9 Implants

9

Implants

Shawneen M. Gonzalez


Introduction
This chapter covers aspects regarding implant placement including accuracy of measurements, Hounsfield units, and mandibular nerve tracing. This chapter will not go into depth about stent construction or different software applications capable of this.

Imaging for Implant Purposes

American Academy of Oral and Maxillofacial Radiology (AAOMR) Recommendations

In 2000, the AAOMR recommended conventional CT to create cross-sectional slices for implants. Since this original statement, CBCT availability has increased. The AAOMR published a position statement on implants imaging specifically regarding CBCT use in June of 2012 with 11 primary recommendations.

Initial Examination

Recommendation 1

Panoramic radiography should be used as the imaging modality of choice in the initial evaluation of the dental implant patient.

Pantomographs or panoramic radiograph units show information about both the maxilla and mandible and associated structures that may create issues with implant placement such as the mandibular nerve and maxillary sinuses. Accuracy of measurements on pantomographs is not always reliable as there are many factors that may distort the final image. One of the most common factors is patient positioning. Measurements are able to be made only in an inferior-superior aspect and not facial-lingual width of the ridge.

Recommendation 2

Use intraoral periapical radiography to supplement the preliminary information from panoramic radiography.

Periapical radiographs have a high spatial resolution showing minute detail. Again, as with pantomographs, error in positioning of the image receptor can create distortion in the final image making accurate measurements not possible.

Recommendation 3

Do not use cross-sectional imaging, including CBCT, as an initial diagnostic imaging examination.

CBCT imaging should be recommended only after an initial evaluation; using CBCT as an initial diagnostic tool is in violation of recommendations from the AAOMR, ADA, and EADMFR (see Chapter 2).

Pre-operative Site-Specific Imaging

Recommendation 4

The radiographic examination of any potential implant site should include cross-sectional imaging orthogonal to the site of interest.

This recommendation is consistent with the AAOMR’s stance in 2000. This allows for visualization of ridge morphology and bone quality in the area of the proposed implant(s) placement.

Recommendation 5

CBCT should be considered as the imaging modality of choice for pre-operative cross-sectional imaging of potential implant sites.

The use of CBCT is lower radiation dose compared to traditional CT.

Recommendation 6

CBCT should be considered when clinical conditions indicate a need for augmentation procedures or site development before placement of dental implants.

This includes areas of possible bone grafts including a possible maxillary sinus lift with graft placement.

Recommendation 7

CBCT imaging should be considered if bone reconstruction and augmentation procedures have been performed.

This is to evaluate bone graft uptake for adequate bone prior to implant placement.

Post-operative imaging

Recommendation 8

In the absence of clinical signs or symptoms, use intraoral periapical radiography for the postoperative assessment of implants. Panoramic radiographs may be indicated for more extensive implant therapy cases.

Radiographs are used to assess the bone-implant interface and whether the implant shows adequate osseointegration over time. CBCT images are not recommended due to streak artifacts created by the metal implant obscuring the implant-bone interface.

Recommendation 9

Use cross-sectional imaging immediately postoperatively only if the patient presents with implant mobility or altered sensation, especially if the fixture is in the posterior mandible.

The immediate CBCT use is to evaluate whether there />

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Jan 12, 2015 | Posted by in Oral and Maxillofacial Radiology | Comments Off on 9 Implants
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