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