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

1. PRESENTED BY:
DR. MONALI PRAJAPATI
PG PART III
UNDER GUIDANCE OF:
DR. JIGNA SHAH
PROFESSOR AND HOD
ORAL MEDICINE AND RADIOLOGY DEPARTMENT
GDCH, AHMEDABAD

2. In the present era when it comes to oral rehabilitation, a wide array of options are available
to restore the missing teeth using the fixed or removable prosthesis. The advent of implants
in the field of dentistry has given the dental professionals a viable option to provide the
patients with nearly a third set of dentition.

5. Figure -2Figure -1
Figure -3 Figure -4

7. 1.5mm
3mm

9. Bone Density Description Tactile Analog Typical Anatomical
Location
D1 Dense Cortical Oak or maple wood Anterior mandible
D2 Porous cortical and
coarse trabecular
White pine or spruce wood Anterior mandible
Posterior mandible
Anterior maxilla
D3 Porous cortical (thin) and
fine trabecular
Balsa wood Anterior maxilla
Posterior maxilla
Posterior mandible
D4 Fine trabecular Styrofoam Posterior maxilla

10. ORAL AND
MAXILLOFACIAL
RADIOLOGISTS
IMPLANTOLOGIST
S

11. MAXIMISE DIAGNOSTIC EFFICIENCY
MINIMISE RADIATION RISK

12.  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 structures such as
the inferior alveolar nerve and maxillary sinus,
 To ascertain bone quantity,
 To decide the length and width of the implant to be placed

13.  PHASE 1: PRE-PROSTHETIC IMPLANT IMAGING
 PHASE 2: SURGICAL AND INTERVENTIONAL
IMPLANT IMAGING
 PHASE 3: POST-PROSTHETIC IMPLANT IMAGING

14.  PLANAR TWO DIMENSIONAL IMAGING
 QUASI THREE DIMENSIONAL IMAGING
 THREE DIMENSIONAL IMAGING

15. DETERMINE
IMPLANT
ORIENTATION
DETERMINE
IMPLANT POSITION
IDENTIFY
DISEASE
DETERMINE BONE
QUANTITY
DETERMINE
BONE
QUALITY

17. MAXILLARY SINUS
LINING
VERTICAL HEIGHT
ORIENTATION
MESIODISTAL WIDTH
FOR SINGLE IMPLANT SITE

18. Residual bone cyst Dense bone islands

19. Sites with acute infection
including exudate or pus flow are
considered high-risk, and can
cause post-surgical
complications if implants are
inserted in these infected sites.

20. FLOOR OF NASAL CAVITY NASOPALATINE CANAL INCISIVE CANAL
MAXILLARY SINUS

21. INCICIVE FORAMEN
MENTAL FORAMEN
MANDIBULAR CANAL

22. A reduced vertical bone
height at an adjacent
root surface (>6mm)
affect the height of the
Interdental papilla
following implant
therapy.

23. COMPUTER-ASSISTED MEASUREMENTS, RULERS, CALIPERS, AND SUPRABONY
THREAD EVALUATION

25. DISTORTION

27. LACKS THIRD
DIMENSION

28. FI NE TRABECULAR
PLATES AND MULTIPLE
SMALL TRABECULAR
SPACES
GENERALLY SHOWING LARGE
MARROW SPACES AND SPARSE
TRABECULATION
COARSER TRABECULAR
PLATES AND LARGER
MARROW SPACES

29. CRESTAL BONE LOSS EVALUATION CAN BE BENEFITTED USING
DIGITAL PERIAPICAL RADIOGRAPHY

30. ASSESS ALVEOLAR CREST

32. The mandibular occlusal radiograph shows the
widest width of bone (i.e., the symphysis) versus the
width at the crest, which is where diagnostic
information is needed most .

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

36. THESE TECHNIQUE PRODUCES A NUMBER OF CLOSELY SPACED
TOMOGRAPHIC IMAGES

38. VERTICAL HEIGHT MESIODISTAL WIDTH
ORIENTATION PERIODONTAL CONDITION
PATHOLOGY VITAL ANATOMIC
STRUCTURES

40. WHEN PANORAMIC AND THE PERIAPICAL IMAGES
ARE THE ONLY DIAGNOSTIC TOOL TO ASSESS
AVAILABLE BONE HEIGHT
ZONE OF SAFETY

41. DEMERITS
 Distortions inherent in the panoramic systems
 Fixed vertical magnification of upto 10%
 Uncertain horizontal magnification upto 20%

42. RADIOGRAPHIC MARKER

43. (a)Cropped panoramic radiograph
demonstrating excellent bone height in
the lower right molar region. (b)
Reformatted cross-sectional CT images
showing reasonable bone height but the
ridge is narrow bucco-lingually.

44. CROSS SECTIONAL DIAGRAM
OF THE MANDIBLE
SHOWING THAT
STRUCTURES THAT ARE
MORE LINGUAL ARE
PROJECTED HIGHER ON THE
FILM THAN STRUCTURES
THAT ARE MORE BUCCAL

46. DOES NOT DEMONSTRATE BONE
QUALITY
NO SPATIAL RELATIONSHIP BETWEEN
STRUCTURES CAN BE ESTABLISHED

50. Dentascan imaging provides programmed
reformation, organization and display of the imaging
study.

52. Cancellous bone density Hounsfield unit
D1 > 1250HU
D2 850-1250HU
D3 350-850HU
D4 150-350HU
D5 <150HU

53. DEMERITS
HIGH RADIATION DOSE
TECHNIQUE SENSITIVE
EXPENSIVE

55. EXPOSURE TIME – 36seconds
SINGLE EXPOSURE REQUIRED
LESS RADIATION EXPOSURE
EXPOSES BOTH ARCHES SIMULTANEOUSLY
LESS SCATTER

59. If the facial wall is thin (≤ 1 mm), this bone will resorb
within 4 to 8 weeks leading to a horizontal, crater-
shaped bone defect and a loss of bone height on the
facial aspect.

