Selecting the best viewing or planning modality for Conventional or Guided Implant surgery
Cone beam Computed Tomography opens up a wealth of new diagnostic and treatment possibilities. At Cavendish Imaging we want to help you to get the maximum diagnostic yield out of your patients 3D scans.
Scan data may be viewed using a number of different systems, all of varied sophistication, which should be used according to the complexity of the treatment that is planned.
Viewing Only
Printouts
We can always supply print-outs of “panoramics” and cross-sectional images along a panoramic curve - and more if desired. However, this is primitive, and of limited value compared to, more direct on-screen viewing, or actually handling a model of the jaw – so see below!
New Upgraded I-CAT Vision, with 3D Reconstruction
Most software will permit the straightforward viewing of data. If all that is required is a simple three-dimensional view of the dental arches in panoramic form, and as cross-sectional images, this is easily achieved. We now include I-CAT Vision on all our discs, which means that viewing of your patient data is as simple as putting our disc into your CD drive.
I-CAT Vision is quite sufficient for the majority of straightforward treatments where the question: “Do I have enough bone in that particular position?” – needs to be answered. However, using I-CAT Vision alone will not allow on-screen virtual planning of implant surgery, or production of a drill guide.
For improved diagnostic return, you might consider providing the patient with a simple radiographic stent, which would perhaps incorporate radiographic markers to indicate the planned implant / prosthetic tooth positions, or radio-opaque prosthetic teeth.
Viewing and Planning
Anatomical modelling
Using our various 3D printing technologies, we are able to produce physical models from nearly any scan data ( including data from other scanning services). Physical models provide an entirely tangible means to understand a patient’s bony anatomy. They are also far more straightforward to manipulate at the time of surgery than paper printouts or on screen images.
The ability to be able to carry out model surgery on these models pre-warns the operator of potential problems and pitfalls, giving the surgeon a huge amount of information as to the practicality of treatment.
This type of modelling is fantastically useful in situations where there is limited bone availability either as a result of narrow ridges, limited bone height below the sinus and posterior mandible, and where grafting is anticipated.
The models may be produced in a variety of materials including titanium, but are usually provided in a translucent resin.
Nobel Guide
Nobel Guide is a highly sophisticated planning and viewing software solution, which also allows for the production of drill guides. If used in conjunction with the Nobel Guide surgical kit it may also be used to full effect to produce provisional or even definitive bridgework before surgery has even taken place. To get maximum benefit from this software the patient should be provided with a radiographic stent.
This radiographic stent must be entirely radiolucent except for 6-9 radiographic markers scattered throughout. The stent should have extended flanges and should be well-fitting and stable. Contact us or your local NobelBiocare rep for more information on the design.
You can choose to use Cavendish Imaging’s own software to plan your first case if you prefer.
There are two versions of software: Nobel Guide Premium and Nobel Guide Pro. Nobel Guide Premium allows the raw data or “Dicom” data to be converted. Once converted Pro and Premium users can carry out the planning process. The conversion is tedious, so even if you have the facility for data conversion, we will routinely carry out this process on your behalf.
You will be provided with a disc containing the files, (or if prefer, the files will be placed in your folder on our FTP site). The disk / folder will containing a file with the generic form patientnameMXL.orp or patientnameMND.orp. These files should be moved to the directory called “3D planning” on your computer hard-drive. Do not try to start the file from the CD or FTP site as this will not work.
The CT data will also be on the disk along with a I-CAT Vision, to immediately allow for a more conventional survey of the jaws.
Contact us if you would like your case planned by our team.
Simplant
Users of Simplant planner software will need to have the dicom data reformatted. We will anyway provide I-CAT vision on disk immediately, so that the data may be viewed whilst the reformat takes place over a period of a few days (or in 24 hours at extra cost). We can then transfer the reformatted data on CD or to your folder on our FTP site.
The reformatting process introduces an additional cost, and an element of delay. A number of possibilities exist:
“Simple” reformat. The raw data is converted to a format that will allow the file to be read by Simplant planner.
Reformat with “segmentation”. Before reformatting the data for Simplant planner, the jaw, remaining teeth, and the radiographic stent (if present) may be individually “picked out”. Various software tools will then allow the different structures to be highlighted or hidden from view, on screen.
Simplant “pro” users can avoid the time and expense of the reformatting process, as simplant pro is able to accept DICOM data directly. This is very much worthwhile, as the extra cost can be covered by as few as 15-20 scans. The software also allows the user to carry out and control the segmentation process, and as a result gain a more complete understanding of the patient’s anatomy.
Anyone with Simplant software can order a surgery guide compatible with nearly all well known implant types. This process is straightforward. To get the most out of the software, particularly if planning to making a surgical guide, it is necessary to provide the patient with a well fitting and stable radiographic stent, along with a radiolucent bite index. It is essential that the radiographic stent is rendered radio-opaque, by using e.g. 10% barium sulphate. When used in conjunction with “Safe” surgical instrumentation it is also possible to pre-fabricate a provisional, or even a definitive prosthesis – contact us for more information.