CBCT in the Periodontic Practice

cbct

The potential advantages of cone beam computed tomography (CBCT) to periodontology are fairly well known. Implementing a CBCT system into your practice can: streamline the workflow; enhance diagnostic techniques and treatment planning; hone surgical anatomic expertise; and improve outcomes in specific implant and periodontal cases. But because CBCT is a relatively new technology, there’s little evidence-based everyday guidance for the periodontist to rely on. In the absence of this information—and because CBCT technology is so promising—the American Academy of Periodontology (AAP) used a model of scientific inquiry called best evidence consensus (BEC). BEC is based on the best available current published evidence, as well as expert opinion, and serves as a guide for reasonable uses for CBCT in selected clinical scenarios. In this blog, I would like to highlight several key points from my paper in the Journal of Periodontology, Commentary: Cone-Beam Computed Tomography: An Essential Technology for Management of Complex Periodontal and Implant Cases, regarding the use of CBCT in for three different clinical situations. Continue reading

CBCT at Its Best: Get Involved

Dr. Kunal Shah is the Principal of a new practice in Hendon, London – LeoDental. With a state-of-the-art CBCT installed, the practice is receiving referrals for implant planning cases. Completing his series of articles looking at the use and benefits of CBCT in implant treatment, Kunal explores where dentists can start when getting involved with implantology, highlighting the importance of mentorship.

Unlike other areas of dentistry, there is no clear path to follow when looking to get involved in implantology. It is often down to the individual to seek the appropriate training through courses and postgraduate qualifications that satisfy the GDC’s requirement for implant dentists to be competent in the field.

When looking for an initial training course, I would recommend asking the following questions in order to overcome some of the hurdles I faced:

  • What does the course entail? What do you gain at the end of it? – You need to establish whether you’re looking for a qualification or clinical experience, as this will determine what type of training you chose. The qualification courses tend to be the MScs and Diplomas, which are heavily theory-based, while others are more clinical and practical-based. I personally preferred the clinical element – as a dentist, you already have knowledge of the anatomy, so implantology is simply building on this. I also believe you need practical experience to develop your skills, learn from your mistakes and understand the different scenarios that can occur in practice. Continue reading

Implants and CBCT

It is no longer a debatable fact that three-dimensional imaging is standard of care when it comes to the surgical component of implant placement.1 The key here is to understand the value of achieving the three-dimensional view, simply phrased as the depth component of the visual anatomy. CBCT images are valuable to understand the topography and—more importantly—the inner component of the osseous structures.

Although all the image stacks are very critical to forming an opinion of the anatomical region in consideration, it is the cross-sectional view that are the most used when it comes to virtual planning of implants. Surgeons are better able to appreciate the buccal-lingual dimension of the bone when viewing the cross sectional reconstruction of the scanned anatomical area of the jaws. While viewing this reconstruction and other multiplanar images, there are some key anatomical markers to be evaluated as a part of the visual assessment of the bone.

It is expected that the morphology of the edentulous areas varies not only between individuals, but in an individual’s oral cavity. Age is a critical factor in the change noted in the osseous structures. Another critical factor is time; the longer a patient stays edentulous, the more the probability of resorption of the alveolar crest. This leads one to note the following three (not limited to) critical changes in the jaws:

Examples of lingual undercut, knife edge ridges and ridge angulation. Continue reading