CT-guided implant surgery: you have nothing to fear but fear itself!

Dentists can be a funny bunch. We all, for the most part, like new technology and gadgets, yet it is very difficult for some of us to change the way we do things, especially when it comes to our practices. Some of our colleagues would be content if they could continue doing procedures and using clinical techniques just as they learned them in dental school. If they never had to learn anything new, they would be very content. Fortunately, I am privileged to be associated with a very select group of forward-thinking, technology-embracing, progressive and sophisticated dentists. I am speaking, of course, of Townies. On September 18, 2009, a few hundred Townies and similar 21st Century dentists witnessed history in the making – a true milestone in the practice of dentistry, that represents only a tip of the iceberg of what is to come. This event was the first live presentation of the merging of the two most significant technological advances in dentistry since the first dental radiograph was taken in 1896. The first is the CEREC CAD/CAM system, which allows dentists to accurately scan a dental preparation and then create a restoration that is milled from a solid piece of ceramic or composite material. The second is the GALILEOS cone beam CT scanner. This revolution in implant dentistry transfers the image of the dental and soft tissue topography in and around an edentulous space into a three-dimensional radiograph of the patient’s jaws. This information is then used for the planning of dental implants. This is the next quantum leap in the evolution of CT-guided dental implantology. It is my belief that, within 10 years, CT-guided implant surgery will become the standard of care (I hate using this term) for implantology. There are already a number of dental implant manufacturers who have embraced this technology and developed CT-guided surgical kits for their implant systems. There are also a number of fine software packages on the market that allow for CT-based implant planning and the manufacture of a guided surgical stent. So, for those of you who are not familiar with this technology, I will elaborate. When I began practicing almost 20 years ago, implant surgeons would plan their dental implant placement off of a study model and panoramic radiograph. We would lay a large flap to visualize the bony anatomy and place the implants to engage the greatest volume of bone. Six months later, we would uncover the implants and send the patient to their restorative dentist and hope that the implant fixtures were positioned well enough to be restored. Sometimes they were. Sometimes they were not, in which case, the implant would be “buried” and never restored. Fortunately, today we are a little smarter. Implantology today is, at least theoretically, restoratively driven. That makes sense, since the goal of tooth replacement therapy with dental implants is to give the patient a functional and aesthetic prosthesis to restore their chewing function and self-confidence. However, most dentists today still use a stone model and panoramic radiograph to design the surgical stent. Sometimes at surgery, it is discovered that the implants cannot be placed where desired, and so the implant position or angulation is cbct integration & oral surgery feature