Computer-aided Design/Computer-aided Manufacturing Applications Using CT and Cone Beam CT Scanning Technology

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CT and cone-beam CT technology provides clinicians with new methods to view patient anatomy exceeding conventional two-dimensional radiology. Interactive software applications allow for improved interpretation of the CT scan data. Proper use of this new technology must be based on a solid foundation of fundamental surgical and prosthodontic protocols. Advances in software and associated hardware have empowered clinicians with the necessary tools to harness the technology, while remaining true to conventional standards. The enhanced capability of innovative software applications that allow clinicians to interpret and maneuver through various three-dimensional images has far-reaching implications when interactive treatment planning software is combined with computer-aided design and manufacturing. Using all available virtual tools, true restoratively driven implant dentistry can be accomplished, ultimately benefiting patients.

Section snippets

Clinical applications

A 55-year-old male presented with severe and advanced periodontal disease in his remaining mandibular teeth (Fig. 1). He had been informed about the hopeless prognosis of the mandibular teeth for many years, however his fear of dentistry prevented him from completing the recommended care. The seeding of bacteria as a consequence of the periodontal disease became a focus when other heart-related concerns were discovered. The patient was adamant in his desire to replace the teeth with a fixed

Surgical intervention

Surgical templates have been fabricated in several forms: (1) the original bone-borne template, (2) the tooth-borne template, and, more recently, (3) a soft tissue–borne template. As this particular case presentation involved tooth extraction, bone reduction, and implant placement, it was elected to use a bone-borne template. There is an important caveat with regard to tooth extractions and alveolectomy when working with bone-borne templates: do not remove the bone until all osteotomies have

Computer-aided design planning capabilities

Presurgical prosthetic planning for placement and restoration of dental implants should follow a sound foundation of accepted prosthodontic protocols. The importance of accurate study casts, determination of vertical dimension of occlusion, proper articulation, diagnostic wax-ups, lip support, and an understanding of the functional and esthetic concerns cannot be underestimated to achieve predictable results. To facilitate accurate planning, it is desirable to create a radiopaque template that

Present and future CAD-CAM applications

The advent of realistic CAD implants, realistic CAD abutments, and virtual teeth allows for premier planning capabilities right now. This technology however has also proven to be a direct path to the future [3], [11]. There are several companies currently developing new and exciting methods to harness digital dentistry through the use of intraoral optical scans, flash-CT scanning of impressions, laser-scanning of casts or impressions, and advanced CAD/CAM machining of both titanium and Zirconia

Summary

CT and CBCT technology provides clinicians with new methods to view patient anatomy exceeding conventional 2-D radiology. Interactive software applications allow for improved interpretation of the CT scan data by incorporating tools for identifying vital anatomy, bone topography and quality, simulated implant placement, simulated abutment placement, and the fabrication of CT-derived surgical templates. The use of realistic CAD implants and CAD abutments provides the clinician with unprecedented

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