As we all know, bone is needed in areas that we plan to place implants. And we also know that sometimes it looks like we have plenty of bone to place an implant, but in reality, we don’t.

One awesome tool we now have at our disposal to help determine this are Cone Beam CT Scans (CBCTs). It is, of course, great when CBCT scans tell us we do not have enough bone when clinically it appeared we did. But one frustrating thing about CBCT scans is how often they tell us this. Now don’t think I am saying this is a bad thing – I am not, as clearly not knowing this ahead of time would be way more frustrating, and I know we all want to keep any frustration to a minimum. What I want to share in this article is the fact that sometimes CBCT scans can actually show us things are better than we thought!

Take for example the area here:


My implant surgeon and I took one look at this area and agreed that while we wanted an implant here (along with other areas as well), we were sure we would need substantial grafting in this area to do so. As we do with any case of this nature, we obtained a CBCT scan so we could know exactly what we were dealing with and just how bad things were. I must say when we looked at the scan we could barely believe our eyes! As you can see here, there was way more bone under the tissue than we expected.

Cone Beam

As I am sure you have guessed, we were super excited to see that while ideally we would still like to graft the area to some extent, we had enough bone to get an implant in the general area we would like. The next question, of course, is will we just want soft tissue grafting or will we still want some additional bone (although way less than originally thought prior to the CBCT) to get the implant in the most ideal position?

While this scan seems to show we will still want both soft tissue and bone grafting, we will not know the full extent of our grafting needs until we have him scanned with a radiographic template based upon our diagnostic wax-up. Nevertheless, the fact of the matter is we are in way better shape than we initially thought!

John R. Carson, DDS, PC, Spear Visiting Faculty and Contributing Author