Bagga M B, Jindal S. Role of CBCT in Dental Implants : Current perspectives. J Periodontal Med Clin Pract 2016;03: 45-50

1 2Dr Mun Bhawni Bagga , Dr Shaifi Jindal

Role of CBCT in Dental Implants: Current perspectives

Review Article

Affiliation

1. Reader Department of Oral & Maxillofacial Radiology, MN DAV Dental College & Hospital,

Tatul,Solan (H.P.)

2. Senior Lecturer, Department of Periodontics, Swami Devi Dyal Dental College and Hospital, Barwala,

Panchkula

Corresponding Author:

Dr. Shaifi Jindal

Senior Lecturer

Department of Periodontics,

Swami Devi Dyal Dental College and Hospital, Barwala, Panchkula�Conflict of Interest – Nil

45

ABSTRACT:

Dental implant placement has become an integral part

of comprehensive treatment plans for dental

rehabilitation for edentulous patients. A thorough

patient assessment is a pre-requisite for adequate

treatment planning and placement of dental implants.

Dental imaging is an important tool to accomplish this

task. Traditional radiographs provide a two-

dimensional (2D) representation of three-

dimensional (3D) structures. Their limited film size,

image distortion, magnification, and 2-D view restrict

their use in some cases. To overcome this, cone-beam

computed tomography (CBCT) systems have become

available for 3D visualization of the craniofacial

complex. CBCT produces views and volumetric

reconstructions of craniofacial structures similar to

multi-slice conventional computed tomography

(CT); however, it does so with reduced acquisition

times, lower effective radiation doses, and a

decreased financial burden compared with CT. The

present paper reviews the role of CBCT in dental

implant imaging.

Keywords: Dental Implants, Cone-beam computed

tomography

INTRODUCTION

Dental implants are gaining immense popularity and

wide acceptance because they are the conservative

method of replacing lost teeth and restore function

with proprioception, esthetics and thereby revamp the 1 self-esteem of the patients. Successful implant

treatment depends on efficient planning. This should

include information on height, width, morphology

and density of the bone, and evaluation of critical 2 structures in imaging techniques. The type of imaging

technique selected should be able to provide the

Vol-III, Issue - 1, Jan-Apr 2016

Role of CBCT in Dental Implants: Current perspectives

46

required information with adequate precision and

dimensional accuracy. In whatsoever technique used,

the patients X-ray beam and imaging receptor should be

positioned to minimize distortion. The imaging

information should balance with the radiation dose and 3financial cost to the patient.

Earlier conventional radiographic techniques like

IOPA, panoramic were accepted as standard methods.

However improvements in sectional images led to use

of tomographic methods to investigate potential implant

sites. The American Academy of Oral & Maxillofacial

radiology (AAOMR) recently recommended CBCT as 2 best option for implant imaging. To improve the overall

success of implant therapy with possible reduction in

surgical and postoperative implant complications,

implantologists should have three -dimensional (3D)

information of bone volume and topography prior to 4implant placement.

PRINCIPLES OF IMAGING FOR DENTAL

IMPLANT ASSESSMENT

The basic principles of radiology apply to imaging for

implant evaluations. Images should have appropriate

diagnostic quality and not contain artifacts that

compromise anatomical structure assessments. Images

should extend beyond the immediate area of interest to

include areas that could be affected by implant

placements. The goal of radiographic selection criteria

is to identify appropriate imaging modalities that

complement the goals at each stage of implant therapy.

Cone beam computed tomography (CBCT) is the

preferred option for implant dentistry, providing greater

accuracy in measuring compared to 2D imaging, while 1utilizing lower doses of radiation.

Use of a CBCT, because of its ability to reconstruct a

fully three dimensional model of the maxilla and

mandible, will help identify critical anatomic structures

accurately for precise placement of dental implants with 5minimal complications.

RIDGE MORPHOLOGY

Bucco-lingual ridge pattern cannot be viewed on 2D ra-

diographs, but CBCT provides with advantage of ap-

preciating the type of alveolar ridge pattern present.

