Abstract
In depth understanding of clinical CBCT is essential for the diagnosis and treatment planning of dental implant patients. Software planning using CBCT data allows a greater in-depth understanding of a patient’s osseous anatomy and dental condition, as well as the ability for the surgeon to presurgically plan precise dental implant trajectories and the creation of a surgical drill guide. Surgical drill guides as the output of rapid printing technologies permit the surgical implementation of the treatment planning. This allows decreased operating time, improved implant placement, and the possibility of flapless surgery. From simple to complex cases, surgical guidance can improve the results for both the dental implant placement and the prosthetic restoration. Zygomatic implants can also be planned and placed using CT-guided surgical techniques. Immediate temporization is another capability of CT-guided surgery. Based on the surgical guide, the dental laboratory can prefabricate the temporary prosthesis. CAD CAM technologies can also create the immediate temporary prosthesis. Patients with complex pathological conditions can have coordinated surgical excision of the pathology and later precise dental implant placement and prosthetic rehabilitation to achieve a satisfactory esthetic and functional outcome. Single dental implants in the anterior maxillary esthetic zone benefit from surgical guidance to ensure correct angulation. Surgical guidance provides complex multiple implant cases such as the “All on 4” or full-arch cases with the avoidance of the mandibular nerves and maxillary sinus perforations. New technologies such as optical scanning allow the merger of a clean data set with the CBCT and the avoidance of a radiographic stent, whether this technology is available in the office or dental laboratory.
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References
Klein M, Abrams M. Computer-guided surgery utilizing a computer-milled surgical template. Pract Proced Aesthet Dent. 2001 Mar;13(2):165–9.
Klein M, Cranin AN, Sirakian A. A computerized tomography (CT) scan appliance for optimal presurgical and preprosthetic planning of the implant patient. Pract Periodontics Aesthet Dent. 1993 Aug;5(6):33–9.
Tardieu PB, Vrielinck L, Escolano E, Henne M, Tardieu AL. Computer-assisted implant placement: scan template, simplant, surgiguide, and SAFE system. Int J Periodontics Restorative Dent. 2007 Apr;27(2):141–9.
Jacobs R, Adriansens A, Naert I, Quirynen M, Hermans R, van Steenberghe D. Predictability of reformatted computed tomography for pre-operative planning of endosseous implants. Dentomaxillofac Radiol. 1999;28(1):37–41. Clin Proc. 1996 Mar;71(3):288
van Steenberghe D, Glauser R, Blombäck U, Andersson M, Schutyser F, Pettersson A, Wendelhag I. A computed tomographic scan-derived customized surgical template and fixed prosthesis for flapless surgery and immediate loading of implants in fully edentulous maxillae: a prospective multicenter study. Clin Implant Dent Relat Res. 2005;7(Suppl 1):S111–20.
van Steenberghe D, Naert I, Andersson M, Brajnovic I, Van Cleynenbreugel J, Suetens P. A custom template and definitive prosthesis allowing immediate implant loading in the maxilla: a clinical report. Int J Oral Maxillofac Implants. 2002 Sep-Oct;17(5):663–70.
Tselios N, Parel SM, Jones JD. Immediate placement and immediate provisional abutment modeling in anterior single-tooth implant restorations using a CAD/CAM application: a clinical report. J Prosthet Dent. 2006 Mar;95(3):181–5.
Amorfini L, Storelli S, Romeo E. Rehabilitation of a dentate mandible requiring a full arch rehabilitation. Immediate loading of a fixed complete denture on implants placed with a bone supported surgical computer planned guide: case report. J Oral Implantol. 2011;37:106–13.
Turkyilmaz I, Suarez JC, Company AM. Immediate implant placement and provisional crown fabrication after a minimally invasive extraction of a peg-shaped maxillary lateral incisor: a clinical report. J Contemp Dent Pract. 2009 Sep 1;10(5):E073–80.
Rubin GD. Computed tomography: revolutionizing the practice of medicine for 40 years. Radiology. 2014 Nov;273(2 Suppl):S45–74.
