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The Benefits of SICAT Implant


Open to all Cone beam and CT systems

- SICAT Implant is compatible with all modern Cone beam and CT


systems.
- Data import via DICOM is extremely straight-forward:Patient cases
are quickly and easily read into the software
- Immediately available for diagnosis and implant planning.

Reassure patients with the integrated diagnostic tool

- The examination window guides you intuitively through the 3D


volume and all slices.
- The case can be diagnosed right in front of the patient with the
aid of the integrated diagnostic tool.

Quick steps from planning to implant surgery

- In just a few steps, SICAT Implant guides you through positioning


implants
- abutments to selecting sleeves from any system straight to
ordering a surgical guide.
- The implant library includes implants, abutments and sleeves
from all major suppliers.

Achieving the desired result with prosthetic-based planning

The SICAT Implant CAD/CAM software allows optical surface scan data to
be integrated with 3D X-ray data.
In addition to visualizing 3D X-ray data, SICAT Implant CAD/CAM allows
implants to be positioned on the basis of a virtual prosthetic proposal.
Laborious fabrication of radiographic templates or double scans can now
be dispensed with entirely. The optical surface scan data also clearly show
the gingival surface.

SICAT Implant Product Solutions

In addition to the familiar features of SICAT Implant, SICAT Implant


CAD/CAM makes it possible to merge optical surface scans with 3D
X-ray data.
In addition to visualizing 3D X-ray data, SICAT Implant CAD/CAM
allows simultaneous planning of implants on the basis of a virtual
prosthetic proposal.

SICAT Implant Product Solutions

As radiological 3D software for diagnosis and dental implant planning, SICAT


Implant is compatible with all modern Conebeam and CT systems.
Importing data via DICOM and the subsequent application couldnt be easier:
the patented examination window guides you through familiar views such as the
panoramic view to enable you to diagnose and plan where you want to, and in
3D.
Only a few steps remain from positioning one or more implants to ordering the
surgical guide that fits your case.

Guided Surgery with SICAT Implant

Registration accuracy of three- dimensional


surface and cone beam computed tomography
data for virtual implant planning.
Clin. Oral Impl. Res. 23, 2012;447452

Authors affiliations:
L. Ritter, S. D. Reiz, D. Rothamel, T. Dreiseidler, V. Karapetian, M. Scheer, J. E. Zo ller, Department
for Craniomaxillofacial and Plastic Surgery, University Hospital of Cologne, Cologne, Germany

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Introduction

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Dental implants
Dental implants are an established treatment option to rehabilitate function and
esthetics of the stomatognathic system after tooth loss or aplasia.

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Planning of implant positions


Cone beam computed tomography (CBCT) is increasingly used in order to
provide three-dimensional (3D) information of the patients anatomy that can also be
accurately measured for implant planning
(Ganz 2008; Peck & Conte 2008; Schneider et al. 2009).

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Wax-up to Computer
Systems currently on the market let the patient wear a barium sulfate radioopaque wax-up showing the planned prosthesis when being scanned. Using this
approach anatomical and prosthetic information can be rendered simultaneously
within the software for implant planning.
After planning, either the scanning template is trans- formed into a surgical
guide by CAD CAM technology or stereolithography is used to manufacture the
surgical guide. Alternatively, a navigation system can be applied to guide the
surgeon during implant placement.
(Ploder et al. 1995; Wanschitz et al. 2002; Jabero & Sarment 2006; Mischkowski et al. 2006).

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Objective & aim


Objective: Virtual wax-ups based on three-dimensional (3D) surface models can be
matched (i.e. registered) to cone beam computed tomography (CBCT) data of the
same patient for dental implant planning. Thereby, implant planning software can
visualize anatomical and prosthetic information simultaneously.
The aim of this study is to assess the accuracy of a newly developed registration
process.

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Material & Method

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Material & Method :

Patients and data acquisition


16 1 4 7
35 (54.7%)
29 (45.3%)
34 (59.4%)

12 composite filling
10 (15.6%) metallic or ceramic restoration
8 (6.3%) had a metallic crown.
CBCT AND CEREC Bluecam scan
2 -
implant
3 (Galileos, Sirona Dental Systems)

Material & Method :

3D CBCT imaging
Technical parameters of the scanner 1

Material & Method :

3D surface imaging the optical impression


Optical data were captured from plaster models poured from alginate
impressions (CEREC stone BC, Sirona Dental Systems) using the CEREC AC
system (Sirona Dental Systems).

