Radiographs for placement of Dental Implant is essential. It is required before, after and during dental implant placement. Oral Rehabilitaion : wide range of options available Implant : nearly 3rd set of teeth. OBJECTIVES OF IMPLANT IMAGING To decide if implant treatment is appropriate for the patient To detect any possible pathological conditions To ascertain height, buccolingual width, and angulation of alveolar process To identify the location of vital anatomical stuctures such as the inferior alveolar nerve and maxillary sinus To ascertain bone quantity To decide the length and width of implant to be placed

1. IMAGING FOR DENTAL IMPLANT
PRESENTED BY:
DR. ABHISHEK GUPTA
Assistant Professor and Incharge,
Department of Oral Medicine and Radiology,
Chitwan Medical College

2. CONTENTS
• INTRODUCTION
• TREATMENT PLANNING
• FACTORS TO BE CONSIDERED
• GOAL OF DIAGNOSTIC IMAGING
• OBJECTIVES OF IMPLANT IMAGING
• PHASES OF IMPLANT IMAGING
• IMAGING MODALITIES
• SUMMARY AND CONCLUSION

3. INTRODUCTION
• Oral Rehabilitaion : wide range of options
available
• Implant : nearly 3rd set of teeth.

4. One of the significant factor :

5. Is it that simple??

7. TREATMENT PLANNING
• DENTAL HISTORY
• MEDICAL HISTORY
• CLINICAL EXAMINATION
• RADIOGRAPHIC EXAMINATION
• DIAGNOSTIC CAST

8. FACTORS TO BE CONSIDERED

11. ONLY TECHINICAL SKILL DOES NOT
SUFFICE

12. GOAL OF DIAGNOSTIC IMAGING

13. OBJECTIVES OF IMPLANT IMAGING
• To decide if implant treatment is appropriate for the
patient
• To detect any possible pathological conditions
• To ascertain height, buccolingual width, and angulation
of alveolar process
• To identify the location of vital anatomical stuctures such
as the inferior alveolar nerve and maxillary sinus
• To ascertain bone quantity
• To decide the length and width of implant to be placed

14. 3 PHASES OF IMPLANT IMAGING
• PHASE 1: PRE-PROSTHETIC IMPLANT
IMAGING
• PHASE 2: SURGICAL AND INTERVENTIONAL
IMPLANT IMAGING
• PHASE 3: POST- PROSTHETIC IMPLANT
IMAGING

15. IMAGING MODALITIES
• PLANAR TWO DIMENSIONAL
IMAGING
• QUASI THREE DIMENSIONAL
IMAGING
• THREE DIMENSIONAL IMAGING

16. PREPROSTHETIC IMAGING
• DETERMINE IMPLANT ORIENTATION
• INDENTIFY DISEASE
• DETERMINE IMPLANT POSITION
• DETERMINE BONE QUANTITY
• DETERMINE BONE QUALITY

17. PLANAR TWO DIMENSIONAL IMAGING

18. PERIAPICAL RADIOGRAPHY

19. IDENTIFY PATHOLOGY

24. CERVICAL BURNOUT
CRESTAL BONE LOSS EVALUATION CAN BE BENEFITTED USING
DIGITAL PAERIAPICAL RADIOGRAPHY

26. COMPUTER ASSISTED MEASUREMENTS,
RULERS,CALIPERS AND SUPRABONY THREAD
EVALUATION

27. DRAWBACKS
• DISTORATION
• LACKS 3RD DIMESNION
• BONE DENSITY CANNOT BE DETERMINED

28. DISTORATION

29. PARALLELING TECHNIQUE

30. LACKS 3RD DIMESNION

31. BONE DENSITY CANNOT BE
DETERMINED
COARSER TRABECULE
AND LARGER MARROW
SPACES
GENERALLAY SHOWING LARGE MARROW
SPACES AND SPARSE TABECULATION
FINE TRABECULATION AND
MULTIPLES SMALL
MARROW SPACES

32. OCCLUSAL RADIOGRAPHY

33. • MAXILLARY – INHERENTLY OBLIQUE AND SO
DISTORTED THEY ARE OF NO QUANTITATIVE
USE FOR IMPLANT
• MANDIBULAR- LESS DISTORTED BUT
GENERALLY FLARES ANTERIORLY AND
DEMONSTRATES A LINGUAL INCLINATION
POSTERIORLY, PRODUCING AN OBLIQUE AND
DISTORTED IMAGE OF THE MANDIBULAR
ALVEOLUS

34. THE MANDIBULAR OCCLUSAL RADIOGRAPH SHOWS
THE WIDEST WIDTH OF BONE (I.E., THE SYMPHYSIS)
VERSUS THE WIDTH AT THE CREST, WHICH IS REQUIRED

35. DETERMINATION OF BONE WIDTH IN SYMPHYSIS REGION AN DRELATION BETWEEN
BUCCAL CORTEX AND THE ROOTS OF ANTERIOR TEETH MAY BE DETERMINED BEFORE
HARVESTING THIS BONE FO RRIDGE AUGUMENTATION

