[Oradlist] Guidelines for CT/CBCT

[SDGIMPLANT at aol.com]

Hello Ann -
 
Thank you for your thoughts.  While I certainly understand your  
suggestion, I agree with Allan when he suggests that CBCT is important as a  
diagnostic tool for dental implant placement - due to the incredible variation  in 
bone and root anatomy and clinical presentation.  
 
That stated, you are correct that the person placing the implant should  
have good training, and experience.  As it is important to handle all  
situations which may arise, with a proper clinical / surgical skill set,  wouldn't 
you agree that it is better to have an understanding of the anatomy  prior 
to the scalpel ever touching the patient?  In this way, we can plan  ahead, 
and have everything ready, without the guesswork, and full knowledge  and 
disclosure to the patient of what will be done.  In my opinion, CT  and CBCT 
imaging helps clinicians to appreciate these anatomical variations, as  each 
patient is unique, allowing us to have a sound basis for our  decision-making 
process.
 
I, and perhaps many on this list, can cite a myriad of what  appeared to be 
simple, single tooth cases - immediate extractions even, where  the bone 
topography was completely different that what appeared on clinical  exam, 
panoramic or periapical radiograph.  In fact sometimes the single  tooth 
application presents the most challenge - especially in the  esthetic zone with 
convergent roots, or facial concavities.
 
Perhaps discussions like this help us to understand what type of  
guidelines should be recommended - based upon sound clinical judgement  which relates 
to the treatment at hand.  The end result should be a more  favorable 
outcome for the patient, the surgeon, and the restorative  dentist.
 
Best regards to Denmark!  
 
Scott
________________________________________________________
Scott  D. Ganz, DMD
Prosthodontics, Maxillofacial Prosthetics & Implant  Dentistry
President Computer Aided Implantology Academy: _CAI Academy_ 
(http://www.caiacademy.org/)  

158 Linwood Plaza -  Suite 204 Fort Lee, NJ 07024
TEL: (201) 592-8888  FAX: (201)  592-8821

Website:  _http://www.drganz.com/_ (http://www.drganz.com/) 
Computer  Aided Implantology Academy - _CAI  Academy_ 
(http://www.caiacademy.org/) 
CT Imaging Forum:   _CT IMAGING  FORUM_ 
(http://www.drganz.cncdsl.com/SIM_plant/index.htm) 
New Course Offerings: _www.kineticguidance.com_ 
(http://www.kineticguidance.com/)   





In a message dated 1/7/2010 2:52:54 A.M. Eastern Standard Time,  
awenzel at odont.au.dk writes:

Another  voice from Europe:
it would be unfortunate if new guidelines are too  bombastic on demands for 
CBCT before any implant placement. Following the  implant litterature, we 
are 
aware of the trend to install an implant  immediately after extracting the 
tooth - or if the tooth had periapical  infection - a few weeks after. This 
may become  the standard of care  at least in some regions of the jaws. In 
these cases the bone is certainly  available and no cross-sectional imaging 
needed.
In my university the  students are doing implant installation as part of 
their curriculum with  the aid from the surgeons, and we do no 
cross-sectional imaging in  connection with this. If in a few cases the 
surgeon lacks bone when  opening up, they have ways to take care of this.
Maybe the question should  be more about who is installing implants ...

all the best
Ann  Wenzel
Aarhus
Denmark



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