Conventional regular two-dimensional X-rays (2D) are not always sufficient to determine the extent and nature of a bone lesion or a lesion of the jaw associated with a tooth. In some cases the very presence of a lesion is only verifiable with 3D imaging because often 2D imaging superimposes neighboring structures and the actual lesion becomes blurred or less visible.
The situation presented here is one where there was no pain or any other symptoms at all. The patient actually came in for an implant consultation and this cyst was discovered. The patient was immediately referred out for biopsy and treatment. The lesion was found to be benign, it was cleaned out and bone grafting done to correct the defect.
This is a case report published in Prexion3D’s December 2011 newsletter. All phases of this case were completed by Dr. Noumbissi. A patient had a missing tooth in the anterior maxilla, 3D dental imaging technology (CBCT) and software (InVivo5) were utilized to adequately and accurately plan the placement and temporization of a metal free zirconia dental implant.
The CBCT radiation from the Prexion is extremely low compared to medical CT scanners. The InVivo 5 software was used to perform virtual implant placement prior to surgery. From the implant placement simulation a surgical guide was generated using CAD/CAM technology. The surgical guide was then utilized to place the implant in a precise manner allowing for much safer and more predictable implant placement.
Sammy Noumbissi DDS MS
The case presented here details the process by which Dr. Noumbissi uses dental Cone Beam Computed Tomography (CBCT) technology also commonly called 3D dental imaging to diagnose and plan the course of treatment for all our implant patients. This technology has been available in our practice since 2007. The images obtained from the CBCT are reconstructed with a specialized software called InVivo5 (www.Anatomage.com).
The diagnostic aspect of the InVivo5 software allowed Dr. Noumbissi to visualize the patient’s bone and determine prior to surgery the volume (height and width) and the quality (density) of the bone at the projected implantation site. Critical anatomical structures like the floor of the nose in relation to the implant were also evaluated in a three-dimensional manner.
The implant planning aspect of InVivo5 software made it possible for Dr. Noumbissi to select the precise implant size and type specifically indicated to replace this patient’s front tooth. A surgical guide was also generated from the CBCT data;the surgical guide makes it possible for Dr. Noumbissi to transfer the virtual plan to the patient during implant placement.
IN LAYMAN’S TERMS, A DENTAL CBCT IS A COMPACT, FASTER AND SAFER VERSION OF THE REGULAR MEDICAL CT.
This technology unlike medical CAT scans uses of a cone shaped X-Ray beam, therefore the size of the scanner, the radiation dosage and time needed for scanning are all dramatically reduced. The cone beam CT scanner we have in our office is a Prexion 3D. This CBCT scanner (see photo) will rotate 360°around your head and only needs 19 seconds to capture multiple images of your head from different angles. As a result the radiation dosage is up to a hundred times less than that of a regular medical CAT scanner. These images are then reconstructed with specialized software (www.Anatomage.com) to create a 3D image of your internal anatomy. This protocol will help to visualize internal anatomy that cannot be diagnosed externally, assess risk, generate implant placement surgical guides and plan treatment and surgery.
OUR OFFICE USES STATE OF THE ART STERILIZATION TO ENSURE PATIENT SAFETY.
Sterilization and disinfection are the basic steps in instrument processing and surface asepsis. Sterilization refers to the use of a physical or chemical procedure to destroy all forms of microorganisms, including the highly resistant spores.
WE USE RAPID STEAM AUTOCLAVE AT 275º F(35PSI), FOR 15-20 MINUTES
First, the instruments are prepared for the sterilization process. Patient debris and fluids are removed by placing the instruments in 3.2% glutaraldehyde for 40 minutes. Following this pre-disinfection step the instruments are transferred to an ultrasonic cleaner for another 15 minutes. Then the instruments are rinsed, dried, placed in self sealing sterilization pouches and sterilized in the autoclave. Instruments which can not be heat sterilized, are immersed in 2% glutaraldehyde for 10 hours to cold sterilize.
WE USE BIOLOGICAL, CHEMICAL AND MECHANICAL INDICATORS TO MONITOR OUR STERILIZATION PROCESS.
Using bacterial spores to monitor the sterilization process is referred to as biologic monitoring (or spore-testing), and the bacterial spores used for monitoring the sterilization process are referred to as biologic indicators (BIs). Of the three methods, biologic monitoring is regarded as the most valid for monitoring the sterilization process, for it uses live, highly resistant bacterial spores.
We biologically monitor our sterilizer once a week to ensure complete sterilization using spore strips and keep accurate records for our monitoring. These strips are enclosed in a glassine envelope and processed through the sterilizer. They are then sent to our spore testing center where they are tested for live spores.
Chemical monitoring involves using chemical indicators (CIs) that change color or form when exposed to specific high temperatures or to the sterilizing conditions within a sterilizer. This is referred to as chemical monitoring (or process monitoring). We use sterilization pouches that have special marking that change color when subjected to sterilizing temperatures.
Mechanical monitoring involves observing and recording the physical aspects (e.g., temperature, pressure or time) of the cycle when the sterilizer is being operated. Our Sterilizer is serviced regularly to ensure proper functioning.
Our State of the art facility is equipped with the most advanced technology available. We offer 3D dental imaging, Computer guided surgery, ultrasonic bone surgery, metal free dental implants and soft tissue laser therapy.