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Creating Surgical Guides Using
CBCT and Intraoral Scanning
by
Perry E. Jones, DDS, FAGD
INTRODUCTION
One
of the recent advances in the use of the iTero
optical scanner (Align Technology; San Jose, Calif.)
has been the use of generic STL files to allow the
creation of very precise surgical guides. CBCT DICOM files
can be merged with iTero STL files to create 3-D renderings
that support virtual planning of prosthetic restorations and
“crown down” planning of hard tissue considerations. Soft
tissue-borne surgical guides have been used for several years;
however, limitations of CBCT DICOM data has restricted
the development of tooth-borne surgical guides. This article
will demonstrate the merging of CBCT DICOM and iTero
STL files, virtual wax-up with case planning in the 3-D
environment, CAD/CAM processing of the surgical guide,
and clinical application consisting of implant placement
and the fabrication of final, model-less implant restorations
through the use of dedicated scanning abutments.
Dental History
A 50-year-old Caucasian male in good health presented with
multiple missing teeth amid otherwise healthy dentition
(Fig. 1). The patient reported he had several congenitally
Figure 1: Mandibular occlusal view demonstrating healthy dentition, with
edentulous sites #29 and #30 planned for implant restoration
– Creating Surgical Guides Using CBCT and Intraoral Scanning – 83