Rich Rosenblatt I really love what cone beam technology allows me to do when helping to treatment plan a case with a patient. It gives me the ability to be able to “know before I go”. If I only had a pano in the case I’m about to show, I would have a much more difficult time trying to determine if this was I case that I was comfortable taking on. Having cone beam technology makes me feel sometimes like a super hero because I truly feel like I have 3D x-ray vision.
This patient came to my office wanting a permanent, non-removable solution in her anterior. She had an accident about a decade ago and had to have #s 7-10 extracted. A partial denture was placed and she has been wearing it since. She decided that she really wanted to explore a permanent option and came in to discuss it with me.
In the pano view, there appears to be plenty of length of bone to be able to place implants. She was somewhat price conscious, but even so, when I have tackled these cases as of late, I have preferred 2 implants in the #7 and #10 area and bridge between them.
I took a look at the bone in the area of #7 and #10 and you can see in this one screen shot, the bone is very thin. Time to see if my implant would even fit in the space she had.
I place Straumann bone level implants and decided to work up the case placing implants in the #7 and #10 positions. As you can see, the maxillary bone have ample length but nowhere near enough width to get a 3.3mm implant in without there being an issue of possible buccal and or lingual perforation of the implant through the bone. I knew at this point that without significant grafting, this was not going to be an option here.
Even if the bone was just thick enough (and it obviously is not), there is another view that I showed her, the 3D view, to give her an idea of the angle the implants were going to come out of the bone compared to the adjacent teeth. This case would have been significantly flared to the buccal and extremely difficult to restore, even with the area of bone that was a bit wider.
I informed the patient that this was out of my personal comfort zone and she would have to talk to one of my excellent specialists about her options. My specialists absolutely love this because I have done all the pre op work for them so they know exactly what will need to be done in this case. Such would not be the case If I was relying completely on 2D films. I love my cone beam technology and am grateful that I never have to practice another day without it.
