This document discusses the use of CBCT imaging in dental implant treatment planning and assessment. It provides details on how CBCT can be used to evaluate bone quantity and quality, anatomical structures, ridge morphology, and is recommended for pre-operative planning of sinus lift procedures. CBCT allows accurate measurements and 3D visualization to determine suitable implant size, position, and angulation without superimposition. This helps optimize implant placement and outcomes.
This presentation deals with radiographic imaging of three important phases of implant placement; PHASE 1: PRE-PROSTHETIC IMPLANT IMAGING
PHASE 2: SURGICAL AND INTERVENTIONAL IMPLANT IMAGING
PHASE 3: POST-PROSTHETIC IMPLANT IMAGING
A very precise and intimate description on radiographic considerations in dental implants, since the advent of the first radiographic modality in 1905, the dental health care professionals have been striving to achieve clarity & excellence in the development & usage of dental radiographic imaging modalities.
I hope this presentation will make this wonderful topic more understandable and easier to digest in the minds of young and experienced dental health care professionals.
by Dr Ishaan Adhaulia
This presentation deals with radiographic imaging of three important phases of implant placement; PHASE 1: PRE-PROSTHETIC IMPLANT IMAGING
PHASE 2: SURGICAL AND INTERVENTIONAL IMPLANT IMAGING
PHASE 3: POST-PROSTHETIC IMPLANT IMAGING
A very precise and intimate description on radiographic considerations in dental implants, since the advent of the first radiographic modality in 1905, the dental health care professionals have been striving to achieve clarity & excellence in the development & usage of dental radiographic imaging modalities.
I hope this presentation will make this wonderful topic more understandable and easier to digest in the minds of young and experienced dental health care professionals.
by Dr Ishaan Adhaulia
The biological fixation determines the longevity of dental implant treatment. It ensures the long term survival of dental implant. Better the osseointegration,higher will be the survival rate
The content covers majority of the aspect of immediate implant placement - why immediate implants?, case selection, decision making, classifications, surgical technique, healing following immediate implant placement, immediate implants in infected sockets/periapical infections, literature reviews and recommendations for clinical practice.
Hey Guys, this presentation is all that a BDS graduate needs to know. A very basic yet important facts about CBCT.
Stay Safe
Regards
Battisi - Dr. Jasmine Singh
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
The biological fixation determines the longevity of dental implant treatment. It ensures the long term survival of dental implant. Better the osseointegration,higher will be the survival rate
The content covers majority of the aspect of immediate implant placement - why immediate implants?, case selection, decision making, classifications, surgical technique, healing following immediate implant placement, immediate implants in infected sockets/periapical infections, literature reviews and recommendations for clinical practice.
Hey Guys, this presentation is all that a BDS graduate needs to know. A very basic yet important facts about CBCT.
Stay Safe
Regards
Battisi - Dr. Jasmine Singh
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Temporomandibular joint imaging 2 /certified fixed orthodontic courses by Ind...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
triple scan protocol (Dr. Gross) - a new and effective protocol for 3D planni...Michael Gross
triple scan protocol (Dr. Gross) - a new and effective protocol for 3D planning and guided surgery of partially edentulous cases
Cortex guide - complete service for advanced 3D planning and guided surgery of dental implants
This is a presentation describing in brief regarding the physics behind MRI and it's application from dental point of view. It contains few videos as well.
Soft tissue considerations for implant placementGanesh Nair
pre and post soft tissue considerations prior and post implant placement including various surgical technique for simple and advanced soft tissue augmentation
Prosthesis is one of the most important component of an implant. There are various prosthetic factors that must be considered for a successful implant. Few of them include prosthesis type and material, the connection between abutment and prosthesis, occlusal factors, etc.
omfs journal club ppt on bone ridge augmentationAkhil Sankar
This is a journal club to start with for new omfs pgs . This is correctly criticized and cross-checked ppt. Also, it is a relevant topic in day to day preactise
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
5. 2. Periodontal/tissue biotype
Thin gingival tissue Thick gingival
tissue
- Highly scalloped, thin,
nonkeratinzied and flabby
mucosa more susceptible
to gingival recession and
mechanical trauma soft
tissue grafting indicated
- Thick, keratinized and non-mobile
mucosa Less susceptible to gingival
recession following implant treatment
- Esthetics: thick mucosa is able to mask
the implants’ color and their
submucosal metallic components,
reducing the risk of a nonesthetic
result.
