The 3-D anatomical information from a CBCT scan is now being combined with photographs of a patient’s face and digital impressions of the patient’s dentition to create a surgical guide for tooth replacement with dental implants. This is a true digital/prosthetic-based surgical workflow.
This month’s Implants Today focus is on future trends in implant dentistry. We conducted an interview with one the members of our Implants Today advisory board, Dr. Michael Scherer, dealing with issues related to this topic. Dr. Scherer talks about his experience as an implant dentist and also about how his passion for technology has helped his practice career. He discusses how printed guides, as one example, are changing the way he practices, allowing directed implant placement. This is a great vignette into the future of implant dentistry.
Technology is certainly behind many aspects of the future of implant dentistry. Most of the technological advances that are being utilized now, and in the future, are based on cone beam CT (CBCT) imaging. With the data obtained from a CBCT, many areas of implant treatment can be assisted and brought into a digital workflow. The 3-D anatomical information from a CBCT scan is now being combined with photographs of a patient’s face and digital impressions of the patient’s dentition to create a surgical guide for tooth replacement with dental implants. This is a true digital/prosthetic-based surgical workflow.
As Implants Today board member Dr. Scott Ganz has said, “We still need to use our minds for these plans on many levels. IBM’s Watson computer is a great data resource, but there are certain intuitive decisions that, at this point in time at least, the human mind can still make best. All the digital information can be available, but the bottom line is that we are humans treating humans.”
Digitally created CAD/CAM implant surgical guides are very predictable for single-tooth replacement when the guides are supported by stable adjacent teeth. Generally speaking, having a stable hard-tissue reference for a guide offers the most predictability. If an implant is going to be placed through a guide sleeve, then the stability of that implant can be tested through an implant stability meter such as the Ostell ISQ meter. This is yet another example of technology making a difference for treatment.
It is my opinion that when guides are used for full-arch tooth replacement with extractions involved, there needs to be more of a human intuitive element involved. There are full-arch guided systems being promoted that are based on CBCT scan information estimating post-tooth extraction anatomy and density. When that anatomy or bone density turns out to be different after teeth are extracted, then the preplanned guide can become clinically challenging. In situations where the anatomy turns out different than the plan, the clinician needs to be able to complete the case without the guide, if required. While safe aviation relies upon instrumentation during landings and takeoffs, a pilot still needs to be capable of flying the plane without guidance at times. The same holds true for any clinician doing implant dentistry.
If you have any questions or comments about this topic, or any other subject presented in Implants Today, feel free to contact Dr. Tischler at mt@tischlerdental.com.
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