CLINICAL CASE KODAK 9000 3D Extraoral Imaging System

Focused-Field CBCT for Evaluation of Socket Prior to Implant Placement

Case Overview
This patient is a 65-year-old healthy Caucasian female. She presented to us in July 2009 with recurrent caries under an existing PFM on #4. A periapical lesion was present extending to the floor of the sinus. The tooth was deemed unrestorable due to caries extending deep into the post space. The tooth was extracted with periotomes and luxating elevators, and careful rotational movement, attempting to spare the thin buccal plate. The socket was debrided, inspected for buccal bone damage and repaired using an intrasocket Type I collagen membrane1 and solvent preserved mineralized cancellous allograft2. The membrane was closed over the socket and tucked under the palatal flap.
Joel B. Henriod, DDS MHS Pasadena, CA
Dr. Joel B. Henriod graduated from UCLA School of Dentistry in 2006. He received his Periodontics specialty certificate and Masters in Health Science in 2009 from Medical University of South Carolina. He practices in Pasadena, CA. He focuses his practice on contemporary periodontics emphasizing regenerative therapy, minimally invasive tissue grafting, advanced dental radiology, and dental implants. Dr. Henriod presents dozens of CE courses each year to dentists and hygienists. He developed Dental School in a Day, an interactive training program for dental sales teams. Dr. Henriod belongs to various organizations: the American Academy of Periodontology, the ADA, the California Dental Association, the California Society of Periodontists, and the San Gabriel Valley Dental Society.

Recurrent caries under existing PFM on #4.

Post-extraction: the socket is repaired with a Type I collagen membrane.

KODAK Product KODAK 9000 3D System

CLINICAL CASE KODAK 9000 3D Extraoral Imaging System

3D Guides the Treatment Decisions

Healing was uneventful, and the Kodak 9000 3D system was used for a pre-implant scan at 4 months. The CT scan revealed favorable bone density and volume for implant placement. Exact measurements were used to select an appropriate implant. Interpretation of the rest of the volume showed very thin buccal bone and root dehiscence on adjacent roots, as well as exact sinus anatomy near the proposed implant apex.

Coronal slice with exact measurements to select the appropriate implant.

Axial slice reveals favorable bone density.

A tapered implant3 was placed according to an acrylic surgical guide maintaining at least 1.5 mm from adjacent tooth to implant edge, with implant platform placed 3-4 mm from the proposed CEJ of the implant restoration. The implant site was found to have good bone density approaching D2. The implant torqued greater than 35 NCM. A healing abutment was placed with 1 mm flare and allowed to heal for 8 weeks.

At 8 weeks the healing abutment was removed, and a final impression was taken after try-in abutments estimated potential abutment options for the lab. A precontoured abutment was selected and a PFM was fabricated as the final restoration. The final restoration was cemented after torquing the final abutment to 32 NCM.

Sagittal slice with virtual implant placed.

3D volume with virtual implant placed.

PA image with implant placed.

CLINICAL CASE KODAK 9000 3D Extraoral Imaging System Testimonial This case presents the routine use of focused-field cone beam scans in our implant practice. Due to high resolution, low radiation, and the ability to image the specific area of interest, we employ CT scans at various timepoints in implant therapy: pre-bone graft, post-bone graft / preimplant, and during evaluation of peri-implantitis lesions. The advent of cone beam technology is a natural and necessary in implant dentistry. Implant dentistry requires careful planning to achieve long-term stability and biologic imitation. Three-dimensional radiology allows evaluation of anatomy that is difficult or impossible to interpret from two dimensional radiographs. Superimposition of structures, anatomic variations, and bone volume are critical to proper implant planning, yet require extrapolation with traditional radiology. Seeing the true anatomy present in each patient affords greater confidence in selecting bone graft techniques and final implants for the conservative and careful implantologist.

Healing abutment with sutures.

Final restoration cemented after torquing the final abutment to 32 NCM.

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Carestream Dental
Carestream Health, Inc. 2011. The Kodak trademark and trade dress are used under license from Kodak. 1.Socket Repair Membrane. Zimmer Dental. Carlsbad, CA. 2.Puros Mineralized Cancellous Bone Graft 250-1000 micron. Zimmer Dental. Carlsbad, CA. 3.Tapered Screw Vent Implant 4.1 x 11.5 mm. Zimmer Dental. Carlsbad, CA.