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Figure 3: Pre-extraction 2011 (same day as 2-D periapical), a CBCT scan reveals a moderate-sized radiolucency at the midpoint of the root. This is a 0.07 mm saggital slice. Figure 4: Pre-extraction axial slice (0.07 mm) showing the extent of the lesion to the distal Figure 5: A 2-D radiograph showing the immediate post-extraction placement of the implant in the modified socket. the distal side of the root (Fig. 3). Further examination of the scan revealed a lateral canal midway down the root with a 3 mm by 5 mm area of radiolucency in the interproximal bone (Fig. 4). Root canal retreatment was discussed with the patient and refused. Having been successfully treated with dental implants in the past, she decided on implant treatment instead. Immediate implant placement after extraction was selected as the treatment of choice because it would greatly decrease the patient’s treatment time. Luxators were used to atraumatically remove the offending tooth, and surgical spoons were used to mechanically debride the socket. The granuloma was removed in its entirety, and the entire area of the socket was decontaminated using laser energy. Osteotomy drills were then used to modify the socket, and an implant was immediately placed in the modified socket (Fig. 5). The discrepancy between the socket shape and the diameter of the implant on the buccal and lingual was less than 1.5 mm, so no additional grafting materials were placed. Within two to four months, native bone will fill in the gap. A postoperative CBCT scan taken immediately after implant placement revealed the position and the engagement of the implant in the apical half of the socket (Figs. 6, 7). The patient is healing well and will soon move forward with the final restoration. Compared to the 2-D periapical radiographs, the 3-D and MPV views provided by the CBCT scan enabled us to make a much more complete diagnosis. Immediate implant placement after extraction was selected as the treatment of choice because it would greatly decrease the patient’s treatment time. 16 – www.inclusivemagazine.com –
Figure 6: CBCT saggital image taken immediately after placement of the implant Figure 7: Coronal slice (0.07 mm) post implant placement showing buccal to lingual span in the existing extraction site Compared to the 2-D periapical radiographs, the 3-D and MPV views provided by the CBCT scan enabled us to make a much more complete diagnosis. Conclusion Three-dimensional CBCT offers a more complete view of dental anatomy and disease than traditional 2-D radiography alone. Using this technology allows the clinician to more accurately evaluate endodontic anatomy and better diagnose the true extent of dental disease. Having a more accurate diagnosis results in a more appropriate treatment plan and helps guide a patient’s treatment toward a successful outcome. For clinical questions, contact Dr. Daniel McEowen at drdan13106@gmail.com. For technical questions, contact Keith Bateman at kbateman@prexion.com. References 1. Law J. The influence of focal spot size on image resolution. Br J Radiol. 1993 May;66(785):441–46. 2. Cesmeli E, Berry JL, Carr JJ. Tube focal spot size and power capability impact image quality in the evaluation of intracoronary stents. Proc. SPIE 5745. 2005;676–84. doi:10.1117/12.596035. – Missed Diagnosis Using Conventional 2-D Radiography – 17
Page 1 and 2: Inclusive® Restorative Driven Impl
Page 3: Contents ALSO IN THIS ISSUE 32 Clin
Page 6 and 7: Publisher Jim Glidewell, CDT Editor
Page 8 and 9: CAD/CAM Technology in Implant Abutm
Page 10 and 11: So is the best transgingival design
Page 12 and 13: ■ Posterior Case Example Figure 7
Page 14: Chairside Processing of LOCATOR ®
Page 17: Figure 1: Pre-endodontic treatment
Page 21 and 22: Dr. Bradley Bockhorst: Before we ge
Page 23 and 24: need a minimum of 3 mm to 4 mm, whi
Page 25 and 26: SJ: Connective tissue grafting lead
Page 27 and 28: Three-Dimensional Treatment Plannin
Page 29 and 30: The accuracy of each surgical guide
Page 31 and 32: Cook-Waite Lidocaine ® HCI 2% and
Page 33 and 34: with the O-ring Housings built in.
Page 35 and 36: Figure 3a: Smile line without prost
Page 37 and 38: www.glidewellce.com
Page 39 and 40: GLIDEWELL INTERNATIONAL TECHNOLOGY
Page 41 and 42: Date Course Name Instructor Course
Page 43 and 44: Discussion Figure 3: Natural facial
Page 45 and 46: Removable dentures should provide o
Page 47: SOFT PMMA Clusters BOLD YOUTHFUL UN
Page 50 and 51: or her restoration on an interim ba
Page 52: CASE 2 The following case depicts a
Page 55 and 56: Many people are unaware of the rela
Page 57 and 58: were used to visualize tooth positi
Page 59 and 60: Figure 12: Severely resorbed mandib
Page 61 and 62: Figure 19: Facial photograph of our

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