Material & Method :

Prosthetic planning using CEREC software


the software tools (CEREC, Sirona
Dental Systems)

FDI dental scheme

After the design was finished,the virtual wax-up was saved and transferred into the
implant planning software including the virtual model of the neighboring teeth.

Material & Method :

Prosthetic planning using CEREC software


software 2

CEREC restoration virtually designed. Note the color-coded occlusal contact

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Material & Method :

Registration of data from CBTC and CEREC


- Implant planning software

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Material & Method :

Registration of data from CBTC and CEREC

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Material & Method :

Measuring procedure
Horizontal measuring points, 90o to the reference
implant:
1. vestibular
2. lingual/palatinal
3. mesial (in case of approximal contact measure
mesiolingual)
4. distal (in case of approximal contact measure
distovestibular)

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Material & Method :

Measuring procedure
Vertical measuring points parallel to the implant axis:
5. middle of incisal edge/at the central fissure
6. mesial at the incisal edge/at the (disto-)buccal
cusp
7. distal at the incisal edge/at the (mesio-)lingual/
palatinal cusp.

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Material & Method :

Statistical analysis
1. PASW statistics 18.0 for Mac OS X (SPSS Inc., Chicago, IL, USA).
2. The Wilcoxon rank test
was used to compare measurements at the different measuring points and to
reveal directional error in the registration process.
3. The Spearmans correlation coefficient
was used to test for a correlation of restoration type and measurement error.

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Results

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Results

All data pairs were matched successfully and mean distances between CBCT and 3D surface
data were between 0.03( 0.33) and 0.14( 0.18) mm. At two of seven measuring points,
sta]s]cally signicant correla]ons were determined between the measured error and the
presence and type of restora]ons. Registra]on errors in maxilla and mandible were not
sta]s]cally signicantly dierent.
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Discussion

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Discussion
This study shows that the process of registering
optical 3D data of the dentition with CBCT data of
the skull is feasible with measured mean accuracies
from 0.02 to 0.14mm.
Results for maxilla and mandible showed equal distributions of errors
except for the mesial/mesiolingual measuring point, so it can be assumed
that the registration works for both maxilla and mandible.

Discussion

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Discussion
Results show that the registration error tends
to be negative, i.e. that the visualized surface of
the CEREC model overlaps the visualized surface
of the CBCT.
Possible error sources are the registration process of datasets per se,
the visualization of CBCT data and/or the visualization of the CEREC data as
well as geometric differences in models and anatomy of the patient.
Furthermore, a systematic error in the measurements is possible.

Discussion
To compensate for measurement errors two investigators took the
measurements in two separate iterations with good intra and interobserver
agreement.
This study is limited since no ground truth for the measurements
could be established, due to its retrospective clinical character using real
patient data. On the other hand in vitro studies make a ground truth
accessible but have limits in their clinical application and preceded this study.

Discussion
So far the approach of registering optical data of the dentition with a
3D CT or CBCT has was mostly been applied for planning of orthognathic
surgery (Nkenke et al. 2004; Swennen et al. 2009) or intra-operative navigation (Shamir et
al. 2009).

Advantages of this approach are manifold: Prosthetic planning can be


easily adapted and changed, visualization is improved, measurements can be
digitally made and scanning templates are not required anymore.

Discussion
No dental technician or lab work is required in order to make a
prosthetic based implant planning. Furthermore, radiation can be saved for the
patient: a specific scan with the patient wearing the scanning template is not
required anymore and the prosthetic plan can simply be matched onto the
data later.
Further applications are currently under investigation: a drilling
template based on the implant planning could be manufactured by the CEREC
milling machine and would be adaptable to any implant system.

Discussion
So far only one or two teeth replacements were investigated, in the
future larger restorations could be planned using this approach. For restorative
procedures it is already possible to work with the CEREC system
for whole quadrants (Ender et al. 2003).

Conclusion

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Conclusion
According to the results of this study, registration of 3D surface data
and CBCT data works reliably and is sufficiently accurate for dental implant
planning. Thereby, barium-sulfate scanning templates can be avoided and dental
implant planning can be accomplished fully virtual.

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