Evaluation of anatomical structures and variations in the maxilla and the mandible before dental implant treatment.

BACKGROUND: Cone beam computed tomography (CBCT) allows a detailed visualization of the anatomic structures of the jaw. There have been presented variations of the anatomic structures between genders after evaluating the structures in detail. OBJECTIVES: The aim of this study was to investigate the anatomic variations of the jaws according to gender and age in an effort to avoid complications during implant surgeries. MATERIAL AND METHODS: In this retrospective study, a total of 159 scans (87 of the maxilla, 72 of the mandible) were evaluated in order to analyze the effect of age and gender on these anatomic variations. RESULTS: According to statistical analysis, gender affected the crestal dimensions above the mandibular canal and sinus mucosal thickening. The mean value of the width of the mandibular canal, the distance between the mandibular canal and the superior border of the mandible, the distance between the mandibular canal and the inferior border of the mandible, the diameter of the mental foramen, the distance between the mental foramen and the inferior border of the mandible, and the distance between the lingual foramen and the inferior border of the mandible were significantly greater in female patients than in male subjects (p < 0.001). However, sinus mucosal thickening and the diameter of the posterior superior alveolar artery (PSAA) were significantly greater in males as compared to females (p < 0.001). While the configuration of the nasopalatine canal was funnel-shaped in female patients, this configuration was found to be cylinder-shaped in male subjects. A high prevalence of sinus septa (43.7%) and PSAA (87.4%) was detected in the scans. CONCLUSIONS: When planning dental implants, radiographic examinations, alongside clinical examinations, have become necessary to reduce the risk of implant surgery failure and complications. The CBCT imaging is a valuable tool to determine the anatomic structures before carrying out any surgeries, including implant surgery. Gender affects anatomical variations and dimensions significantly, even when they are not affected by age. Large population focused and multicenter studies may provide a better understanding of the need to evaluate the anatomical structures in detail.

Transplantation of Autogenous Bone Block With an Osseointegrated Implant: Seedling Technique With Twelve-Month Follow-Up.

OBJECTIVE: Loss of teeth frequently results in compound horizontal and vertical alveolar bone defects. An appropriate bone structure is the key for implant placement and bony support of soft tissues. Advanced bone augmentation techniques are required for the reconstruction of these defects. This report will present a new bone block grafting technique with 12-month follow-up. METHOD: The seedling technique was used to augment the alveolar bone 3-dimensionally with autologous bone block and an osseointegrated implant in a 2-stage procedure. Horizontal and vertical bone loss is revealed after cone beam radiographic examination in the right maxillary lateral incisor area. Initially, the implant was placed at the right maxillary tuber area, where the bone was abundant. After 2-months healing phase, the osseointegrated implant was harvested with the surrounding bone and transplanted to the anterior region of maxilla to augment the horizontal and the vertical components of the recipient site. Transplanted implant inserted into autogenous bone block was fixed with mini plate to the adjacent native bone. Prosthetic restoration was applied 4 months after the transplantation. RESULTS: Seven months after the first surgery, treatment of anterior bone deficiency was accomplished. The patient was fully satisfied with the function and the esthetics of the restoration. The radiological and clinical examinations at 1-year follow-up evaluation showed successful outcome of transplanted autogenous bone block without any resorption. CONCLUSION: This clinical report demonstrated that anterior maxillary single-tooth replacement, according to seedling concept of autogenous bone block with osseointegrated implant, is a successful and predictable treatment modality.