6. 3) Lip line
The lip line is associated with the amount of tooth and supporting tissues visible
when patient chews, speaks, or smiles.
High lip line: patient’s entire maxillary teeth and part of his/her alveolar process is
revealed
presents highest esthetic risk in implant treatment
provide a diagnostic set up or a temporary prosthesis for the patient to try on
before implant treatment to assess appearance regarding the lip line
provisional prosthesis can also serve as a model for a surgical guide or stent to
aid placing implants
LowMediumHigh
7. 4) Occlusal status and functional exam
1. Parafunctional habits such as bruxism and
clenching must first be diagnosed and treated
before implant treatment to ensure occlusal
stability
2. Parafunctional habits cause excessive
loading on implants causing technical
complications such as screw or framework
fractures
8. 5) Evaluate edentulous ridge
1. Visually assess the contour, height and width of the edentuglous ridge
2. Fibrous overlying tissue can be deceiving
3. Palpate to detect any concavities or depressions
4. This step is essential to detemine if patient needs bone augmentation
5. Nevertheless, edentulous ridge must be radiographically examined
6. Observe crown to bone relationship (distance between the ideal position of the
clinical crowns and the underlying bone)
7. measure the distance between the dentulous ridge and the opposing dentition to
ensure there’s enough space for the restoration
8. length of endentulous area can be measured to determine the approximate
number of implants needed only verified through radiographs
Labially, this ridge reveals a slight loss in
the center and the presence of healthy
keratinized gingiva
Occlusally, ridge appears wide enough
to accommodate implants verified
through radiography
9. a. Characteristics of Ideal Imaging Techniques in Implants:
1. Ability to visualize the site of implant site in the mesiodistal,
faciolingual, and superoinferior dimensions
2. ability to determine axial orientation of implants
3. ability to allow reliable, accurate measurements
4. capacity to evaluate trabecular bone density and cortical
thickness
5. capacity to correlate the imaged site with the clinical site
6. reasonable access and cost to the patient
7. minimal radiation risk
Preoperative Radiographic Assessment
10. b. Preoperative radiographs should reveal: (15)
1. Position and size of relevant normal anatomic structures, including the:
a. Inferior alveolar canals
b. Mental foramina
c. Incisive or nasopalatine foramen and canal
d. Nasal floor
2. Shape and size of the antra, including the position of the antral floor and
its relation to adjacent teeth
3. Presence of any underlying disease that could compromise the outcome
of treatment e.g. osteoscleorosis
4. Presence of any buried teeth or retained roots
5. Quantity of alveolar crest/basal bone, allowing direct measuremtns of the
height, width and shape
6. Quality (density) of bone, noting:
a. Amount of cortical bone present
b. Density of the cancellous bone
c. the trabecular spaces size
12. Advantages of CBCT in implant dentistry:
1. Evaluates all possible sites and anotmical structures:
2. No superimposition
3. Uniform magnification
4. Measurements accurate withing about 1 mm
5. Simulates implant pacement with implant planning software
6. CBCT dose of radiation exposure is less than that produced by CT scanning
7. Can limit radiation exposure according to Field of View chosen (FOV): small,
medium, or large
8. provides precise information about pathology
9. Less expensive than CT scanning
10. allows for the 3-D evaluation of an arch
Limitations of CBCT in implants:
1. Moderate cost and radiation risk as compared to other imaging techniques
2. Some metallic image artifacts
3. Special training for interpretation
4. Relative bone density measurements (HU) not calibrated
13. Pre-operative Diagnostic Planning
To decide the precise healing scope of a
prosthetic implant therapy to re-establish
chewing function, it’s imperative to assess
Bone availability and the existing anatomical
landmarks. This is easier when using 3D
diagnostics than using illustration with
traditional images
14. A) Bone Availability
The most frequently reported indication for the
use of CBCT in implant planning area are to
measure the alveolar ridge and map the bone
morphology of possible implant sites for
osseointegration of the implant.
1. Quantitative Evaluation of Bone Availability
Bone compactness is an significant factor for implant placement to expect the ability to
stabilize the implant when minimal bone height is otherwise available.
