Radiographic Assessment Options For Dental Implants Flashcards
Role of imaging
Pre/peri/post-operative roles
Preoperative modalities
Roles/ technologies / assessment
Radiographic templates (ITI Video)
Prescriptive/ indicative
Why is cross sectional CBCT imaging unique in contrast to tomography and multi-slice CT imaging
It is a dynamic and interactive process
Can be used to direct the placement of implant fixtures - indirectly by construction of restrictive surgical guides or directly by the use of image guided navigation
Preoperative roles
Determine bone volume
Prosthodonticall/Surgical driven site assessment
Bone quality
Width/height
Orientation
Correlation
Anatomic consisderations
Proximity to vital structures
What is the quality of bone within the alveolar ridge?
Cortical bone/trabecular bone pattern
Bone resorption topography
What vital structures encroach on the residual alveolar ridge ?
Maxilla - sinus, nasopalatine canal
Mandible- mental foramen, inferior alveolar canal
Consider prosthetic space requirements
Inter-coronal space
Oro-facial space
Inter-radicular space
Inter-occlusal space
Fixed inter occlusal space
Allow for soft tissue, abutment, metal, restorative material, +/- cement
Anterior - 10-12mm
Posterior - 8-9 mm
Removable inter occlusal space
Allow for soft tissue, adequate abutment and prosthetic thickness
Bar - greater than or equal to 15 mm (15 -17 mm)
Attachment - greater than or equal to 7mm (10-12mm)
A guide, derived from the diagnostic ___________, used to assist in the preparation for and the placement of implants. It dictates drilling _________ and angulation.
Wax-up, position
Post operative objectives
- Monitor osseointegration - bone to implant interface, marginal bone level stability
- Immediate or delayed review of implant position
- Establish osseointegration failure
- Prior to implant retrieval
- Graft success
Monitoring ossoeintegration : Radiographic success criteria
Subjective (patient satisfaction)
Prosthetic criteria
Peri-implant soft tissue criteria
Implant - absence of pain, mobility, Radiographic
Implant radiography
< 1.5 mm crestal bone loss at 1 yr
<0.2 mm annual crestal bone loss after 1st year
Absence of peri-implant radiolucency
Bone to implant interface
0.2 mm pa limitation
Non integration = continuous RL
Overshoot artifact
Apical RL = drill/mental foramen
Marginal bone level stability
Initial angular defect after loading
Subsequent bone loss
Subsequent bone loss type
Branemark - 0.05 mm/yr
Roughened surface - 0.4-0.5 mm/yr
Subsequent bone loss load
0.05-0.1 mm /yr
2 stage - 0.5-1mm 1st year
1 stage - 0.6mm (Mn) 1.1 mm (Mx)
Radiographic grid ruler Half units of interthread distance (thread pitch)
Branemark 0.6 thread pitch, accuracy = 0.3mm
Digital intraoral radiography
Highest resolution of all modalities
10% magnification
Long cone paralleling technique mandatory
Cost and utility
Rigid = minimizes distortion
Measurement algorithm = reduces intra/inter observer realizability
Digital intraoral radiography advantages
Identification of local anatomy
Assessment of mesio-distal orientation- relative root angulations
Measurement accuracy = good MD, excellent A-C (vertical) using standardized (callibration) techniques
Digital intraoral radiography disadvantage
No bucco-lingual information
Pano advantages
Available
Simple to perform
Cheap
Excellent screening of the status of the dentition
Pano linear measurement calibration
-Digital image calibration with RO balls provides clinically acceptable vertical measurement accuracy (95% confidence interval approx 10%)
-2mm safety zone
-Linear opaque markers assist in determining trajectory for measurement