Wesolowski JR, Lev MH. CT: history, technology, and clinical aspects. Semin Ultrasound CT MR. 2005 Dec;26(6):376–9.
Scarfe WC, Farman AG, Levin MD, Gane D. Essentials of maxillofacial cone beam computed tomography. Alpha Omegan. 2010 Jun;103(2):62–7.
Scarfe WC, Farman A, Sukovic P. Clinical applications of cone-beam computed tomography in dental practice. J Can Dent Assoc. 2006;72(1):75–80.
Ahmad M, Jenny J. Downie M application of cone beam computed tomography in oral and maxillofacial surgery. Aust Dent J. 2012 Mar;57(Suppl 1):82–94.
Chau AC, Fung K. Comparison of radiation dose for implant imaging using conventional spiral tomography, computed tomography, and cone-beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Apr;107(4):559–65.
Oliva L. Alessandro Vallebona (1899–1987). Radiol Med. 1988 Jul-Aug;76(1–2):127–9.
Scarfe WC, Eraso FE, Farman AG. Characteristics of the Orthopantomograph OP 100. Dentomaxillofac Radiol. 1998 Jan;27(1):51–7.
Beckmann EC. Godfrey Newbold Hounsfield. Phys Today. 2005;58(3):84–5.
Oransky, Ivan (2004). “Sir Godfrey N. Hounsfield”. Lancet 364 (9439): 1032.
Beckmann EC. CT scanning the early days. Br J Radiol. January 2006;79(937):5–8.
Shampo MA, Kyle RA. Allan Cormack – codeveloper of computed tomographic scanner. Mayo Clin Proc. 1996 Mar;71(3):288.
Raju TN. The Nobel chronicles. 1979: Allan MacLeod Cormack (b 1924); and Sir Godfrey Newbold Hounsfield (b 1919). Lancet. 1999;354(9190):1653.
Goodman LR. The Beatles, the Nobel prize, and CT scanning of the chest. Radiol Clin N Am. 2010 Jan;48(1):1–7.
Rogalla P, Kloeters C, Hein PA. CT technology overview: 64-slice and beyond. Radiol Clin N Am. 2009 Jan;47(1):1–11.
Sittig DF, Ash JS, Ledley RS. The story behind the development of the first whole-body computerized tomography scanner as told by Robert S Ledley. J Am Med Inform Assoc. 2006 Sep-Oct;13(5):465–9.
Alexander RE, Gunderman RB. EMI and the first CT scanner. J Am Coll Radiol. 2010 Oct;7(10):778–81.
Kalender WA, Seissler W, Klotz E, Vock P. Spiral volumetric CT with single-breathhold technique, continuous transport, and continuous scanner rotation. Radiology. 1990;176(1):181–3.
Kalender WA, Vock P, Polacin A, Soucek M. Spiral-CT: a new technique for volumetric scans. I. Basic principles and methodology. Rontgenpraxis. 1990 Sep;43(9):323–30.
Soucek M, Vock P, Daepp M, Kalender WA. Spiral-CT: a new technique for volumetric scans. II Potential clinical applications. Rontgenpraxis. 1990 Oct;43(10):365–75.
Hornich H. A tribute to Johann Radon. IEEE Trans Med Imaging. 1986;5(4):169.
Katsevich A. Analysis of an exact inversion algorithm for spiral cone-beam CT. Phys Med Biol. 2002 Aug 7;47(15):2583–97.
Schaller S, Flohr T, Steffen P. An efficient Fourier method for 3-D Radon inversion in exact cone-beam CT reconstruction. IEEE Trans Med Imaging. 1998 Apr;17(2):244–50.
Anastasio MA, Pan X, Clarkson E. Comments on the filtered backprojection algorithm, range conditions, and the pseudoinverse solution. IEEE Trans Med Imaging. 2001 Jun;20(6):539–42.
Morvidone M, Nguyen MK, Truong TT, Zaidi H. On the v-line Radon transform and its imaging applications. Int J Biomed Imaging. 2010;pii:208179. Epub 2010 Jul 13.
