When placing implants, I try to answers the questions of “how many,” “where” and “what size.” When asking “where,” bone volume plays a huge role. If I find bone deficiencies or inadequacies at the implant site, the treatment plan can go from very basic to very involved, as an autogenous bone graft may be necessary. Fortunately, cone beam computed tomography (CBCT) lets me view multiple planes in 3D. It not only reveals if there is a need to regenerate or augment bone, but also helps me identify possible donor sites for a bone graft.
The “Gold Standard”
Of course, there are is a cache of treatment options—autogenous, bone substitutes, ridge splitting, guided bone regeneration, block grafting, tissue engineering, mesh, etc—but for an oral surgeon the gold standard is the autogenous bone graft. A bone graft can stabilize the jaw, correct deformities and preserve the jaw in preparation for the next step of treatment, i.e., the implant.
Assessing a Donor Site
There’s been a big shift towards minimally invasive implant dentistry—that is, focusing on minimizing morbidity for patients. Once I’ve determined that an autogenous bone graft is the best course of action, I then use CBCT to assess possible donor sites. Since I’ve been using CBCT, I look at donor sites differently. I used to go to the hip or the leg to borrow bone; now, I borrow bone from the maxillofacial region. It’s amazing how many areas you can borrow bone just from local donor sites within the oral cavity, such as the tuberosity, dogmatic buttresses or ramus. Many times, I can harvest enough bone from within the surgical site I’m already working in: Say, I’m working on the upper right jaw in the cuspid region where there’s a bone defect. If I can borrow bone from the upper right jaw and move it from one place to another, I can minimize morbidity.
Additional Benefits of CBCT
CBCT provides a 3D scan in seconds at a lower dose than traditional CT technology. Units these days are compact and affordable, perfectly sized and priced for oral surgeries. Three-in-one units with multiple fields of view allow the practitioner to perform several different kinds of exams within the same practice, with no need to refer out patients.
As an oral surgeon, I have found CBCT is invaluable tool. It allows for quick assessment of bone quality and quantity, and it even allows me to seek out potential donor sites if a bone graft is necessary. It has changed the way I practice.