"In the Zone with the Triangle of Bone"
It has been stated that the “goal of implant dentistry is not the implant, it is the tooth that we replace…” Achieving successful implant reconstruction is therefore dependent on many factors. Placing the implant within the existing bone allows for osseointegration to occur, but this process has little impact on esthetic and functional outcomes. The most desirable implant receptor site should always correlate with the ultimate restorative goal, and under ideal conditions should be known in advance of the surgical intervention.
If the receptor site is not ideal, there are ever evolving methods to manage the bone and soft tissue. Success can best be achieved through the initial diagnosis and treatment planning phase.
New surgical and prosthodontic paradigms have now been established over the past 25 plus years first through the utilization of CT and now lower dosage CBCT three dimensional imaging technologies which provide clinicians with an unprecedented appreciation of the patient’s anatomy for pre-surgical assessment of dental implant receptor sites, bone grafting or other procedures. Currently available planning software can interface with the 3-D CT/CBCT data with virtual tools and interactive treatment planning capabilities. However, even today, in 2017 many clinicians are not well versed in how best to use technology. The “Triangle of Bone” (TOB) concept was originally conceived in 1992 and first published in 1995 to provide a foundation to assess the potential implant receptor site to identify a“blueprint for success.” The TOB concept if used properly can help clinicians achieve true restoratively driven implant dentistry by matching the receptor sites to the design specifications of the implant and abutments before the scalpel touches the patient. In addition, the TOB can help identify when other treatment modalities such as bone grafting should be used to facilitate treatment. The merging of analog and digital technologies has re-defined the workflow, developed new paths between diagnosis and CAD CAM applications, while enhancing both accuracy and consistency in establishing new paradigms for today and beyond.