The evolution of multiplanar diagnostic imaging: predictable transfer of preoperative analysis to the surgical site

Presurgical planning and communication between the prosthodontist and the surgeon is essential to achieve optimal placement of functional implants. Besides the basic clinical examination and the use of mounted study casts, radiographic imaging is an essential adjunctive aid in treatment planning. In the past decade, multiplanar reformatted computerized tomography (CT) has become the most comprehensive and accurate aid for implant treatment planning. Available software programs allow precise assessment of the 3-dimensional architecture and internal anatomy of the jaws. The programs enable accurate preoperative evaluation for planning implant placement with a maximum use of bone. However, the accurate transfer of the implant analysis from 2- and 3-dimensional computer reconstruction to the surgical site was not predictable until recently. As advancements occurred in technology with the advent of the helical CT scanner and rapid prototype 3-dimensional model production by stereolithography, a CAD-CAM program was developed to create an accurate transfer from the image to the surgical site. Detailed preoperative analyses of the quantity and quality of bone as well as the ideal positioning of implant fixtures may be established with the aid of a surgical guide that is placed directly on the bone for precise implant insertion.