Precise estimation of the alveolar bone height and width are mandatory:
1. For selecting the suitable implant size
2. Establish the degree of angulation of the edentulous alveolar ridge.
15. Bone Height: Bone Width:
Measured from the
crest of the alveolar
ridge to the opposing
border of the bone or
an anatomical
structure.
According to the bone
height, implant length
is determined
It is the bucco-lingual
width of the alveolar
bone. Implant diameter
is selected based on
this parameter.
18. Height of the maxillary alveolar ridge
measured at a specific point at a specific
point prior to implant placement
Width of the maxillary alveolar
ridge measured at a specific point
prior to implant placement
19. After adequate height is available, the next most
significant criterion affecting long-term survival of
implants is the width of the available bone.
Axial cross-section on the
root level showing the
space around the implant.
20. Note the little space
between the mesial
and distal surfaces of
the implant and the
adjacent teeth
22. Hounsfield scale
Referred to as HU, it is a scale used to measure the bone
density in the CBCT scans. It can measure accurately the
density of the selected point, whether it’s related to bone or
other tissues. HU gives a quantitative assessment of the bone
density where it’s measured by the ability of the tissue to
attenuate x-ray beam.
HU scale range from -1000 (air) to +3000 (enamel). While
bone quality refers to both thickness and density of the
cortical plates as well as trabecular portion of the bone. This
parameter affects to high limit the success of the treatment.
23. Example of Trabecular bone
density in the anterior region
of maxilla.
Example of Trabecular bone
density in the anterior region
of mandible.
Example of Cortical bone
density in the anterior region
of mandible.
24.
25. Length of the Edentulous Area
Missing upper left
lateral incisor to
be restored with
implant. In 3D and
Axial Slice.
26.
27. 3- Ridge Orientation and morphology:
it is the inclination of the alveolar edentulous ridge. Virtual implant can
be positioned in a cross sectional alveolar bone using special planning
software.
CBCT Shows the type of alveolar bone present
- Cross-sectional CBCT revealing three types of mandibular ridge
morphology:
- line A represents a the line of reference 2 millimeter coronal to
the inferior alveolar nerve canal
29. According to Tolstunov, a Diplomate of the American Board of Oral Implantology/Implant
Dentistry the alveolar jaw can be divided into four regions or “functional implant zones”
with each region posessing "unique characteristics of anatomy, blood supply, pattern of
bone resorption, bone quality and quantity, need for bone grafting and other supplemental
surgical procedures, and a location related implant success rate.”
Anatomical factors assessed by CBCT imaging
30. Also known as the “traumatic zone”
consists of alveolar ridge of pre-maxilla and the teeth from right to left premolar
exhibits the greatest loss of bone after tooth loss/extraction occurs in the facio-palatal
or horizontal direction and mainly on the facial side of the alveolar ridge
Any bone loss in this area is crucial due to its esthetic risk with dental implants if
severe bone loss occurs, implants are harder to place in an esthetically favorable position.
Functional Implant Zone 1
1) Nasopalatine canal
Nasopalatine canal contains:
a. nasopalatine nerve
b. descending branch of the nasopalatine
artery
c. fibrous connective tissue
if an implant contacts neural tissue in this
canal, it could lead to failure of
osseointegration or sensory dysfunction.
Thus, when one or both central incisors have been
lost for a while, limited CBCT imaging is
indicated to determine the dimensions and
morphology of the nasopalatine canal before
dental implant surgery.
Nasopalatine canal on a
CBCT Coronal section
32. • the sinus zone
• located at the base of the maxillary sinuses
CBCT imaging is indicated to evaluate:
a. bone height between the floor of the maxillary sinus and alveolar bone must be
evaluated through CBCT before placing dental implants in this zone
b. When tooth is lost or extracted pneumatization of Sinus into the area initially
occupied by the tooth vertical augmentation via a sinus lift procedure
c. presence of sinus septa which could complicate the sinus lift procedure if encountered
interoperatively
Functional Implant Zone 2
CBCT sagittal section showing septa
in left maxillary sinus
33. d) Detecting superior alveolar artery
A. CBCT shows the posterior alveolar artery before creating a
lateral windown into the maxillary sinus.
