Dental implants_MA_10_10_2023 UG students.pdf

10/12/2023 Reference for this lecture Ch 33 –Implants- Ch 15 -Dental Implants- Lecture: Diagnostic Imaging Related to Implantology Mohammed Alsaati, BDS, MS, Dip ABOMR Oral & Maxillofacial Radiologist Consultant King Fahd Hospital of The University, Al Khobar, Saudi Arabia Position papers 1 2...

10/12/2023 Reference for this lecture Ch 33 –Implants- Ch 15 -Dental Implants- Lecture: Diagnostic Imaging Related to Implantology Mohammed Alsaati, BDS, MS, Dip ABOMR Oral & Maxillofacial Radiologist Consultant King Fahd Hospital of The University, Al Khobar, Saudi Arabia Position papers 1 2 Outlines Dental implant types / parts Different conventional imaging modalities Cone beam computed tomography Limitation of cone beam CT Assessment of bone quality and quantity Possible complications Anatomical landmarks Sinus evaluation AAOMR Recommendations for Imaging Dental Implant 3 Dental Implant Types Transosteal Implants Blade Implants Subperiosteal Implants Endo-osseous (Root form) Implant 4 Blade Implants Epithelial migration / Plate fracture Transosteal Implants Invasive procedure / Epithelial migration 5 6 1 10/12/2023 Endo-osseous (Root form) Subperiosteal Implants Fibrous encapsulations, chronic infections 7 Subtypes Implants (A&B external hex, C bone level, D tissue level) 8 Implant Parts IL: Implant length IW: Implant width IB: Implant body PL: Platform AB: Abutment IS: Implant supra-structure TP: Thread pitch Ideal imaging modality for Implant evaluation TH: Threads 9 • Evaluate adequacy of bone volume (height, mesiodistal width, and facio-lingual thickness) and quality • Evaluate ridge angulation and morphology for structural abnormalities such as undercuts • Locate adjacent anatomic structures • Detect pathology or osseous irregularity in the region • Provide images with minimal distortion, adequate density and contrast, and no artifacts • Have easy reproducibility, ready availability, low cost, and low radiation dose 10 Imaging Modalities 2D imaging • Intraoral radiograph (Periapical and BWs) • Panoramic Radiography 3D imaging • Cone Beam Computed Tomography (CBCT) • Medical Computed Tomography (MDCT) 11 13 2 10/12/2023 Intraoral Radiographs (PA & BW) Advantages • Low radiation dose • Minimal magnification with proper alignment and positioning • High resolution • Inexpensive Intraoral Radiographs (PA & BW) Limitations • Distortion and magnification • Difficulty in film placement • Minimal site evaluation • Lack of cross-sectional imaging 14 Indications • Evaluation of small edentulous spaces • Alignment and orientation during surgery • Recall/maintenance evaluation 15 Intraoral Radiograph (PA and BW) Panoramic Radiograph Indications • Initial assessment of vertical height of bone • Intraoperative and Post- prosthetic stages evaluation for multiple implant placements (trophy) Correct 16 Correct 17 Panoramic Radiograph Advantages • Broad anatomical coverage of facial bone and teeth • Readily available • Low radiation dose 18 Limitations • Anatomical super-imposition • Lack of cross-sectional imaging (bucco-lingual) • Lower resolution • Distortions and magnification • Patient position errors • Not demonstrate bone quality 19 3 10/12/2023 Panoramic Radiograph Limitations 20 Panoramic Radiograph Limitations 21 3D Imaging Advantage 22 23 Panoramic Radiograph Limitations Panoramic Radiograph Limitations Tamimi, Koenig, etal. Specialty Imaging: Dental Implants . 1 st edn. Amirsys; 2014. 24 25 4 10/12/2023 Cone Beam Computed Tomography Scan Volume (Field of View) Advantages • No superimposition • Accurate Measurements • Evaluates all possible sites and anatomical structures • Simulates implant placement with implant planning software • Less radiation dose and less expensive comparing with MDCT 26 27 How to view CBCT ? Alveolar Bone Quality (Density) • CBCT can only show relative density value • Lekholm and Zarb classification • Hounsfield unit is only limited to MDCT Ardawi MSM, et al. 2004, Tamimi DF 2012 28 29 Density in CBCT Contrast Alveolar Bone Quality (Density) Pauwels R etal, 2015 30 31 5 10/12/2023 Osteoporosis Disuse Alveolar Bone Atrophy (Quantity) • Prevalence of osteoporosis and osteopenia in Saudi Arabia (KSA) is 37.8% and 28.2% in men and women above the age of 50 years Ardawi MSM, et al., Bone mineral density of the spine and femur in healthy Saudis. Osteoporos Int. 2005 Jan;16(1):43-55. Epub 2004 May 27 32 33 CBCT Cross-section angulation Implant planning Recommended minimum distance (millimeter) for single implants • Implant to tooth 1.5 mm • Implant to vital structure • Implant to implant 2.0 mm 3.0 mm • Implant facial/lingual bone > 1.5 mm 36 38 CBCT Cross-section angulation 39 Dental implants are prosthetically driven 40 6 10/12/2023 Cone Beam CT Limitations • Moderate radiation risk comparing with conventional imaging • Metallic image artifacts • Special training for interpretation • Cost 41 42 Beam Hardening Artifact PHASE 1 [ Presurgical implant imaging] Determine the patient's final and comprehensive treatment plan • Presence or absence of disease at the surgery sites • Determine the quantity, quality, and angulations of bone • Determine implant position and orientation • Relationship of critical structures to the implant sites 43 45 PHASE 2 [ Surgical and Intraoperative implant imaging] PHASE 3 [ Prosthetic implant imaging] Assisting in the surgical and prosthetic intervention of the patient • Assist in the optimal position and orientation of dental implants • Evaluate the surgery sites during and immediately after surgery • Ensure that abutment position and prosthesis fabrication are correct 46 Day of surgery Cover screw 3 Months 4 Months Healing abutment Impression transfer crown delivery 47 7 10/12/2023 PHASE 3 [ Prosthetic implant imaging] Vertical bitewings Implant evaluation After the prosthesis placement • Long-term maintenance • Crestal bone levels around implants 48 49 Intraoperative and post-prosthetic phases • Intraoral and panoramic radiographs are sufficient • CBCT in cases of complication 50 51 52 53 8 10/12/2023 54 55 56 57 Example of radiographic guides appears in CBCT • Tin foil • Integrity temporary crown material 58 Triad resin with gutta percha Triad resin with a hole 59 9 10/12/2023 Example of real surgical guides Tooth Borne Bone Borne Mucosa Borne Bone Reduction + Connect 60 61 Day of implant placement Implant Complications 64 65 3 months FU after placement 66 4 months / implants failure 67 10 10/12/2023 Implant Placement What we are trying to avoid here ? 68 Implant Placement What we are trying to avoid here ? 69 Implant bone loss vs implant fracture Occlusal overloading ? Implant Placement Inferior alveolar canal violation & injury 70 71 Implant displacement in maxillary sinus 72 How about this one ? 76 11 10/12/2023 Radiographic signs associated with failing implants Imaging appearance Clinical implications Thin RL area follows the entire outline of the implant Failure of implant to integrate Crestal bone loss around the coronal portion of the implant Osteitis, from poor plaque control or adverse loading Apical migration of the alveolar bone in one side Nonaxial loading resulting from improper angulation of implant Widening of the PDL space of the nearest natural tooth abutment Poor stress distribution resulting from biomechanically inadequate prosthesis-implant system Fracture of the implant fixture Unfavorable stress distribution during function 77 12