Zhang-O’Connor Y, Fessler JA. Fourier-based forward and back-projectors in iterative fan-beam tomographic image reconstruction. IEEE Trans Med Imaging. 2006 May;25(5):582–9.
Kordolaimi SD, et al. Introduction of an effective method for the optimization of CT protocols using iterative reconstruction algorithms: comparison with patient data. Am J Roentgenol. 2014;204(4):W434–9.
Brock RS, Docef A, Murphy MJ. Reconstruction of a cone-beam CT image via forward iterative projection matching. Med Phys. 2010 Dec;37(12):6212–20.
Pan X, Sidky EY, Vannier M. Why do commercial CT scanners still employ traditional, filtered back-projection for image reconstruction? Inverse Probl. 2009 Jan 1;25(12):1230009.
Kampp TD. The backprojection method applied to classical tomography. Med Phys. 1986 May-Jun;13(3):329–33.
Greenberg AM. Basics of cone-beam CT and CT guided dental implant surgery. Select Reading Oral Maxillofac Surg. 2011;19(5):1–48.
Pauwels R, Cockmartin L, Ivanauskaité D, Urbonienė A, Gavala S, Donta C, Tsiklakis K, Jacobs R, Bosmans H, Bogaerts R, Horner K. SEDENTEXCT project Consortium. Estimating cancer risk from dental cone-beam CT exposures based on skin dosimetry. Phys Med Biol. 2014 Jul 21;59(14):3877–91.
Lee CY, Koval TM, Suzuki JB. Low dose radiation risks of CT and CBCT: reducing the fear and controversy. J Oral Implantol. 2015;41(5):e223–30.
Brenner DJ, Hall EJ. Computed tomography – an increasing source of radiation exposure. N Engl J Med. 2007 Nov 29;357(22):2277–84.
Berrington de González A, Mahesh M, Kim KP, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med. December 2009;169(22):2071–7.
Shuryak I, Sachs RK, Brenner DJ. A new view of radiation induced cancer. Radiat Prot Dosim. 2011;143(2-4):358–64.
Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001 Feb;176(2):289–96.
Ludlow JB, Davies-Ludlow LE, White SC. Patient risk related to common dental radiographic examination examinations: the impact of 2007 international commission on radiological protection recommendations regarding dose calculation. J Am Dent Assoc. 2008;139:1237–43.
National Council on Radiation Protection and Measurements. Ionizing radiation exposure of the population of the United States. Bethesda: National Council on Radiation Protection and Measurements; NCRP Report No. 160;2006.
Roberts JA, Drage NA, Davies J, Thomas JW. Effective dose from cone beam CT examinations in dentistry. Br J Radiol. 2009;82:35–40.
De Vos W, Casselman J, Swennen GR. Cone-beam computerized tomography (CBCT) imaging of the oral and maxillofacial region: a systematic review of the literature. Int J Oral Maxillofac Surg. 2009 Jun;38(6):609–25.
Mettler FA, Huda W, Yoshizumi TT, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology. 2008;248(1):254–63.
Brenner DJ, Elliston CD. Estimated radiation risks potentially associated with full-body CT screening. Radiology. 2004 Sep;232(3):735–738. Epub 2004 Jul 23.
Brooks RA. A quantitative theory of the Hounsfield unit and its application to dual energy scanning. J Comput Assist Tomogr. 1977;1:487.
Greenberg AM. Cone beam computed tomography and diagnosis for dental implants. Oral Maxillofac Surg Clin North Am. 2015;27:185–202.
Mardinger O, Namani-Sadan N, Chaushu G, Schwartz-Arad D. Morphologic changes of the nasopalatine canal related to dental implantation: a radiologic study in different degrees of absorbed maxillae. J Periodontol. 2008 Sep;79(9):1659–62.
Soikkonen K, Wolf J, Ainamo A, Xie Q. Changes in the position of the mental foramen as a result of alveolar atrophy. J Oral Rehabil. 1995 Nov;22(11):831–3.
Bou Serhal C, Jacobs R, Flygare L, Quirynen M, van Steenberghe D. Perioperative validation of localisation of the mental foramen. Dentomaxillofac Radiol. 2002 Jan;31(1):39–43.