36. LATERAL CEPHALOGRAPH

37. RELATION OF LINGUAL PLATE WITH PATIENTS
SKELETAL ANATOMY CAN BE DETERMINED
IMPLANTS ARE USUALLY PLACED
ADJACENT TO LINGUAL PLATE IN
ANTERIOR REGION
SPATIAL RELATION OF OCCLUSION AND
ESTHETICS
VERTICAL DIMENSION
CROSS SECTION OF CANINE AND LATERAL
INCISOR REGION

39. PANORAMIC RADIOGRAPH

40. VERTICAL HEIGHT
OREINTATION
PATHOLOGY
MESIODISTAL WIDTH
PERIODONTAL
CONDITION
VITAL STRUCTURES

41. ZONE OF SAFETY

42. RADIOGRAPHIC MARKER

43. DISADVANTAGES
• DISTORATIONS INHERENT OF PANORAMIC
RADIOGRAPHS
• FIXED VERTICAL MAGNIFICATION OF UPTO
10%
• UNCERTAIN HORIZONTAL MAGNIFICATION
UPTO 20%
• DOES NOT DEMONSTRATE BONE QUALITY
• NO SPATIAL RELATIONSHIP BETWEEN
STRUCTURES CAN BE ESTABLISHED

44. CROSS
SECTIONAL
DIAGRAM
DEMONSTRATI
NG THAT
STRUCTURES
THAT ARE
MORE LINGUAL
APPEARS
HIGHER

45. OPG VS CBCT

48. 3D IMAGING

49. CT SCAN
DENTASCAN IMAGING PROVIDES PROGRAMMED
REFORMATION, ORGANIZATION AND DISPLAY OF
THE IMAGING STUDY

50. • INDENTIFY DISEASE
• DETERMINE BONE QUALITY
• DETERMINE BONE QUANTITY
• DETERMINE IMPLANT POSITION
• DETERMINE IMPLANT ORIENTATION

52. DISADVANTAGES
• HIGH RADIATION DOSE
• TECHINIQUE SENSITIVE
• EXPENSIVE

53. CONE BEAM COMPUTED
TOMOGRAPHY

54. ADVANTAGES OVER CT
• EXPOSURE TIME – 36 SECONDS
• SINGLE EXPOSURE REQUIRED
• LESS RADIATION EXPOSURE
• EXPOSES BOTH ARCHES SIMULTANEOUSLY
• LESS SCATTER

56. BIFID MANDIBULAR CANALS

57. ARTIFACTS

58. IF THE LABIAL CORTICAL BONE PLATE IS THIN (<1MM),
THIS BONE WILL RESORB WITHIN 4-8 WEEKS LEADING
TO A HORIZONTAL, CRATER-SHAPED BONE DEFECT
AND A LOSS OF BONE HEIGHT ON THE LABIAL ASPECT.

59. PHASE II- SURGICAL AND
INTERVENTIONAL PHASE
• EVALUATES SURGICAL SITIES DURING AND
IMMEDIATELY AFTER SURGERY
• OPTIMAL POSITIONING AND ORIENTATION OF
DENTAL IMPLANTS
• TO ASCERTAIN THE HEALING
• TO ENSURE APPROPRIATE ABUTMENT
POSITIONING AND PROSTHESIS FABRICATION

60. ORIENTATION
SEATING OF
PROSTHESIS

61. INVERSION OF
GRAY SCALE TO
EVALUATE
OSSEOUS QUALITY
AND LOCATION OF
VITAL STRUCTURES

62. EDGE ENHANCEMENT: ABILITY TO DETECT SPACE BETWEEN THE
IMPLANT AND THE SURROUNDING BONE
ALLOW VIEWING OF ANY SUBTLE CHANGES IN
BONE DENSITY AROUND THE IMPLANT INTERFACE

64. A PANORAMIC RADIOGRAPH USED FOR
POSTOPERATIVE ASSESSMENT OF MULTIPLE
SUCCESSFULLY RESTORED ROOTFORM IMPLANTS

65. TO CONCLUDE FOR NOW

66. THE CROSS-SECTIONAL REFORMATTED CBCT IMAGES REVEALS NON
RESTORABLE ECTOPIC PLACEMENT OF THE EXISTING IMPLANTS
WITH LINGUAL CORTICAL PERFORATION AND EXTENSION INTO THE
LINGUAL TISSUES

67. POST PROSTHETIC IMAGING
• DETERMINE CRESTAL BONE LEVELS
• ASSESS THE BONE ADJACENT TO THE DENTAL
IMPLANT

71. CONCLUSION
FACTORS 2D 3D
MESIODISTAL WIDTH ASSESSED ASSESSED
BUCCOLINGUAL WIDTH NOT ASSESSED ASSESSED
VERTICAL HEIGHT ASSESSED ASSESSED
SPATIAL RELATION WITH
ANATOMICAL STRUCTURE
NOT ASSESSED ASSESSED
RADIATION LESS MORE
MAGNIFICATION MORE LESS
AVAILABILITY AND
CONVENIENCE
EASY, CONVENIENT DIFFICULT
BONE DENSITY NOT EVALUATED EVALUATED

76. REFERENCES