Implant dentistry has been developed to provide long-lasting, aesthetic and functional restorations for the partially or completely edentulous patient. As tooth loss is often a result of poor oral hygiene and the resulting dental health conditions, such as periodontal disease, clinicians must ensure that implant placement is viable before proceeding with treatment.
To assess the suitability of a patient for such care, clinicians must understand the anatomical conditions of the surrounding dentition, as well as the local hard and soft tissue. Optimising the evaluation of the site and the subsequent formulation of a treatment plan is essential. This is possible by engaging high-quality imaging systems, which have grown to provide a greater depth of detail for clinicians – when utilised correctly.
A clinical advantage
The advent of 3D imaging solutions such as cone beam computed tomography (CBCT) scanners has allowed clinicians to garner a wider array of information to better support their treatment plans. The solutions generate a 3D dataset that digitally reconstructs an image made of hundreds of projections, but they still often retain the ability to generate 2D images where needed.
Whilst CBCT imaging provides a greater depth of information, it is important to justify its use in clinical care as it typically provides an increased radiation dose when compared to 2D techniques. This is in line with the fundamentals of only using radiographic exposures that are ‘as low as reasonably practicable’ (ALARP). The European Association of Osseointegration (EAO) has previously stated that no cross-sectional imaging is required if a clinical evaluation can reveal adequate bone width, and 2D radiographs present bone height and the relevant anatomical structures correctly. That being said, the EAO agrees that CBCT should be considered when augmentation or other advanced preparations of an implant site are necessary.
Change of perspective
The implementation of CBCT imaging can dramatically change the outcome of a patient’s care. A 2024 study found that implant surgeries prepared with just orthopantomographic imagery led to seven per cent of treatments being aborted mid-surgery without implant placement, all because of a lack of bone quality and/or a lack of primary stability. When CBCT was used through the planning process, no patients left surgery without an implant placed. A major reason behind the failed surgeries was due to encountering unexpected ridge topography, where the completion of the treatment would be either impossible or would severely compromise treatment success; even mid-surgery, the best option was to close up the treatment site and prepare an entirely alternative approach.
The impact of CBCT imaging in these situations will not surprise many clinicians. 2D radiographic images and, in particular, panoramic results, are known to be susceptible to distortion. There is also the possibility that panoramic radiographs help determine the availability of viable bone height, while not allowing measurement of the bone width. As a result, clinicians must turn to the alternative CBCT in order to be confident in a treatment plan.
In many implant cases, the use of CBCT imaging falls well within the realms of exposures being ALARP. Consider the aforementioned aborted implant surgeries; where CBCT was not used, patients not only suffered unnecessary surgical intervention, but perhaps lost time, money and confidence in their practitioner, potentially being unwilling to seek a new treatment plan. Without appropriate care, they could suffer further with edentulism.
Choose the right solution
When it comes to selecting a CBCT scanner for the dental practice, it is imperative to consider what a clinician will want from it, and the purposes it would need to fulfil. It will need to exhibit high-quality imaging capabilities, in a range of formats for widespread clinical use, as well as the ability to minimise radiation exposure to better justify its use in diagnosis and treatment preparation.
The CS 9600 CBCT Scanner from Carestream Dental excels in each regard, with five imaging modalities including panoramic, cephalometric and CBCT imaging. Ultra-sharp images can be delivered, and an innovative Face Scan feature can generate realistic 3D facial images that are superimposed onto CBCT images to support patient communication. Clinicians should also consider the CS 9600 CBCT Scanner’s low-dose mode, which minimises radiation exposure by so much that a 3D image can be delivered at an 86 per cent lower dose than a typical 2D panoramic radiograph.
CBCT scanners have become an essential piece of equipment in the assessment and treatment of edentulism, especially when providing dental implants. Ensuring clinicians understand the need for such solutions in conjunction with 2D radiographs is essential, as well as the importance of justifying their safe and effective use.
References available on request.
For more information visit www.carestreamdental.co.uk