60. EVALUATES THE
SURGICAL SITES
DURING AND
IMMEDIATELY
AFTER SURGERY
OPTIMAL
POSITIONIN
G AND
ORIENTATIO
N OF
DENTAL
IMPLANTS
TO
ASCERTAIN
THE HEALING
TO ENSURE
APPROPRIATE
ABUTMENT
POSITIONING
AND
PROSTHESIS
FABRICATION

61. ORIENTATION OF
IMPLANT
SEATING OF PROSTHESIS

62. INVERSION OF GRAY
SCALE TO EVALUATE
OSSEOUS QUALITY AND
LOCATION OF VITAL
STRUTURES

63. EDGE ENHANCEMENT,” WHICH IS THE 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. BONE LOSS AROUND A ROOT-
FORM DENTAL IMPLANT (THIN
RADIOLUCENT BAND
SURROUNDING THE IMPLANT),
INDICATING FAILURE OF
OSSEOUS INTEGRATION.
PERIAPICAL VIEW OF A
FRACTURED
ENDOSSEOUS IMPLANT.

65. A panoramic radiograph used for
postoperative assessment of multiple
successfully restored rootform implants.

67. The cross-sectional reformatted CBCT images reveal nonrestorable ectopic
placement of the existing implants with lingual cortical perforation and extension
into the lingual tissues.

68. DETERMINE
CRESTAL BONE
LEVELS
ASSESS THE BONE
ADJACENT TO THE
DENTAL IMPLANT

69. CLOSE
APPOSITION OF
THE BONE TO THE
SURFACE OF
EACH IMPLANT.
MINOR AMOUNT OF SAUCERIZATION IS PRESENT AT THE
ALVEOLAR CREST ADJACENT TO THE DISTAL FIXTURE

70. BITEWING RADIOGRAPH

73. FACTORS TWO DIMENSIONAL
IMAGING
THREE DIMENSIONAL
IMAGING
MESIODISTAL WIDTH ASSESSED ASSESSED
BUCCOLINGUAL WIDTH NOT ASSESSED ASSESSED
VERTICAL HEIGHT ASSESSED ASSESSED
SPATIAL RELATION WITH
ANATOMIC STRUCTURE
NOT ASSESED ASSESSED
RADIATION LESS MORE
MAGNIFICATION MORE LESS
AVAILABITY AND
CONVENIENCE
EASY, CONVENIENT DIFFICULT
BONE DENSITY CAN NOT BE EVALUATED CAN BE EVALUATED

74. PERIAPICAL RADIOGRAPHY
ADVANTAGES DISADVANTAGES INDICATIONS
• Low radiation dose
• Minimal magnification
with proper technique
• High resolution
• Inexpensive
• Distortion and magnification
• Minimal site evaluation
• Difficulty in film placement
• Lack of cross-sectional imaging
• Bucco-lingual width can not be
measured
• Spatial relation can not be
established
• Bone density can not be
evaluated
• Single implant site
(anterior, middle,
posterior
maxilla/mandible)
• Alignment and
orientation during
surgery
(interventional
phase)
• Post- prosthetic stage
evaluation

75. OCCLUSAL RADIOGRAPHY
ADVANTAGES DISADVANTAGES INDICATIONS
• Low radiation dose
• High resolution
• Inexpensive
• spatial relation can not be
established
• Bone density can not be
evaluated
Of little value
CEPHALOMETERIC IMAGING
• Height / width in
anterior region
• Low magnification
• Skeletal relationship
• Crown/ implant ratio
in anterior region
• Relation of lingual
cortical plate to
skeletal structure can
be established
• Availability
• Image information limited to
midline
• Reduced resolution
• Single implant site
evaluation
• Anterior
maxilla/mandible
region
• Symphysis bone graft
evaluation

76. PANORAMIC RADIOGRAPHY
ADVANTAGES DISADVANTAGES INDICATIONS
• Single image of maxilla
and mandible
obtained
• Convenience, ease,
and speed in
performance
• Distortion and magnification
• Lack of cross-sectional imaging
• Bucco-lingual width can not be
measured
• Spatial relation can not be
established
• Bone density can not be
evaluated
• Single implant site
(middle, posterior
maxilla/mandible)
• Multiple implant site
• Implant overdenture
site
• Alignment and
orientation during
surgery
(interventional
phase)
• Post- prosthetic
stage evaluation

77. DENTASCAN/ CBCT
ADVANTAGES DISADVANTAGES INDICATIONS
• Negligible
magnification
• High contrast
• Axial, coronal sagittal
views
• Buccolingial width
determined
• Spatial relation can be
established
• Interactive treatment
planning
• High radiation exposure
• Cost
• Technique sensitive
• Single implant site (anterior,
middle, posterior
maxilla/mandible)
• Multiple implant site
• Implant overdenture site
• Unless any complication, not
advisable for interventional
and post prosthetic
evaluation
• Bone density

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