Carruth P, He J, Benson BW, Schneiderman ED. Analysis of the size and position of the mental foramen using the CS 9000 cone-beam computed tomographic unit. J Endod. 2015 Jul;41(7):1032–6.
Haas LF, Dutra K, Porporatti AL, Mezzomo LA, De Luca CG, Flores-Mir C, Corrêa M. Anatomical variations of mandibular canal detected by panoramic radiography and CT: a systematic review and meta-analysis. Dentomaxillofac Radiol. 2016;45(2):20150310.
Miles MS, Parks ET, Eckert GJ, Blanchard SB. Comparative evaluation of mandibular canal visibility on cross-sectional cone-beam CT images: a retrospective study. Dentomaxillofac Radiol. 2016;45(2):20150296.
Bornstein MM, Seiffert C, Maestre-Ferrín L, Fodich I, Jacobs R, Buser D, von Arx T. An analysis of frequency, morphology, and locations of maxillary sinus septa using cone beam computed tomography. Int J Oral Maxillofac Implants. 2016;31(2):280–7.
Neugebauer J, Ritter L, Mischkowski RA, Dreiseidler T, Scherer P, Ketterle M, Rothamel D, Zöller JE. Evaluation of maxillary sinus anatomy by cone-beam CT prior to sinus floor elevation. Int J Oral Maxillofac Implants. 2010 Mar-Apr;25(2):258–65.
Becker A, Chaushu S, Casap-Caspi N. Cone-beam computed tomography and the orthosurgical management of impacted teeth. J Am Dent Assoc. 2010 Oct;141(Suppl 3):14S–8S.
Ghaeminia H, Meijer GJ, Soehardi A, Borstlap WA, Mulder J, Bergà SJ. Position of the impacted third molar in relation to the mandibular canal. Diagnostic accuracy of cone beam computed tomography compared with panoramic radiography. Int J Oral Maxillofac Surg. 2009 Sep;38(9):964–71.
Katheria BC, Kau CH, Tate R, Chen JW, English J, Bouquot J. Effectiveness of impacted and supernumerary tooth diagnosis from traditional radiography versus cone beam computed tomography. Pediatr Dent. 2010 Jul-Aug;32(4):304–9.
Magnusson B, Borrman H. The paradental cyst a clinicopathologic study of 26 cases. Swed Dent J. 1995;19(1–2):1–7.
Weber AL. Imaging of cysts and odontogenic tumors of the jaw. Definition and classification. Radiol Clin N Am. 1993 Jan;31(1):101–20.
Baykul T, Saglam AA, Aydin U, Başak K. Incidence of cystic changes in radiographically normal impacted lower third molar follicles. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 May;99(5):542–5.
Simon JH, Enciso R, Malfaz JM, Roges R, Bailey-Perry M, Patel A. Differential diagnosis of large periapical lesions using cone-beam computed tomography measurements and biopsy. J Endod. 2006 Sep;32(9):833–7.
Tyndall DA, Rathore S. Cone-beam CT diagnostic applications: caries, periodontal bone assessment, and endodontic applications. Dent Clin N Am. 2008;52(4):825–41.
Zhang ZL, Qu XM, Li G, Zhang ZY, Ma XC. The detection accuracies for proximal caries by cone-beam computerized tomography, film, and phosphor plates. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011 Jan;111(1):103–8.
Hariya Y, Yuasa K, Nakayama E, Kawazu T, Okamura K, Kanda S. Value of computed tomography findings in differentiating between intraosseous malignant tumors and osteomyelitis of the mandible affecting the masticator space. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Apr;95(4):503–9.
Hendrikx AW, Maal T, Dieleman F, Van Cann EM, Merkx MA. Cone beam CT in the assessment of mandibular invasion by oral squamous cell carcinoma: results of the preliminary study. Int J Oral Maxillofac Surg. 2010 May;39(5):436–9.
Closmann JJ, Schmidt BL. The use of cone beam computed tomography as an aid in evaluating and treatment planning for mandibular cancer. J Oral Maxillofac Surg. 2007 Apr;65(4):766–71.
