Replacing missing teeth with an implant supported restoration represents both a surgical and restorative challenge. Often there can be lack of space between the roots for standard diameter implants or issues with root convergence, bony defects/concavities, soft tissue concerns, emergence profile, and insufficient bone volume and/or density to stabilize an implant. The use of two-dimensional periapical or panoramic imaging fails to provide clinicians with an adequate appraisal of the existing bone anatomy. The evolution of CT and now, lower radiation Cone Beam CT (CBCT) allows for an unprecedented three-dimensional visualization of the bone, adjacent roots, and nearby vital structures.

This empowers the clinician with new state-of-the-art tools to diagnose and treatment plan. In addition, in order to improve accuracy of planning, it is possible to take digital data from intraoral optical scans or desktop scanners and MERGE that dataset with our CBCT images.

Utilization of this enhanced data set improves every aspect of the diagnosis, aids in communication between the patient and clinician, and sets a new standard for guided surgical applications. The “Triangle of Bone®” concept provides clinicians with a decision tree protocol to evaluate implant receptor sites, and to achieve the goal of “restoratively driven” implant reconstruction. The purpose of this presentation/workshop will be to help clinicians understand how to achieve successful diagnosis and management of deficient sites, matching implant types with receptor sites within the framework of restoratively driven protocols and long-term success. Navigating through this new digital world can be difficult as clinicians may be confused by the increased number of software solutions that all claim to have advanced diagnostic capabilities. Participants are encouraged to bring their own computers, and also stone casts, or diagnostic wax-ups of their patients if they wish to experience software applications first hand, and learn concepts from one of the leading pioneers in this area of digital dentistry.

Learning Objectives: Attendees can expect to learn the following from this presentation:
1. Pre-surgical prosthetic planning using CT/CBCT imaging and 3-D interactive treatment planning software
2. The “Triangle of Bone®” concept to maximize results
3. Pre-surgical prosthetic planning concepts for single-tooth to full-mouth reconstruction
4. “Restorative dilemma” and its impact
5. Basics of segmentation/masking
6. Basics of virtual teeth and restoratively driven planning
7. Decision tree for choosing the appropriate abutment for individual cases (screw-retained or cementable)
8. Methods of surgical templates/surgical guides for a variety of cases
9. Importance of scannographic templates
10. How to merge OPTICAL surface scans (Intra-oral or desktop) with CBCT data
11. Patient communication maximization and marketing with 3-D imaging and case presentations
12. How case plans can be managed through the internet