Cbct Analysis Of Alveolar Bone Dimensions In Mandibular Posterior Teeth: A Preliminary Study

OBJECTIVES: Extraction of mandibular posterior teeth followed by immediate implant placement is considered as an optimal technique of immediate prosthetic rehabilitation. The analysis of alveolar bone dimensions with Cone Beam Computerized Tomography prior to implant placement is a prime determinant in treatment planning. Hence this preliminary study was conducted to analyze the alveolar bone dimensions in dentate mandibular posterior teeth to evaluate the available bone which can be utilized for immediate implant placements. MATERIALS AND METHODS: Retrospective data of 200 cases of full volume CBCT was procured from Riyadh Elm University (REU) database and reviewed for eligibility. Atotal of 10 cases were included in the study. Scans were assessed for thickness of buccal and lingual walls at 4mm below the CEJ (MP1) and at midroot level (MP2). Alveolar width was assessed at most coronal point on alveolar bone (BW1) and at superior border of mandibular canal (BW2). The height was be calculated by measuring the vertical distance between BW1 and BW2. Data was tabulated and statistically analyzed using unpaired t-test. RESULTS: The results of our study indicates that dimensions of buccal and lingual bone walls of all teeth at MP1 and MP2 in PM1, PM2 and M1 were statistically significant. Also only the 1st premolar (PM1) showed statistical significance with regard to dimensions at BW1 and BW2. CONCLUSION: The present study highlights the need for further studies with larger samples which can impact the immediate implant success rates in mandibular posterior teeth

Submandibular Gland Fossa Assessment with Cone Beam Computed Tomography

Introduction: Cone beam computed tomography (CBCT) is often used in pre-implant planning where it helps assessing theamount of bone availability and its relationship from its surrounding structures. In certain vital areas such as inferior alveolarnerve canal and submandibular gland fossa, it is important to know the dimensions of the bone to avoid post-operativecomplications. The aim of the study was to evaluate the deepest area or the concavity depth submandibular fossa on CBCTand also to measure/determine the distance from the mental foramen to the deepest concavity depth and the height of alveolarcrest from the deepest concavity depth.Materials and Methods: Retrospective studies of CBCT images were obtained on a KODAK 9000 three-dimensional (3D)extraoral imaging systems using CS 3D imaging software. The site of the submandibular gland fossa was identified, andmeasurements were done to evaluate the depth of the fossa, its distance from the alveolar crest and from the mental foramen.Results: The lingual concavity depth over a range up to a maximum value of 3.70 mm and the minimum depth up to 0.5 mm.Analysis of variance compared the mean values and standard deviation for mandibular measurements between male and female.The sexes did not differ significantly. Independent sample t-test did not demonstrate any difference among the age group,#P > 0.05.Conclusion: CBCT is an important tool for assessing the mandibular region and planning for safe implant placement in theposterior mandible.

Quando a satisfação autorrelatada do paciente com a prótese implantossuportada mandibular influencia na colocação de uma prótese total fixa na maxila: os benefícios do planejamento e colocação 3D baseados na TCFC e nos guias estereolitográficos – acompanhamento de dois anos e 11 meses / When the self-reported patient satisfaction with implant-supported mandibular denture influences on the use of implant-supported maxillary prostheses: the benefi ts of a 3-D implant planning and placement based on CBCT and stereolithographic guides – two year and 11-month follow-up

Este relato mostra um paciente de 72 anos de idade onde sua prótese total inferior sobre implantes motivou-a para usar uma prótese total fixa na maxila. Após os procedimentos de TCFC e protéticos no plano de tratamento, guias estereolitográficos foram construídos para uma colocação de implantes dentários sem levantamento de retalho. Cinco implantes foram colocados nas regiões 14, 13, 11, 22, e 24 com torque de inserção de 32 Ncm. A prótese total fixa definitiva foi entregue em até 48 horas. Após dois anos e 11 meses, não foram registradas complicações. Quando adequadamente indicada, a cirurgia virtual guiada tem se tornado uma realidade efetiva para pacientes idosos.

