What 3D Imaging Shows Before Dental Implants

What is dental 3D imaging?

Dental cone-beam computed tomography uses a cone-shaped X-ray beam to collect information that software reconstructs into a three-dimensional image. The U.S. Food and Drug Administration explains that dental CBCT can show structures in the teeth, mouth, jaws, and nearby areas and is used for clinical applications that include dental implant planning.

Unlike a conventional dental X-ray, which provides a two-dimensional image, CBCT can provide information in three dimensions. The appropriate type of image depends on the clinical question; more imaging is not automatically better.

What may a dentist evaluate before implant treatment?

The exact review depends on the missing tooth or teeth, the proposed restoration, and the patient's anatomy. When clinically indicated, 3D imaging may help the treatment team evaluate the proposed implant site and its relationship to nearby structures.

Imaging is only one part of the evaluation. The dentist also needs to examine the mouth, review relevant health history, assess the gums and remaining teeth, and understand the planned restoration. Advanced Dentistry & Orthodontics uses 3D imaging to help plan implant placement, but the recommended imaging and treatment sequence depend on the individual evaluation.

The dental implant treatment page explains candidacy, treatment stages, alternatives, risks, and maintenance.

Does every implant patient need a CBCT scan?

Not every dental problem requires CBCT. The FDA and American Dental Association recommend that dental X-ray examinations be performed only when necessary for diagnosis or treatment. The ADA's radiography guidance says clinicians should first perform a clinical examination and should incorporate CBCT only when lower-exposure options will not provide the necessary diagnostic information.

The dentist should be able to explain the clinical question the image is intended to answer. Existing images may also be reviewed when they are current and adequate, although the treating dentist must decide whether they provide the information needed for the proposed care.

What are the benefits and limitations?

The principal benefit is additional three-dimensional information that may assist diagnosis, treatment planning, and evaluation in selected situations. The limitation is that CBCT uses ionizing radiation and generally delivers more radiation than conventional dental X-rays, although usually less than other types of medical CT examinations.

The appropriate balance depends on the clinical need. The FDA recommends using the lowest radiation dose that provides image quality adequate for diagnosis and limiting the scanned area to what is needed.

A scan also cannot promise implant success. Healing and long-term maintenance may be affected by anatomy, oral hygiene, gum health, smoking, medical conditions, medications, bite forces, and other individual factors. These issues need to be discussed as part of informed consent and treatment planning.

What should patients ask before the scan?

1. What clinical question are you trying to answer?
2. Could an existing or lower-exposure image provide the necessary information?
3. What area will be included in the scan?
4. How might the result change the proposed implant or restoration plan?
5. Who will review the entire image?
6. Can I receive a copy for my records or for another treating provider?
7. What additional examination, records, or consultations are needed before a final plan is made?

What happens after the imaging review?

The dentist combines the imaging findings with the examination, health history, and restorative goals. The discussion may include whether the natural tooth can be preserved, whether an implant is appropriate, reasonable alternatives, the anticipated treatment stages, material risks, maintenance needs, and which clinicians will perform each stage.

Advanced Dentistry & Orthodontics offers implant evaluations through its Pomona, Newport Beach, and Brea offices. Dr. Nabeel Cajee leads implant surgery for the practice. A consultation is still required to determine which imaging and treatment options are appropriate for a particular patient.