 2.5-7.5mm
o CT Scan: 0.2-0.5mm – Essentially a 1:1 ratio
· AAOMR: 70% of case- implant sizes have been changed when tx planning with a CT Scan
· Where?
o Hospital – Medical CT Scans
o Scan centers – Medical CT Scan
o Colleague’s office
o Own one in an office - $180,000
o Precision Dx – Affordable and convenient
· How?
o Proprietary download
§ iCAT vision
o DICOM 3 file
o Tx planning software
§ PVS, Bite – Send to lab and they do waxup and make a scannable waxup with barium sulfate teeth
· Beneficiaries
o The surgeon
§ See things in 3D
§ Width of ridge
§ Height of idge
§ Bone density
§ Bone grafting success
§ Location of mandibular nerve
§ Location of maxillary sinus
o Measures bone density in Hounsfield units
o Tx planning w/o surprises
§ Grafting?
§ Type of graft?
§ Harvesting sites
§ Exact placement and parallelization of dental implants
o The restorative dr
§ Optimal occlusion
· Esthetics
o Emergence profile
o Allows you to control the case and the implant team
o The patient!
§ Low post-op pain
§ Heals quicker
§ Pt can understand tx plan
· Is 3D imaging the standard of care
o Now at the pt of informed refusal level