IMPLANT IMAGING

FEBINSHALU N V FINAL YEAR PART-1

Dental implants are metal posts that are surgically implanted in the jaw to support a fixed dental prosthesis

1. Root form 2. Blade form 3. Subperiosteal

Diagnostic imaging and techniques help to develop and implement a cohesive and comprehensive treatment plan for the implant team and the patient

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Preprosthetic implant imaging Surgical and interventional implant imaging post prosthetic implant imaging

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To determine the quantity,quality and angulation of bone To determine the relationship of critical structures to the prospective implant site To determine the presence or absence of disease at the proposed implant site

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To evaluate the surgical site during and immediately after surgery Assist in the optimal position and orientation of dental implants Evaluate healing and orientation of dental implants Ensure that abutment position and prosthesis fabrication are correct

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2.

Evaluate the long-term maintenance of implant rigid fixation and function,including crestal bone leval around each implant Evaluate the implant complex

Stage of tretment Time(months) Treatment planning surgery -1 0

Radiograph PA,pan,tomo,CT, ceph PA,pan,tomo,CT, ceph

healing

0-3

PA,pan,tomo,CT, ceph
PA,pan, PA,pan, PA,pan,CT

remodeling maintenance complication

4-12 13+ Any time

Periapical radiography Advantages a) High resolution images b) High yield modality for ruling out local bone or dental disease c) Valuable in identifying critical structures
1.

Disadvantages a. It provides only lateral view of jaw and no cross sectional information b. It may suffer from distortion and magnification c. It become impossible to make precise measurements of vertical height of the alveolar process

d. e. f.

Burnout effects are common,making crestal bone loss evaluation difficult It is of little value in determinig bone density or mineralization It is of little value in depicting the spatial relationship between the vital structures and the proposed implant site

Advantages 1. Reduce patient exposure to radiation 2. Incresed patient comfort 3. Instant results 4. Elimination of inconvenience associatedwith developing 5. Cost saving

6.Images can be manipulated for the desired contrast ,color enhancement,inversion,rotation of the image 7.Distance measurement in 0.1mm increment is possible 8.Pseudo three dimensional view 9.Images can be stored with in an electronic device.

Advantages 1. Provides generalized information about bone density 2. Standard occlusal film provides width of the inferior border of mandible. 3. Laterally exposed film shows the width of the bone in the midline

Disadvantages 1. Two dimensional 2. Oblique and distorted images of the mandibular alveolus 3. Mandibular occlusal radiograph shows widest width of bone versus the width at crest

4.The spatial relationship between the critical structures and proposed implant site is lost with this projection 5.The degree of mineralization of trabecular bone is not determined from this projection

Advantages 1. The lateral cephalometric radiograph is useful because it demonstrates the geometry of the alveolus in the anterior region. 2. The width of bone in the symphyseal region and the relationship between the buccal cortex and the roots of anterior teeth may be demonstrated.

3.Together with regional periapical radiograph quantitative spatial information is available. 4.Lateral cephalogram also can help to evaluate a loss of vertical dimension,skeletal arch inter-relationship,anterior crown/implant ratio. 5.Used to evaluate profile alteration after prosthodontic rehabilitation

Disadvantages 1. Not useful for demonstrating bone quality 2. Only demonstrates the cross sectional image of the alveolus.

Advantages 1. Gross anatomy of the jaw and other related pathologic findings could be evaluated. 2. Opposing landmarks are easily identified 3. The vertical height of the bone initially can be assessed. 4. Easy procedure and speed.

Disadvantages 1. Magnification depending upon the anatomic location,position of the patient the focusobject distance and the relative location of the rotation center of the x-ray system. 2. Uniform magnification of the structures produces images with distortion.

3.Little use in depicting the spatial relationship between anatomic structures and implant site. 4.Maxillary anterior region is difficult to evaluate. 5.Does not demonstrated bone quality mineralization 6.Resolution and sharpness is less.

Advantages 1. It was superior to panoromic radiography for bone height determination and for location of the mandibular canal 2. Use of tomography increases the efficacy of periapical/panoramic images to predict the appropriate implant size. 3. Less cost than CT 4. Less radiation exposure

Disadvantages 1. Not useful in determining bone quality or identifying dental or bone diseases. 2. Image blurring and magnification error can effect the accuracy of measurements. 3. Accurate localization of critical structures is sometime not possible. 4. Anatomic variation may result in images that are difficult to interpret.

Advantages 1. It produce very high resolution images. 2. With software programes,shows three dimensional images . 3. The use of CT splint with barium sulfate and methyl methacrylate in the tooth portion, permits the implant team to evaluate proposed tooth position ,abutment selection and implant placement.

4.Position of critical structures can be accurately assessed. 5.It is helpful in patient education and motivation

Disadvantages 1. High radiation factor 2. Resolution is less than spiral tomograms 3. Expensive and time consuming procedure

Advantages 1. Ionization radiation is not used 2. No adverse effect have been demonstrated 3. High resolution images 4. Images can be reconstructed in all planes without reformatting

5.Excellent differentiation is possible between different soft tissues and between normal and abnormal tissues. 6.Intramedullary spread of pathology can be determined 7.MRI visualizes the fat in the trabecular bone and differentiates the inferior alveolar canal and neurovascular bundle.

Disadvantages 1. Scanning time can be long 2. Contraindicated in patient with certain surgical clips, cardiac pacemakers, first trimester pregnancy. 3. Equipment tends to be claustrophobic and noisy 4. Metallic object should be removed

5.Bone,teeth,air,metallic objects, all appear black, making differentiation difficult 6.Estimate of bone quality may be problematic 7.Geometric distortion may arise when the homogeneity of the applied magnetic field is disturbed.

Computer assisted implant imaging Advantages a) Highly accurate, with an error margin of less than 1mm b) Injury to any critical structures is avoided
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Disadvantages a) Pulse registration and the shifting of the headgear will produce inaccurate results. b) High radiation dosage CT scans limits its use for navigation in oral surgery

2.Periaical radiography Disadvantage a) Requirement of darkroom and 5 minutes delay due to processing time required

3.Panoramic radiography Disadvantage a) The patient must leave the surgical suite and stand or sit still for the procedure

Periaical radiography Panoromic radiography