Implant Planning Imaging

Implant Planning Imaging
Several radiographic imaging options are useful for dental implant diagnosis and treatment planning. The options
range from standard intraoral projections (eg, periapical, occlusal) and extraoral projections (eg, panoramic, cephalometric) to more complex cross-sectional imaging (eg, computed tomography [CT], cone-beam computed tomography [CBCT]).
Multiple factors, however, influence the selection of the radiographic techniques used for any particular case.
Such factors as cost, availability, radiation exposure, and the type of case must be weighed against the accuracy
of identifying important anatomic structures within a given bone volume and the ability to perform the surgical
placement without injury to these structures. The areas of study radiographically include:
1. The location of important structures
A. Mandibular canal
B. Anterior loop and extension of the mandibular canal
C. Mental foramen
D. Maxillary sinus (floor, septums, walls, pathologic features)
E. Nasal cavity
F. Incisive foramen
2. Bone height
3. Root proximity and angulation of existing teeth
4. Evaluation of cortical bone
5. Bone density and trabeculation
6. Pathologic features (eg, abscess, cyst, tumor)
7. Existence of anatomic variants (eg, incomplete healing of extraction site, impacted teeth)
8. Cross-sectional topography and angulation (best determined using CT and CBCT)
9. Sinus health (best evaluated using CT and CBCT)
10. Skeletal occlusal classification (best evaluated using lateral cephalometric images)
Radiographic images allow one to quantify the dimensions and to take measurements. Traditional radiographs
must be calibrated for potential magnification. The magnification on a traditional panoramic image can be as
much as 25%. One method to determine the amount of magnification is to place metal spheres near the plane
of occlusion when taking the radiograph. By comparing the radiographic size with the actual size of the sphere,
the degree of magnification can be determined (Fig III-1). Digitally acquired periapical, panoramic, lateral cephalometric images and CT and CBCT scans have bundled software applications that provide very accurate
measurements.