Cassatly MG, Greenberg AM, Kopp WK. Bilateral giant cell granulomata of the mandible: report of case. J Am Dent Assoc. 1988 Nov;117(6):731–3.
Cohen MA, Hertzanu Y. Radiologic features, including those seen with computed tomography, of central giant cell granuloma of the jaws. Oral Surg Oral Med Oral Pathol. 1988 Feb;65(2):255–61.
DeTomasi D, Hann JR. Traumatic bone cyst: report of case. J Am Dent Assoc. 1985 Jul;111(1):56–7.
Marks R, Block M, Sanusi ID, et al. Unicystic ameloblastoma. Int J Oral Surg. 1983;12:186.
Singer SR, Mupparapu M, Philipone E. Cone-beam computed tomography findings in a case of plexiform ameloblastoma. Quintessence Int. 2009;40:627.
Araki M, Kameodka S, Matsumato N, et al. Usefulness of cone-beam computed tomography for odontogenic myxoma. Dentomaxillofac Radiol. 2007;36:423.
Madras J, Lapointe H. Keratocystic odontogenic tumor: reclassification of the odontogenic keratocyst from cyst to tumour. J Can Dent Assoc. 2008;74:165.
Kamel SG, Kau CH, Wong ME, Kennedy JW, English JD. The role of cone beam CT in the evaluation and management of a family with Gardner’s syndrome. J Craniomaxillofac Surg. 2009 Dec;37(8):461–8.
Manganaro AM, Millett GV. Periapical cemental dysplasia. Gen Dent. 1996 Jul-Aug;44(4):336–9.
Ackermann GL, Altini M. The cementomas – a clinicopathological re-appraisal. J Dent Assoc S Afr. 1992 May;47(5):187–94.
Ribeiro AC, Carlos R, Díaz KP, Gouvêa AF, Vargas PA. Bilateral central ossifying fibroma affecting the mandible report of an uncommon case and critical review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011 Feb;111(2):e21–6.
Cavalcanti MG, Ruprecht A, Vannier MW. Evaluation of an ossifying fibroma using three-dimensional computed tomography. Dentomaxillofac Radiol. 2001 Nov;30(6):342–345; J Oral Pathol Med. 2007 Aug;36(7):383–393.
Philipsen HP, Reichart PA, Siar CH, Ng KH, Lau SH, Zhang X, Dhanuthai K, Swasdison S, Jainkittivong A, Meer S, Jivan V, Altini M, Hazarey V, Ogawa I, Takata T, Taylor AA, Godoy H, Delgado WA, Carlos-Bregni R, Macias JF, Matsuzaka K, Sato D, Vargas PA, Adebayo ET. An updated clinical and epidemiological profile of the adenomatoid odontogenic tumour: a collaborative retrospective study. J Oral Pathol Med. 2007 Aug;36(7):383–93.
Alkhader M, Hudieb M. Comparison of mesiodistal space measurements of single-implant sites on panoramic and oblique images generated by cone-beam CT. Surg Radiol Anat. 2014 Apr;36(3):255–8.
Greenstein G, Carpentieri JR, Cavallaro J. Dental cone-beam scans: important anatomic views for the contemporary implant surgeon. Compend Contin Educ Dent. 2015 Nov-Dec;36(10):735–41.
Greenberg AM. Digital technologies for dental implant treatment planning and guided surgery. Oral Maxillofac Surg Clin North Am. 2015;27:319–40.
Uchida Y, Noguchi N, Goto M, Yamashita Y, Hanihara T, Takamori H, Sato I, Kawai T, Yosue T. Measurement of anterior loop length for the mandibular canal and diameter of the mandibular incisive canal to avoid nerve damage when installing endosseous implants in the interforaminal region: a second attempt introducing cone beam computed tomography. J Oral Maxillofac Surg. 2009 Apr;67(4):744–50.
Kuribayashi A, Watanabe H, Imaizumi A, Tantanapornkul W, Katakami K, Kurabayashi T. Bifid mandibular canals: cone beam computed tomography evaluation. Dentomaxillofac Radiol. 2010 May;39(4):235–9.
