#AskT-Bone – Edentulous Implant, CEREC Guide, and Which CBCT


Hello and welcome to another episode of Ask T-Bone.


Today I would like to begin by apologizing if he here Harry Potter in the background. My 10 years old son is watching Harry Potter and I cannot get him to turn the volume down. So we shall hopefully be able to work this out, or you’ll just have to deal with it in the background. So, I apologize.


So today’s question:


Hi Tarun!

I am wanting to attend a course on more advanced implant placement using guides and CEREC. I place about a hundred and fifty implants a year, but looking to do more fixed edentulous with the aid of their guides etc..


The next question is I have currently have a J. Morita small field of view CBCT. I am opening up a second office and taking that CBCT to the next office and upgrading to a newer full volume field, full field of view CBCT for my current office. Just wondering your suggestion of which unit to purchase. I’m currently looking at this Sirona ORTHOPHOS SL to give me pano and 3D usages. Thanks for your help.


So, thank you for submitting the question. For those of you that would like to submit questions please visit www.tbonespeaks.com and at the bottom of the page you can submit your question. So let’s answer this.

Number one I want to attend a course some more advanced implant placement using guides and CEREC. Well, quite honestly, humbly I would say that there’s no better place to learn that from, than from our workshop in Raleigh North Carolina. Our focus, we have a the ultimate 3D workshop, and it’s focused exactly on utilizing CEREC and sirona Cone beam CBCT to really kick up a notch your implant placement. It’s really focused on the onesies and twosies and about the technology.


Now, certainly we do cover CEREC guides in great detail at that Workshop.


Now, the second part is: I want to use CEREC guide to do more fixed edentulous. Unfortunately, CEREC guide is not an appropriate guide for fixed edentulous. CEREC guide chairside is limited to tooth borne guides for a single site, Cerec guides through lab is limited to tooth borne multiple sites. So, for the typical fixed edentulous, we are recommending that use a bone foundation guide, and there’s several different ones available. I would encourage you to consider our 3d dentist Workshop which is agnostic in terms of implants and The Cone beam that you have, and it has very little to do with digital impression systems. So, our 3D Edentulous Workshop is a fantastic Workshop to learn more about how to digitize your fixed hybrids and get them down to about 5 to 6 visits, and have unbelievable predictability with that.


The next question was about the smaller field of view.


Quite frankly, I’m not a big fan of really small field of view, I’m not familiar with the J Morita field of view, I don’t know exactly how large that is. But to me, a true minimum size field of view, it probably would be an 8 by 8, and quite honestly I’m not even a big fan of an 8 by 8 size scan for the general practice. To me the really useful size, minimum size, is 11 by 10, because that allows us to capture all of the maxilla and mandible and the sinus and the third molars. An 11 x 10. unfortunately will not always get the joint in there, and 90% of the times the 11 by 10 will also get the airway scan in there.

Now, the reason that I would recommend an 11 x 10 as a minimum for you, is that since you are trying to do fixed hybrids edentulous cases, you will want to get a good view of the maxillary sinus, the sinuses, so that when you’re planning your all on X cases if you need to do till to implants, you can see enough of the sinuses without having to position your patient on the Machine to trick it. So I would go for at least a minimum size of 11 x 10.


Now, I must admit that I am clinically biased towards the Sirona units. And I am a trainer and speaker for Sirona. I do not have a financial relationships in terms of any benefits of that, I may receive for Sirona units sold through me, or any programs that I am a part of. But, what I have found is, if you are a CEREC owner, and makes all the sense in the world to have a Sirona 3D CBCT, because they are perfectly integrated together, they worked unbelievably well together.

So, the ORTHOPHOS SL is the unit that I actually have in my office right now. I have the ORTHOPHOS SLAI, for the airway which is the 11 x 10 view, it does 11 x 10, 8 x 8 and the 5 x 5 scan. It does high definition, it does 2D and 3D, and we’ve been unbelievably happy with that unit. The image quality is fantastic, the image quality for the pano-x is also fantastic, but to be honest with you, in 9 months of owning the unit, we would probably only take an about 12 to 15 true pano-x with it. We have so heavily used the relay on the 3D that there is minimun time that I want to use a panorex, other than children, and honestly the only other time we used it is when we’ve placed multiple implants. We don’t feel like taking individual PA, you rather have a quick panorex to be able to verify seating of the implants or impression copings on multiple implant.


So, you know what I would tell you is that the CEREC and Cone Beam go unbelievably well together. You’re placing 150 implants a year, I often find that those dentists who are placing implants already especially that significant volume which is 150 implants would be that getting you to let go of the traditional mindset and move into the digital mindset, is sometimes a little bit of a difficult sell. But once I get you there, what would I find is that you’ll never go back, you’ll reduce your chair time, you will reduce the number of visits that you take, and you’ll get a significant more accuracy to allow to make your restorations easier.


So, I want to thank you for submitting your questions, and if you have any more clarity that is needed please don’t hesitate to reach out again.


And again, if you guys could do me a favor, if you could go on iTunes and review our podcast I will try to get our rankings up. number two, we are trying to increase of subscribers, So if you can go on Facebook and share a podcast and recommend it to a friend for them to sign up and subscribe, obviously it’s free, that would be great, and certainly if we can help you with any workshops would love to see you and Raleigh North Carolina. We have a very no-nonsense practical approach to our workshops, and we’d love to have you there.


Thanks and have a wonderful day!

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