B. The artery is seen during the sinus lift procedure located at
15 mm from the alveolar crest diagnosed with CBCT
34. “Inter-foraminal zone”
This zone is comprised of the area of the mandibular alveolar ridge between mental
foramen and right and left premolar
associated with a thin alveolar ridge
a) Sublingual undercuts
If the alveolar ridge is not properly evaluatedd preoperatively perforation of lingual
cortex severe bleeding with the formation of expanding sublingual hematomas
Perforated lingual
cortical plate
Severe hematoma on the anterior floor
of the mouth after implant placement in
the anterior mandible
Echymosis on the chin after
implant placement in the
anterior mandible
Functional Implant Zone 3
35. b) Position of mental foramen
Dental implants in the mandibular pre-molar region are dictated by the size and the
location of the mental foramen.
Its location can vary from the mandibular canine to the first molar.
Once a zone of safety is detected through CBCT, implants can be placed anterior
to, posterior to, or above the mental foramen.
36. d) Detection of Accessory Mental Foramens (AMF)
Detecting AMFs may decrase the risk of haemorrhage,
postoperative pain and paralysis in implant surgeries.
37. Functional Implant Zone 4
This zone is located behind the mental foramen on each side
and extends from the 2nd premolar to retromolar pad.
a. Mandibular canal through which the Inferior Alveolar
Nerve (IAN) passes
• Any damage to this nerve can result in persistent
dysesthesia as it supplies the sensory innervation of the
lower lip.
• A minimum distance of 2 mm from is to be maintained
when placing implants in this zone.
38.
39. Sinus Floor Elevation
Procedure: The procedure of sinus floor lifting is an inner augmentation of the maxillary sinus sheath, with /without grafts
Purpose: Proliferation of the upright bony measurement of the sinus cavity in the side maxilla. This shaped space customarily allows the
possibility of a dental implant to be inserted from the alveolar ridge to this chamber, to thereafter wait for osseo-integration from the
renewing implanted bone.
Indication: When an implant must be located in the posterior area of the maxilla
Pre-operative valuation of the maxillary sinus is vital for the achievement of this surgery. It is significant for the surgeon to be conscious
of the sizes of the facial maxillary sinus wall earlier in the begining .
Existing 2 D radiological methods do not deliver any treasured data in this field.
Pre-operative cone-beam computed tomography scan (CBCT) prior open sinus lift surgery has been recommended:
If the quantity of bone, among the crest of the ridge and the maxillary sinus bottom is insufficient, (<5 mm) then open sinus lift
process is specified. The CBCT technology permits us to quantify the quantity of bone in this zone:
Post-operative assessment of this procedure using CBCT is also necessary:
The height is more than 5 so a
Sinus lift is not recommended
40. Existing 2 D radiological methods do not deliver any treasured
data in this field.
Pre-operative cone-beam computed tomography scan (CBCT) prior open sinus lift surgery has
been recommended:
If the quantity of bone, among the crest of the ridge and the maxillary sinus bottom is
insufficient, (<5 mm) then open sinus lift process is specified. The CBCT technology permits us
to quantify the quantity of bone in this zone:
Post-operative assessment of this procedure using CBCT is also necessary:
The height is more than 5 so a Sinus
lift is not recommended
41. Features (other than the height and the width of the residual alveolar ridge) that should be
assessed in pre-operative CBCT scan for sinus floor lifting include:
Medial wall of the
sinus
Lateral wall of the
sinus
Sinus membrane:
Schneiderian
membrane
a) Wideness of the lateral maxillary sinus wall.
- If the lateral maxillary wall is dense open sinus lift procedure turn
into a more difficult one and more time consuming
- Plummeting the width of bone is essential to diminish problems.
- Extreme convexity of this wall forces the doctor to select exact
methods for this process
42. b) Occurrence of alveolar antral artery and its distance.
- A large diameter artery in the sinus lifting procedure can provoke profuse
bleeding concealing the vision in the surgical field. This blood vessel is
accountable for intraoperative bleeding which is the additional recurrent
problem of sinus lift procedure after membrane puncture. Alveolar antral blood
vessel with a diameter more than 0.5 mm can be observed on CBCT images
and profuse bleeding should be predictable if the artery has a diameter > 3 mm.
- If the entire blood vessel is surrounded by the bone, organization by thermal
cautery is all that is wanted but when this blood vessel is in near contact with
sinus membrane, use of thermal membrane perforation.