This case reports on a 72 years-old patient whose complete mandibular implant-supported prosthesis motivated her to use a fi xed appliance in the maxilla. After CBCT and prosthodontic procedures for treatment planning, stereolithographic guides were constructed for a flapless dental implant placement. Five implants were placed in the regions of 14, 13, 11, 22 and 24 with a 32 Ncm insertion torque. The final maxillary implant-supported prosthesis was delivered until 48 hours. After two years and 11 months, no complications were reported. When properly indicated, virtual guided surgery has become an effective possibility for elderly patients.

A case report of a surgical guide fabricated via intraoral scanning-based implant planning and wax-based rapid prototyping / 대한치과보철학회지

With the recent progress of digital technology, the computer guided surgery utilizing a guide template in the placement of implant has been actively performed, and the method employing the intraoral scanner at the implant prosthesis introduced. Fabrication method of the guide template can be largely classified into design-related rapid prototyping (RP) system and vector milling system, and each of the method has its own weakness in the clinical application despite of excellent accuracy. Thus, in this case study, a working model was fabricated by the wax RP technology using images acquired by CBCT and an intraoral scanner, and the metal bushing was picked up with orthodontic resin cast upon the wax model. Using this method, a surgical guide template was fabricated and used in surgery. From this, we could obtain a satisfactory outcome clinically in the implant placement and the fabrication of the final prostheses and thus report this case herein.

Um novo sistema simplificado para cirurgia virtual guiada com implantes dentários – relato de caso clínico com acompanhamento clínico e tomográfico de 11 meses / A new simplified system for virtual-guided dental implant surgery: a case report with clinical and tomographic 11-month follow-up

O objetivo deste relato foi analisar uma nova proposta de cirurgia assistida por computador, utilizando o planejamento virtual realizado através de imagens tomográficas computadorizadas e de um dispositivo posicionador de tubos (DPT). Uma paciente de 31 anos de idade apresentou-se com fratura do incisivo central superior esquerdo (21). Após o exame por tomografia computadorizada feixe cônico, no modelo de trabalho foi confeccionado um guia de poliuretano e acoplado um suporte tomográfico com três referências metálicas; em seguida, foi certificada a estabilidade deste guia tomográfico (GT) na arcada do paciente. Através do GT, imagens tomográficas foram captadas em ambiente tridimensional virtual computadorizado. O planejamento foi realizado no programa KEA-tech. Um implante cone-morse e um sistema específico de cirurgia guiada, ProssGuide (Dabi Atlante, Ribeirão Preto/SP, Brasil), foram usados, um biomaterial foi colocado na região vestibular, e a paciente recebeu uma coroa provisória em resina acrílica. Novas imagens tomográficas foram geradas para comparação. A maior diferença observada foi no ângulo mesiodistal (1,91°), e a menor na medida vestibulolingual (0,01 mm). As outras medidas tiveram diferenças menores de 1 mm ou 1º. Considerando-se os limites do caso, os dados demonstraram a acurácia do programa computacional e da técnica. Entretanto, mais ensaios clínicos com amostras maiores devem ratificar os dados obtidos neste caso clínico.

The aim of this report was to analyze a new guided-surgery, computer assisted modality through virtual planning according CBCT images and a tube positioning device (TPD). A 31 years-old was referred with a fracture of the maxillary left central incisor (21) After CBCT examining, a stone dental model was made and a polyurethane guide attached to a tomographic support (GT) with three reference points, being its stability certified into the patient´s jaw. Then, CBCT images were made and captured in a virtual environment. Dental implant planning was made with the KEA-tech program. A cone-morse dental implant was inserted with an specific guided surgery hardware ProssGuide (Dabi Atlante, Ribeirão Preto/SP, Brasil). After, a biomaterial was packed into the defect and the patient received an acrylic, provisional cemented crown. New CBCT images were made for comparison. The highest difference was seen at the mesiodistal angle (1.91°), and the lowest linear at the buccolingual aspect (0.01 mm). The other measurements were lower than 1 mm or 1º. Within the limits of this case, initial data revealed accuracy and safety of this computational software and technique. However, more clinical trials with large sample sizes are necessary to corroborate the findings of this clinical case.

