PERIO

1. IMAGING IN
IMPLANTOLOGY
By,
C.DILEEPAN
PG Student
SIMATS

2. INTRODUCTION
Success in implant.....???
IMAGING must provide a database
that facilitates the safe placement of
adequately sized fixtures in appropriate
positions.

3. IMAGING OBJECTIVES
Phase I  Pre-prosthetic implant
imaging
Phase II  Surgical and interventional
implant imaging
Phase III  Post-prosthetic imaging

4. PRE-PROSTHETIC IMAGING
Determines bone quality, quantity and
angulation of bone
Relationship of the critical structures
The presence or absence of disease at
the proposed site

5. SURGICAL & INTERVENTIONAL
IMPLANT IMAGING
Evaluates the sites during and
immediately after surgery
Assist in the optimal position and
orientation of dental implants
To ensure abutment position and
prosthesis fabrication
To evaluate healing

6. POST-PROSTHETIC IMAGING
To evaluate the long-term maintenance
of implant rigid fixation and function
Crestal bone levels around each implant
To evaluate the implant complex

7. IMAGING MODALITIES
The decision to image the patient is based
on the patients clinical needs and its
availability.
Imaging modalities can be:
Analog imaging modalities
Three –dimensional imaging
modalities

8. ANALOG IMAGING MODALITIES
Periapical radiography
Panoramic radiography
Occlusal radiography
Cephalometric radiography
Xeroradiography
Radiovisiography (RVG)

9. 3-D IMAGING MODALITIES
Cross-sectional tomography
Computed tomography
Magnetic resonance imaging
TACT

10. ANALOG IMAGING
MODALITIES

11. PERIAPICAL RADIOGRAPHY
Indicated for single implant site
Provides good detail with minimal
geometric distortion
Exact positioning of mental foramina
Amount of bone loss and peri-
implantitis can be visualized
Subtle variations in bone activity is
clearly seen

13. Limitations:
Small size
Not three dimensional
They do not give information regarding
the bucco-lingual dimension
Difficult to locate the inferior alveolar
canal

14. OCCLUSAL RADIOGRAPHY
Larger area of coverage
Shows the bucco-lingual dimensions
External and internal diameter of the
healing socket is clear
Circumferential bone activity can be
visualized more clearly by occlusal view

16. Limitations:
2-dimensional in nature
Distortion of maxilla owing to technique
Not very reliable in establishing bony
dimensions

17. LATERAL CEPHALOMETRICS
Images are obtained with the mid
sagittal plane
Provides more accurate information on
inclination, height and width of alveolar
bone at the midline
Relationship of the jaws in occlusion can
be obtained

19. Limitations:
Image resolution is less when compared
to intra oral radiographs
6-15% image magnification can occur

20. PANORAMIC RADIOGRAPHY
Indicated when multiple implants are
planned
Larger area of coverage
General view of bone anatomy
Can see anatomic structures such as
foramina, sinuses, etc.,

22. Limitations:
Superimposition
Positioning errors are more likely
Resolution is comparatively less
10-20% magnification occurs- which is
not uniform

23. XERORADIOGRAPHY
Images have a superior resolution
Good detail due to edge enhancement
Vascular margins are better visualized
Trabecular detail of the bone is better
Good image quality
Cost effective

24. Limitations:
Slower speed
Patient discomfort
Manipulative difficulties
Fragility of the thermo conductor

25. RADIOVISIOGRAPHY
All the procedures can be visualized almost
immediately
Any area of the picture can be enlarged
Provides necessary magnification
Good resolution
Conventional developing is not necessary
Bone pattern, its height and depth during
implant placement can be visualized

26. Limitations:
Its not as flexible like a film
Difficult to place in shallow palate
Gagging may occur due to its thickness

27. 3-DIMENSIONAL IMAGING
MODALITIES

28. CROSS-SECTIONAL
TOMOGRAPHY
Exact imaging of the implant site can be
done
Little superimposition of other
anatomic structures
They are least slightly magnified

30. Limitations:
Equipment cost
Limited contrast and resolution
Trained oral radiologist must be
available to perform the procedure

31. COMPUTED TOMOGRAPHY
…..DENTA SCANS…..
Used for imaging multiple implant sites
Precise estimation of bone levels
Automatic calculation of bone height
and width
Reconstruction of image is possible
Can produce images in any plane
High contrast and fine detail

33. Limitations:
Software must be available at hospital
radiology service
Access must be provided to CT unit
Patients head position must remain
constant during imaging
Equipment cost

34. MAGNETIC RESONANCE
IMAGING
MRI can sharply delineate soft and
hard tissues
Can differentiate between cortical and
cancellous bone
‘Zero radiation dose’
Good soft tissue details

35. Limitations:
At present no special software is
available for specific use in implantology
Its application in implantology is still in
its experimental phase
Expensive tool

36. RECENT ADVANCES
Cone beam CT
Micro-tomograph
Multi slice helical CT

37. TUNED APERTURE COMPUTED
TOMOGRAPHY
The beam passes through an object from
several different angles
Can isolate images of desired structures
limited to certain depth
Good contrast and resolution
It has the ability to accommodate
patients motion between exposures

39. SIMPLANTS
Simplant is an interactive dental
implant software package
It allows dentists to view and
manipulate processed CT images
Simplant software can be used to
superimpose images of actual size
implants on the CT images for
treatment planning

41. RADIOGRAPHIC PLANNING
START
ADEQUATE HEIGHT
YES
NO
UNCERTAIN
ADEQUATE WIDTH

42. SUMMARY
There are large number of imaging
modalities available for:
PLANNING
SURVEILLANCE
MANAGEMENT
Clinicians, however, must recognize
that each technique has advantages and
limitations.

43. TO CONCLUDE…....
“One who sees the invisible.......
can do the impossible”…….!!!

44. ACKNOWLEDGEMENTS
GUIDED BY
Dr. R. Haribabu MDS
Professor & HOD
Dr. Vijay Vaikunth MDS
Asst. Professor
Dr. Dhanraj MDS
Dr. Jafar MDS
Dr. Saket Miglani MDS
DEPT. OF PROSTHODONTICS
SIMATS