Alveolar antral artery in in close proximity
to the Schneiderian membrane
43. c) Maxillary sinus floor width.
- It’s the length between the lateral maxillary sinus partition and the medial maxillary sinus partition
(lateral nasal cavity border) and the formed viewpoint.
- In actual thin and very extensive sinuses and sharp angulation between these two constructions,
the open sinus lift surgery becomes hard.
Cone-beam computed tomography (CBCT) scans representing three types of maxillary sinuses with
different widths:
Narrow sinus Average sinus Wide Sinus
a) Indiscretion of sinus floor.
Wrongdoings of the maxillary sinus bottom make the surgery more
problematic in contrast with the flat-surface bone .These irregularities can
be effortlessly noticed using CBCT.
a) Close relative of Schneiderian membrane with roots of nearby teeth
If Schneiderian membrane contacts the adjacent the roots of the teeth head-
to-head to the non-dentate area, the probability of casing puncture during
sinus lift process upsurges.
44. Postoperative assessment
The patient must be assessed every 6 months, starting from the first 4-6 months after
initial healing of the implants.
Postoperative Clinical Assessment
Clinical Signs of Implant Failure:
1) Implants lack sensory feedback of occlusal forces. Thus, occlusion must be
monitored, to detect
a. Screw loosening
b. Fracture of the prosthesis
c. Redness, swelling, discomfort
d. Denture ulcers
45. 2) Examine for signs of peri-implant mucositis: inflammation of the soft
tissues surrounding the implant reversible
3) Examine for signs of peri-implantitis: an inflammatory process affecting
the tissues around an osseointegrated implant in function:
1. Diagnostic feature: crestal bone loss
2. Mobility is its terminal stage
3. Infectious disease causes of inflammation must be excluded such
as retained cement or cementitis
4) Presence of signs of pain, infection, neuropathies, paresthesia
5) Signs of inflammation such as sinusitis indicating involvement of maxillary
sinus
46. Postoperative Radiographic Assessment
Implants should be radiographically assessed on an annual or biannual basis. In the
implant’s first year of service, annual vertical bone loss be less than 0.2 mm is normal
Choice of radiographic technique:
1. For asymptomatic implants:
a. intraoral periapical
b. panoramic imaging in extensive cases
c. CBCT is not indicated for periodic review of asymptomatic implants
2. CBCT imaging
a. Implant mobility
b. altered sensation
c. implant retrievel
Radiographic signs of implant failure:
Peri-implant radiolouceny indicating bone loss: (2mm of loss is
acceptable in the first year, and 0.2mm each year after)
widening of the PDL space of adjacent natural teeth which indicates
poor stress distribution
Evidence of saucerization indicating loss of crestal bone apical
migration of the alveolar bone or indistinct osseous margins.
47. Examination of Implant Failures and Complications
Using CBCT
a. Altered sensation:
Neurovascular disturbances following most often damage to several
canals is often easily detected by CBCT images allowing the
implantologist to indicate the reason of the patient’s constant pain or
numbness the implant should be removed from the nerve canal,
so that any additional compression of the nerve is eliminated
1. Disturbance to the mandibular canal :
Sagittal CBCT image Coronal CBCT image
48. 2. Damage to the nasopalatine canal
b) Infection or postoperative integration failure
Maxillary sinus infection following sinus floor elevation procedures with simultaneous dental
implant placement may be one of the problems that lead to postoperative complications. This
infection cannot be examined on normal panoramic x-rays.
49. c) Implant displacement (malpostion)
Displacement of the dental implant into the maxillary sinus. CBCT allows us to examine the
position of the displaced implant in different aspects allowing the implantologist to locate it for
removal. An intraoral approach consisting is needed where an elevation of a mucoperiosteal
flap and creation of a bony window pedicled to the Schneiderian membrane must be adopted in
reference to the CBCT images because perforation of the membrane is highly relevant in such a
procedure.
50. d) Perforations the implant tip may be shortened until soft tissue
coverage is attained.
1) Perforation of the lingual bone plate in the anterior mandible and
resulting severe hemorrhages and life-threatening airway
obstructions.
2)Perforation of the floor of the nose during implant bed preparation
and/or placement difficulty in breathing and infection