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A Smile Restored, Starting With an i-CAT Scan

Issue: Winter 2016
Ronald Delmanto, DDS

placeholder 3d-cbct-cropped800-220x220.jpg A Smile Restored, Starting With an i-CAT Scan
3D technologies such as CBCT scans and software with CAD/CAM integration help dentists create high-level plans and treatment

As one of the first dentists to use a CBCT scanner in my area, I recognize the vital role it has in the reconstruction process. The extremely comprehensive data gained from 3D scans help me plan decisive aspects of the implant process, such as precise spacing and parallelism. A 3D imaging system has helped me plan even the most challenging cases.

The reconstruction process on one of my patients required creative planning, and an i-CAT 3D imaging system played a significant role. This patient was diagnosed with multiple ameloblastomas from an FMX. He had no symptoms at the time. An oral surgeon resected the portion of his mandible extending from the mesial of tooth No. 18 to tooth No. 27, supporting the intact portions of his jaw with a metal bar. In a second surgery, the patient’s jaw was reconstructed using a cadaver rib and bone marrow from his hip.

Although this removed the ameloblastomas, the patient was concerned about his function and appearance. Before the surgery, he was active in social activities and attractive. Now, with no anterior teeth in the mandible, the lower left side of his face appeared to be collapsed, and he could not chew on that side.

A 3D imaging system has helped me plan even the most challenging cases.

8 patient before and after800-220x220.jpg A Smile Restored, Starting With an i-CAT Scan
Before and After

The data from CBCT scans led to a level of surgical predictability that I could not achieve with 2D imaging alone. Scans showed the buccal aspect of the teeth would have protruded too far into the cheek and the lip for the routine crown and bridge I had originally intended to pursue. With the i-CAT scan, surgical guides were created for placement of the implants. I worked with the laboratory to create custom castings and implant framework that protruded more lingually for a better aesthetic and clinical outcome. I facilitated a removable appliance that functioned like much of the tissue he lost after the oral surgery.

The patient came to me for solutions, and I was able to devise a reconstruction plan that took his individual and challenging needs into consideration. With information from the 3D scans, the spacing is so good, the patient has experienced no residual problems. After treatment, he was able to chew on that side and looked almost the same as he did prior to the surgery.

Symptomless anatomical anomalies can catch a clinician by surprise, so I don’t plan even a single implant unit now without a 3D scan. I am humbled to say that I gave this patient his smile back.

About the Author: Ronald Delmanto, DDS, received his undergraduate degree at Seton Hall University, and dental degree at Fairleigh Dickinson University School of Dentistry. He also served in the Air Force for 3 years as a dentist. He has had extensive training on implant procedures, is a Diplomate of the International Congress of Oral Implantologists (ICOI), and practices general dentistry in Toms River, New Jersey. Dr. Delmanto has no financial interest in i-CAT.

Indications for use: www.i-cat.com/ifu