[Oradlist] Fw: Guidelines for CT/CBCT

[Ann Wenzel]

----- Original Message ----- 
From: Ann Wenzel 
To: SDGIMPLANT at aol.com 
Sent: Friday, January 08, 2010 11:10 AM
Subject: Re: [Oradlist] Guidelines for CT/CBCT


hello all
It would be really interesting if surgeons would take part in this discussion.
What about all of you in the Oradlist who are also surgeons? Ralf Schulze and others?

One of the surgeons here is now  60, and during approximately 30 years, he has inserted 20700 implants.
He is one of the few who has kept a very detailed record on all events before, during and after the operation.
He has had to give up on five patients in whom no implant could be installed after he had opened and displayed the bone. These five could have been avoided if CBCT was used. Some of the patients had a more comprehensive operation than expected with additional surgical procedures. These could have been warned of an increased operation time and the surgeon would have been more prepared if CBCT had been performed. All patients are however told before the operation that additional procedures may be needed.
When balancing the weight, it is not only dose, but surely also all types of resources used for CBCT that should be considered.
We are trying to analyze the data from that study, but even though the data are sampled in a standardized way, the study is stll retrospective. 
We are to do prospective, randomized trials to provide the evidence needed. And not only in one country. I am sure we agree on this. So why do we see so few RCTs in our literature?

We will start a RCT on 3. molars; panoramic vs. CBCT. Maybe you will find this "alarming" or even unethical. In my opinion it is unethical not to do such studies - and the 3 surgeons involved have no problems in this since they have until now removed thousands of 3. molars based on panoramic images alone.  
We hope soon to be able to start a RCT on implants in the same way. 
And try to read the literature in e.g. Clin Oral Implant Res - in the RCTs on immediate implant placement, CBCT is never used, merely periapical radiography. To me this is both logical and ethical.

The implants inserted by students in supervision of surgeons at my place are of course in very selected patients. No evidence can be deducted from this.


all the best
Ann 




----- Original Message ----- 
  From: SDGIMPLANT at aol.com 
  To: awenzel at odont.au.dk 
  Cc: oradlist at lists.ucla.edu 
  Sent: Thursday, January 07, 2010 11:55 PM
  Subject: Re: [Oradlist] Guidelines for CT/CBCT


  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 

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

  Website:  http://www.drganz.com/
  Computer Aided Implantology Academy - CAI Academy
  CT Imaging Forum:   CT IMAGING FORUM
  New Course Offerings: 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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