Jacobs R, Mraiwa N, van Steenberghe D, Gijbels F, Quirynen M. Appearance, location, course, and morphology of the mandibular incisive canal: an assessment on spiral CT scan. Dentomaxillofac Radiol. 2002 Sep;31(5):322–7.
Naitoh M, Hiraiwa Y, Aimiya H, Gotoh K, Ariji E. Accessory mental foramen assessment using cone-beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Feb;107(2):289–94.
De Santis D, Canton LC, Cucchi A, Zanotti G, Pistoia E, Nocini PF. Computer-assisted surgery in the lower jaw: double surgical guide for immediately loaded implants in postextractive sites-technical notes and a case report. J Oral Implantol. 2010;36(1):61–8.
Rosenfeld AL, Mandelaris GA, Tardieu PB. Prosthetically directed implant placement using computer software to ensure precise placement and predictable prosthetic outcomes. Part 1: diagnostics, imaging, and collaborative accountability. Int J Periodontics Restorative Dent. 2006 Jun;26(3):215–21.
Maló P, Rangert B, Nobre M. All-on-4 immediate-function concept with Brånemark system implants for completely edentulous maxillae: a 1-year retrospective clinical study. Clin Implant Dent Relat Res. 2005;7(Suppl 1):S88–94.
Tolstunov L, Thai D, Arellano L. Implant-guided volumetric analysis of edentulous maxillary bone with cone-beam computerized tomography scan. Maxillary sinus pneumatization classification. J Oral Implantol. 2012 Aug;38(4):377–90.
Jensen OT, Adams MW, Cottam JR, Parel SM, Phillips WR 3rd. The all on 4 shelf: mandible. J Oral Maxillofac Surg. 2011 Jan;69(1):175–81.
Jensen OT, Adams MW, Cottam JR, Parel SM, Phillips WR 3rd. The all-on-4 shelf: maxilla. J Oral Maxillofac Surg. 2010 Oct;68(10):2520–7.
US 9,050,665.
US 8,750,590.
Valente F, Schiroli G, Sbrenna A. Accuracy of computer-aided oral implant surgery: a clinical and radiographic study. Int J Oral Maxillofac Implants. 2009 Mar-Apr;24(2):234–42.
Pomares C. A retrospective study of edentulous patients rehabilitated according to the ‘all-on-four’ or the ‘all-on-six’ immediate function concept using flapless computer-guided implant surgery. Eur J Oral Implantol. 2010 Summer;3(2):155–63.
Flügge TV, Nelson K, Schmelzeisen R, Metzger MC. Three-dimensional plotting and printing of an implant drilling guide: simplifying guided implant surgery. J Oral Maxillofac Surg. 2013 Aug;71(8):1340–6.
Nardi C, Borri C, Regini F, Calistri L, Castellani A, Lorini C, Colagrande S. Metal and motion artifacts by cone beam computed tomography (CBCT) in dental and maxillofacial study. Radiol Med. 2015 Jul;120(7):618–26.
Van de Wiele G, Teughels W, Vercruyssen M, Coucke W, Temmerman A, Quirynen M. The accuracy of guided surgery via mucosa-supported stereolithographic surgical templates in the hands of surgeons with little experience. Clin Oral Implants Res. 2015 Dec;26(12):1489–94.
Turbush SK. Turkyilmaz I accuracy of three different types of stereolithographic surgical guide in implant placement: an in vitro study. J Prosthet Dent. 2012 Sep;108(3):181–8.
Greenberg AM, Nelson K. Basic dental implantology. In: Greenberg AM, Schmelzeisen R, editors. Craniomaxillofacial Reconstructive and Corrective Bone Surgery. 2nd ed. New York: Springer Verlag; 2018, In press.
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Greenberg, A.M., Sultan, L.H. (2018). Clinical Cone Beam CT and CT-Guided Dental Implant Surgery. In: Greenberg, A. (eds) Digital Technologies in Craniomaxillofacial Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1532-3_5
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