A clinician's journey into the third dimension: Part 1

By Anthony Ramirez, DDS, DrBicuspid.com contributing writer

March 17, 2016 -- Jonathan Swift wrote, "Vision is the art of seeing things invisible." He could have been writing about dentistry with cone-beam CT (CBCT).

Anthony Ramirez, DDS
Anthony Ramirez, DDS.

Cone-beam CT technology was introduced in 1996 in Europe with the NewTom 9000 (QR, NewTom) and made available in the U.S. in 2001. As an early adopter of CBCT technology, I have used the Galileos CBCT system (Sirona) for more than eight years with consistent clinical success.

This radiographic modality has immeasurably advanced patient care in the field by ensuring precise decisions with optimal outcomes. What's more, the vision derived from a scan is the foundation for a complete examination. I am able to quickly scan, assess, and provide a thorough 3D analysis of any dentate or edentulous dentition with high-definition maxillofacial anatomy images in undistorted dimensions. My clinical expertise -- alongside CBCT images -- allows me to offer my patients pragmatic solutions and restored oral health. My philosophy: Include me in the problem so I can include you in the solution.

“My philosophy: Include me in the problem so I can include you in the solution.”
— Anthony Ramirez, DDS

Improved diagnostic ability leads to improved surgical planning and fosters better patient communication. Pathologies that go unseen by 2D x-rays are revealed via CBCT, thereby leading to better treatment planning and improved treatment outcomes comparatively. Another advantage is that I am able to avoid unnecessary treatment by using the information to confirm or alter prescribed treatment. I manage risk and minimize surgical trauma by maximizing the information from a CBCT scan to avoid vital structures, such as nerves, sinuses, and atypical bone anatomy. Streamlined treatment with proper planning also reduces the number of patient visits, which reduces the obstacles for case acceptance. I'm now able to do extractions, grafts, implants, and restorations all in the same location.

Indications

Patients who present with advanced dental disease, rampant caries, severe periodontal breakdown, missing teeth, and general failing dentistry require a proper diagnosis to fully evaluate the dental disciplines that will be necessary to bring them back to a full complement of teeth and oral health.

View the slideshow below for some of the many indications for a CBCT scan:

user/images/content_images/nws_rad/2016_03_15_14_57_59_944_2016_03_16_CBCT_fig1.jpg
All images courtesy of Dr. Anthony Ramirez.
Implant plan prosthetically driven, left image under proposed Cerec crown and right image under radiopaque crown.
user/images/content_images/nws_rad/2016_03_15_14_57_58_589_2016_03_16_CBCT_fig2.jpg
All images courtesy of Dr. Anthony Ramirez.
To evaluate bone volume for an edentulous site (or multiple sites) and to determine the extent of alveolar ridge resorption -- Image shows alveolar ridge resorption.
user/images/content_images/nws_rad/2016_03_15_14_57_58_146_2016_03_16_CBCT_fig3.jpg
All images courtesy of Dr. Anthony Ramirez.
To evaluate the result of bone augmentation before implant surgery -- Image shows regenerated alveolar bone.
user/images/content_images/nws_rad/2016_03_15_14_57_58_902_2016_03_16_CBCT_fig4.jpg
All images courtesy of Dr. Anthony Ramirez.
To produce surgical guides to use when performing guided implant surgery
user/images/content_images/nws_rad/2016_03_15_14_57_57_264_2016_03_16_CBCT_fig5.jpg
All images courtesy of Dr. Anthony Ramirez.
To evaluate previously placed implants -- Left image shows a poorly positioned previously placed implant. Right image shows a well-positioned implant.
user/images/content_images/nws_rad/2016_03_15_14_57_57_103_2016_03_16_CBCT_fig6.jpg
All images courtesy of Dr. Anthony Ramirez.
To evaluate the proximity of a virtual implant to vital anatomical structure, such as the lingual concavity as shown in images, during implant planning
user/images/content_images/nws_rad/2016_03_15_14_57_57_270_2016_03_16_CBCT_fig7.jpg
All images courtesy of Dr. Anthony Ramirez.
To determine the prognosis of an individual tooth or dentition by performing a tooth-by-tooth analysis -- Image shows hopeless interradicular pathology.
user/images/content_images/nws_rad/2016_03_15_14_57_56_828_2016_03_16_CBCT_fig8.jpg
All images courtesy of Dr. Anthony Ramirez.
To evaluate the sinuses before oral surgery
user/images/content_images/nws_rad/2016_03_15_14_57_56_420_2016_03_16_CBCT_fig9.jpg
All images courtesy of Dr. Anthony Ramirez.
To evaluate the third molars, impactions, and the temporomandibular joints -- Image shows a third-molar evaluation.
user/images/content_images/nws_rad/2016_03_15_14_57_55_925_2016_03_16_CBCT_fig10.jpg
All images courtesy of Dr. Anthony Ramirez.
Complex periodontics where only 3D CBCT imaging can visualize dentoalveolar, crestal defects, and bone morphology in real dimensions -- Image shows advanced periodontal bone destruction.
user/images/content_images/nws_rad/2016_03_15_14_57_55_374_2016_03_16_CBCT_fig11_12.jpg
All images courtesy of Dr. Anthony Ramirez.
Endodontic assessment, canal morphology, number of canals, periapical pathology, and tooth fractures -- Top image shows a perio-endo lesion. Bottom image shows the same lesion in volumetric mode.
user/images/content_images/nws_rad/2016_03_15_14_57_54_489_2016_03_16_CBCT_fig13.jpg
All images courtesy of Dr. Anthony Ramirez.
To evaluate internal and external resorption
Indications for a CBCT scan
All images courtesy of Dr. Anthony Ramirez.
Implant plan prosthetically driven, left image under proposed Cerec crown and right image under radiopaque crown

In the next article, I will present a look at the first CBCT scan I took and a recent one, comparing and contrasting how this modality helped me with treatment planning and patient case acceptance.

Anthony Ramirez practices in Brooklyn, NY. He can be reached at info@dranthonyramirez.com or via his website.

The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.


Copyright © 2016 DrBicuspid.com
 
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