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Implantology > Radiographic Imaging in Implant Planning > Flashcards

Radiographic Imaging in Implant Planning Flashcards

1
Q

What are the imaging techniques used for implant placement?

A
  • Periapical
  • Pan
  • CBCT
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2
Q

Periapical Imaging: Advantages vs disadvantages

A
  • Advantages:
    • High resolution
    • readily available
    • low cost
    • low radiation exposure
  • Disadvantages:
    • Limited anatomic coverage
    • Cannot assess Buccolingual
    • Superimposition
    • Elongation & Foreshortening
    • Difficult to reproduce
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3
Q

When do we recommend to take a Periapical Image?

A
  • Initial exam:
    • single or short edentulous span
  • intraoperative imaging
  • post-op
    • no problem
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4
Q

Panoramic Imaging: Advantages vs Disadvantages

A
  • Advantages:
    • Broad anatomical coverage
    • Readily available
    • low cost
    • low radiation exposure
  • Disadvantage
    • lower resolution
    • Cannot assess buccolingual
    • Distortion
    • Superimposition
    • Technique sensitive
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5
Q

When do we recommend to take a Pan?

A
  • Initial exam of multiple edentulous spaces
  • Radiographic f/u of multiple implants
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6
Q

CBCT: Advantages vs Disadvantages

A
  • Advantages
    • getting more accessible
    • variable field
    • not superimposed
    • Accurate Dimensions
    • Simulate implant surgery w/software
  • Disadvantages:
    • Beam Hardening artifact
    • Moderate:
      • Financial Cost
      • Radiation exposure
    • Technique sensitive
    • Not calibrated for bone density measurements
    • Poor soft tissue contrast
    • Special training to interpret
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7
Q

When do we recommend to take a CBCT?

A
  • Pre-op exam
  • before and after bone augmentation
  • Post-op exam for symptomatic implants (peri-implantitis)
    • not asymptomatic recall imaging
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8
Q

What should be apart of the Pre-op CBCT assessment and treatment planning?

A
  • Bone quantity
  • Bone Quality
  • Vital anatomic structures
  • Pathology
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9
Q

What are the vital anatomy of the maxilla and mandible?

A
  • Maxilla
    • nasopalatine canal
    • Floor of nasal fossa
    • Floor of maxillary sinus
  • Mandible:
    • Inferior Alveolar Canal
    • Mental Foramen
    • Lingual Foramen
    • Submandibular Fossa
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10
Q

What pathology is contraindicated to implant placement?

A
  • Cysts
  • Benign tumors
  • Malignant tumors
  • Residual infection
    • periapical
    • osteomyelitis
  • Cemento-osseous dysplasia
  • Condensing osteitis
  • Idiopathic Osteosclerosis
  • Jaw fracture
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11
Q

How far should an implant be placed from vital structures?

A
  • at least 2 mm away
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12
Q

Radiology recommendations for Dental Implantology cases

A
  • PAN
    • initial eval→ Best choice
    • asymptomatic post op assessment of extensive implant cases
  • PA
    • supplement PAN info from initial exam
    • asymptomatic post-op assessment
  • CBCT
    • do not use for:
      • initial dx exam
      • periodic review of asymptomatic implants
    • any implant should include cross-sectional imaging orthogonal to planned site
      • best choice
    • Pre-op:
      • site development,
      • augmentation procedures
      • bone reconstruction
    • Post-Op
      • Mobility
      • Altered Sensation
      • Retrieval
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13
Q

Rules of using CBCT?

A
  • performed only by:
    • liscensed practitioners
    • certified radiologist supervised by Licensed practitioner
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14
Q

What are the practitioners responsibilities when a CBCT is taken?

A
  • Interpret the exam findings
    • Qualified OMFRs can assist if dentist wont do
  • Review all exposed tissue volume
    • not just implant area
      *
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15
Q

Radiographic Guides

A
  • Shows proposed direction of implants
  • used w/CT to see alveolar bone in the implant site
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16
Q

Advantages of radiographic guides

A
  • Radio-opaque markers in guide → see implant site on x-ray
  • examine in 3D to see:
    • how close to vital structures
    • anatomical variations (ex: Lingual undercut)
  • if pre-implant procedures are needed
  • select Fixture size easily w/software
    • Length & Diameter
  • Design & make Steriolithographic guide
    • accurate implant placement
17
Q

Radiographic Guide: Fabrication for partially edentulous (Steps)

A
  1. Dx wax-up or teeth set up at edentulous site on dx cast
  2. Duplicate cast
  3. Make vacuform template
    1. filled with clear resin
      1. seated on original dx cast (only edentulous area)
    2. Filled with Barrium sulphate & mix w/ resin
      1. drill hole in center
  4. Place radiographic marker
    1. Gutta Percha
      1. center of restoration
    2. Lead/Aluminum foil
      1. buccal or lingual surface of restoration
18
Q

Radiographic Guide: Fabrication for completely edentulous (Steps)

A
  • 1A) Satisfactory denture
    • Duplicate denture using Lang’s Flask & Clear Resin
  • 1B) Unsatisfactory Denture or NO Denture
    • make new denture set up →Duplicate in clear resin
  • 2) Drill hole in center of implant site
  • 3) Fill w/ radiopaque markers= Gutta Percha
  • Duplication step: made with:
    • Base:
      • 10% Barium Sulphate
      • 90% Clear Resin
    • Teeth:
      • 20% Barium Sulphate
      • 80% Clear resin
19
Q

Radiographic Guide: Alternative way for Fabrication

A
  • SR Vivo TAC
    • Ivoclar provides radio-opaque denture teeth
  • Advantages:
    • Saves time in making stents
      • teeth are premade
    • Helps position implants
    • ensured high radiopacity
    • Molds correspond to tooth lines
      • SR Vivodent PE/SR orthotype PE
      • SR Vivodent/SR orthotype
    • can modify shape w/moidifier polymer & monomer
20
Q

Surgical Guides

A
  • used during implant surgery
    • achieve ideal implant placement
  • can be:
    • conventional
      • restricted or non-restricted
    • computerized
21
Q

Surgical Guides: Advantages

A
  • Better communication b/w dentist & surgeon
  • surgeon can confirm implant position & angulation
22
Q

Conventional Surgical Guide: Fabrication (steps)

A
  1. Dx wax-up
  2. Duplicate cast
  3. Make Vacuform template on duplicated cast
    1. Non-Restricted Surgical Guide
      1. drill hole in the center of template
        1. suck-down w/o resin infiltrate
          1. shows where to go “in General”
    2. Restricted Surgical Guide:
      1. Fill template w/ clear resin
      2. seat on original dx cast (w/edentulous arch)
      3. drill hole in center→ wide enough for Thompson marker
        1. suck-down w/resin infiltrate
        2. restricts the drill
23
Q

Computerized Surgical Guide: Fabrication (steps)

A
  1. CT scan imported on software (Simplant)
  2. Plan case
  3. Send case to _Materialise (_3rd party) to make guide
  4. receive a guide w/metal sleeves
    1. change metal sleeves as drill size ⇡
    2. steriolithographic guide
24
Q

Tubidactor

A
  • Guides the drill so you stay centered
25
Q

Radiographic Markers

A
  • Gutta Percha
    • proposed implant angle
  • Aluminum/Lead Foil
    • proposed crown location
  • Barium Sulfate
    • proposed. crown location

Implantology (15 decks)

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