An anatomical study on the mandibular medial surface by CBCT analysis for safer implant placement

INTRODUCTION: This study examined the anatomical morphology of the medial surface of the posterior mandible using 3-dimensional cone-beam computed tomography (CT) images to reduce the number of complications related to dental implant placement. MATERIALS AND METHODS: Fifty patients were enrolled in this study with an average age (+/-standard deviation) of 44.28 (+/-13.05). On the coronal views cone-beam CT of the first molars, the distance between the top of the canal and alveolar crest vertical distance (VD), the distance between the upper-most point of the canal and the point perpendicular to the lingual cortical margin of the mandible lingual distance (LD), the location of the starting point of VD for reducing from the vertical reference line (VD point), and the inclination of the mandibular medial surface (lingual inclination) were measured, and a statistical evaluation was performed using SPSS for Windows version 15.0. RESULTS: The mean VD0 was 16.91+/-2.47 mm and VDx decreased with increasing x value. The mean LD was 5.27+/-1.36 mm. The VD began to decrease at the mean location of 6.12+/-0.96 mm from the vertical reference line. The mean lingual inclination was 1.52+/-0.72degrees. CONCLUSION: These results will assist in the accurate placement of dental implants and the reduction of complications, particularly in the case of preoperative implant planning using only 2-dimensional imaging methods. (ex. panoramic radiography)

A systematic implant treatment planning and concepts for clinical success / 대한치과보철학회지

STATEMENT OF PROBLEM: It is important to have a correct presurgical treatment plan before any implant surgery. It must contain substantial information about the patient concerned. However, the standard classification only notifies the dentist about various structural, pathological and physiological dimensions. Due to diverse structure of the jaw bone, current standard classification does not tell spatial dimensions of the available bone for implant insertion sites. PURPOSE OF STUDY: The purpose of this study is to report the establishment of the systematic implant treatment plan and its clinical treatment using Implan(R) program which is based on ASCIi-classification that is available for future diagnosis and scale of treatment and for systematic implant insertion. RESULTS: By assisting the systemic measurement of the available alveolus dimension during implant surgery, it was easy to set initial implant treatment plan. CONCLUSION: Using Implan(R) program which is based on ASCIi-classification system that allows the establishment of systemic implant treatment plan and successful clinical performance, it was possible to establish the founding of initial implant treatment plan, the acquisition of information, and the systematization of documentation.

Anatomical Site Classification for Implant Insertion: ASCII / 대한치과보철학회지

STATEMENT of PROBLEM: As a standard means of diagnostics, an orthopantomogram(OPT) permits to measure the vertical and mesiodistal dimension of available bone at the desired implant site with the help of suitable radioopaque references. Based on the clinical investigation of the dentition and the edentulous sites, information upon the width of the implant site can be obtained and documented in the dental scheme. Both findings permit together systematic primary planning for endosteal implants. PURPOSE of STUDY: Contents of the present article are the representation of a semiquantitative classification of available bone with the aim to simplify the primary phase of a systematic implant planning. RESULTS: Thus the ASCII-system permits a clear protocol of bone findings for the implant case with all information available during the primary appointment for treatment planning as a basis of further diagnostic and therapeutic measures. CONCLUSION: With the ASCII system, important parameters such as alveolar height and subcrestal alveolar width can be documented systematically, easily and time saving in the dental scheme as a basis for exact treatment planning.

Clinical application of a new systematic implant planning concept (A Clinical Report) / 대한치과보철학회지

STATEMENT OF PROBLEM: Commonly used classification systems do not inform fo dentists the dimension of the available bone at a potential implant site although regarding a variety of morphologic and pathophysiologic aspects using schematic graphs. However, for the implantologist the availability of bone substance is most important independent whether it concerns the jaw basis or the alveolus. PURPOSE OF STUDY: The present article refers to a new evaluation form, to analyze the available bone with regard to optional immediate loading site by site. According to a new systematic implant planning concept will be presented in two case reports. RESULTS: The feasibility of the classification for planning and documentation of immediately loaded implants is presented in two case reports. CONCLUSION: The factor of bone support for immediate functional stability is important in dental implantology. The new systematic implant planning helps to systematically estimate the dimension (ASCIi classification) of the alveolus site by site to evaluate the possibility of immediate loading. The G ttingen classification thus aids to determine the degree of stability that can be expected for the planned solution.