International Journal of Computerized Dentistry, 03/2010

Cone beam computed tomography (CBCT) is a radiological technique available since 1998 in dental and oral medicine in which a cylindrical volume is acquired with a conical x-ray beam during one rotation around the head of the patient (cone beam computed tomography, cone beam CT). This technique is increasingly replacing conventional radiological procedures due to the possibility of arbitrary reconstructions and views free of superimposition. CBCT focuses on the display of the bones of the jaw, so that its use concentrates on problems in implantology, before surgical removal of impacted and displaced teeth, in traumatology, and in craniofacial malformations. The objective of this overview was to emphasize the advantages of cone beam computed tomography in the individual disciplines. However, schematization of examinations should be avoided for reasons of radiation protection and for avoiding forensic pressure. The limits of CBCT and thus an indication for computed tomography exist where there is suspicion of bone tumors with soft tissue participation as well as in extensive fractures with suspicion of craniocerebral trauma. In the case of tumors in the soft tissues and of functional temporomandibular joint symptoms, magnetic resonance tomography is preferable to CBCT. Keywords: Cone beam CT, volumetric CT

Prosthetically based implant planning is necessary so that implants are set expediently and correctly during surgery. A clinical case is presented to describe how this can be performed today purely digitally. Prosthetic planning was undertaken with the Cerec CAD/CAM system. The data record created was transferred and superimposed on a CBCT 3-D radiograph. The position of the implant was planned taking the prosthetic planning into account. Keywords: CAD/CAM, Cerec, cone beam computed tomography, 3-D x-ray, implant planning, prosthetic planning, drilling templates

Für die Bewertung der Wirksamkeit und Effektivität zahnmedizinischer Untersuchungs- und Behandlungsverfahren sind Behandlungsdaten aus Praxen und spezialisierten Zentren sehr wertvoll, speziell in den Bereichen, die Universitätskliniken angesichts zunehmender Spezialisierung nicht abdecken. Die Auswertung dieser Daten scheiterte bei der papiergestützten Dokumentation in der Regel am hiermit verbundenen Aufwand. Bei einer computergestützten Karteiführung kann dieser Aufwand deutlich geringer sein, sofern die Daten entsprechend strukturiert erhoben und gespeichert werden. Da hiermit der Zugang zu sensiblen personenbezogenen Daten enorm erleichtert würde, sind derartige Gesundheitsdaten auf europäischer Ebene besonders geschützt. Anders als gemeinhin angenommen beschränkt sich dieser Schutz nicht allein auf die Pflicht zur Verschwiegenheit (Schweigepflicht), sondern umfasst auch die Verfügungsbefugnis über die Daten (Datenschutz). Dieses führt dazu, dass die Behandlungsdaten auch von (Zahn-) Ärzten, die sie rechtmäßig im Rahmen der Behandlungstätigkeit gesammelt haben, nicht ohne Weiteres legal für wissenschaftliche Studien genutzt werden würden. Einen gesetzlich rechtmäßigen Ausweg aus dieser Problematik bietet die technische Abtrennung der Behandlungsdaten von den Personendaten. Diese muss so erfolgen, dass eine spätere Zuordnung zu einzelnen Personen mit realistischem Aufwand unmöglich ist ("faktische Anonymisierung"). Innerhalb des vorliegenden Beitrags werden die rechtlichen und datentechnischen Grundlagen und deren praktische Umsetzung am Beispiel der Konzeption einer entsprechend rechtskonformen IT-Architektur für die Diagosesoftware dentaConcept CMDfact beschrieben. Eine spezielle Export-Funktion trennt hier automatisiert die anonymisierten Behandlungsdaten ab und ermöglicht so einrichtungsinterne und praxisübergreifende multizentrische Studien. Keywords: Personenbezogene Daten, Behandlungsdaten, faktische Anonymisierung, IT-Architektur, relationale Datenbanken

After a brief historical introduction of virtual reality, the article focuses on why virtual reality is the next step in dental education. Contrary to existing systems for preclinical courses, such as plastic teeth and dummies, virtual reality has no limitations in terms of clinical case studies, objective evaluation, and interactivity. For the past six years we have been developing innovative concepts using force feedback arms and computer 3D simulation at the University of Geneva. After describing the simulator itself, we discuss the results of a preliminary survey we initiated in 2006. The survey concerns the teaching of dental anatomy using 3D rendering capabilities of the simulator for third-year students of the University of Geneva. The aim was to validate the added value of IT integration into our curriculum. The results showed that 70% of the students were satisfied or very satisfied with this module and that the simulation boosted their motivation to learn anatomy. It also became evident that IT did not introduce a supplemental complexity that reduced teaching efficiency. This was a clear message for us to develop a second-generation virtual reality dental simulator with improved tactile features to teach drilling procedures. Keywords: virtual reality, preclinical courses, dental education, force feedback arms, dental simulator, information technology (IT) survey

With the software version 3.80, the Sirona company also delivers the Buccal Scan feature, among other features. This opens up a completely new way of high-precision registration of the occlusion. The new method can be used easily and universally. Keywords: occlusion registration, buccal scan, bite registration, bite impression, virtual articulator

Quadrant restoration has been an integral part of the software since the Cerec 3-D program was introduced. In the new 3.80 version, the program also offers the option of scanning the opposite jaw and correlating it with the prepared jaw by a buccal scan. This innovation is especially appropriate when several teeth in a quadrant are being restored. The procedure is described in detail in this article. Keywords: Cerec, biogenerics, buccal registration, case description, artifact