Chairside Tomosynthesis for Intraoperative Imaging in Implant Dentistry: Clinical Applications and Workflow Considerations.

Cone-beam computed tomography (CBCT) has become an important component of implant dentistry by providing three-dimensional visualization for diagnosis and treatment planning. However, once implant surgery begins, obtaining additional three-dimensional imaging may require interruption of the procedure and transportation of the patient to a dedicated imaging system. Chairside tomosynthesis offers an alternative approach by providing focused sectional imaging directly within the operatory. This article describes the principles, clinical applications, and workflow considerations of chairside tomosynthesis in implant dentistry, with emphasis on its potential role in addressing focused intraoperative imaging questions and supporting real-time clinical decision-making. Unlike CBCT, which provides comprehensive three-dimensional information for diagnosis and treatment planning, tomosynthesis acquires multiple radiographic projections over a limited arc and reconstructs them into sectional images of a focused region of interest. Potential applications during implant surgery include verification of osteotomy trajectory and implant position, assessment of posterior mandibular implants relative to the inferior alveolar canal, evaluation of anterior maxillary implant positioning and cortical plates, immediate implant placement, sinus augmentation, full-arch rehabilitation, revision procedures, and retrieval of retained or fractured implant components. The mobile Lumos 3DX (Valkyrie Bioscience, Lindon) system permits this focused imaging to be performed chairside, potentially reducing disruption of the surgical workflow and providing additional information when a specific clinical question arises. Chairside tomosynthesis should be considered complementary to, rather than a replacement for, CBCT. CBCT remains the preferred modality for comprehensive diagnosis and preoperative treatment planning, whereas chairside tomosynthesis may provide focused sectional information when additional visualization is required during implant surgery. By providing three-dimensional imaging directly within the operatory, chairside tomosynthesis may help bridge the intraoperative imaging gap and the need for timely sectional imaging during surgery without interrupting the procedure to transport the patient to a dedicated CBCT system, while preserving procedural continuity. Further clinical investigation is necessary to define appropriate indications and determine its diagnostic accuracy, clinical utility, and effect on treatment outcomes.