Cross-sectional images provide the implantologist the

appearance of ridge patterns like irregular ridge, narrow

crestal ridge and knife-shaped ridge. Also loss of

cortical plates, undulating concavities can also be

appreciated on cross-sectional images, which cannot be 6seen on panoramic image. McGinvney et al and

Schwartz et al concluded that three-dimensional images

more accurately reflected the true osseous topography 7and considered it as a valuable diagnostic aid.

QUANTITY OF AVAILABLE BONE AT

IMPLANT SITE

Available bone is the amount of bone in the edentulous

area considered for osseo-integration of the implant. As

a general guideline a distance of 1.5 mm is maintained

for surgical error between the implant and any adjacent 6 landmark. Cortical bone is best suited to provide

support for implants. CBCT allows accurate estimates

of the alveolar bone height and width, which is

mandatory for selecting the appropriate implant size

and determining the degree of angulation of the

edentulous alveolar ridge. (Fig: 1) The original height of

available bone in the mandible is twice that of maxilla.

CBCT helps us to determine the amount of bone

required to be removed during the osteotomy procedure

for adequate acquisition of buccolingual width. This

function can be performed by utilizing the linear scale 8tool present on the software. An interesting clinically

relevant classification can be used for determining the

available bone as suggested by Chanavaz and

Vol-III, Issue - 1, Jan-Apr 2016

47

Donazzan. This classification is termed as Chanavaz

and Donazzan French Volumetric Classification (1986) 6 (Table: 1)

QUALITY OF BONE AT IMPLANT SITES

The term bone quality is commonly used in implant

treatment and in reports on implant success and failure.

Lindh et al emphasized that bone density, bone mineral

density (BMD) and bone quality are not synonymous.

Bone quality encompasses factors other than bone

density such as skeletal size, the architecture and 3D

orientation of the trabecular and matrix properties. Bone

quality is not only a matter of mineral content but also of

structure. With CBCT software methods, it is possible to

improve the accuracy of CBCT -HU values for 8-9determining bone densities at implant sites.

CBCT-GUIDED IMPLANT SURGERY

Type and size of the planned implants, its position

within the bone, its relationship to the planned

restoration and adjacent teeth and/or implants, and its

proximity to vital structures can be determined before

performing surgery. This is possible with integration of

CBCT scans with CAD/CAM technology (e.g. CEREC,

Sirona Germany). (Fig: 2) Computer-generated surgical

guides can be fabricated from the virtual treatment plan.

(Fig: 3) These surgical guides are used by the

implantologist to place the planned implants in the

patient's mouth in the same position as in the virtual

treatment plan, allowing more accurate and predictable 10implant placement and reduced patient morbidity.

Figures

Role of CBCT in Dental Implants: Current perspectivesVol-III, Issue - 1, Jan-Apr 2016

48

Figure 2: Virtual implant placement from Galileo (Sirona) implant library. A. Reconstructed

orthopantomograph (OPG); B. Implant library; C. Tangential view; D. Cross-sectional view; E. Axial view.

Figure 3: Three-dimensional reconstruction using virtual implant placement.

Role of CBCT in Dental Implants: Current perspectivesVol-III, Issue - 1, Jan-Apr 2016

49

Table 1: Chanavaz and Donazzan French Volumetric Classification

CONCLUSION:

CBCT provides a subjective assessment of bone

quality and not objective assessment. CBCT allows

the imaging in three dimensional views, thereby

improves the ability to predict the actual implant

length, thus reducing inaccuracy in surgical

planning of dental implants. But, professional

judgment varies depending on skill, competence,

knowledge and experience of the clinician.

REFERENCES

1. Worthington P, Rubenstein J, Hatcher DC.

The role of cone-beam computed

tomography in the planning and placement

of implants. J Am Dent Assoc. 2010;141

Suppl 3:19S-24S.

2. Tyndall AA, Brooks SL. Selection criteria

for dental implant site imaging: a position

paper of the American Academy of Oral and

Maxillofacial radiology. Oral Surg Oral

Med Oral Pathol Oral Radiol Endod. 2000

May;89(5):630-7.

3. Jaju P, Svarna PV et al Pre evaluation of

implant site by denta scan. J Dental impalnts

2011;1(2): 63-74.

4. Tyndall DA, Price JB, Tetradis S, Ganz SD,

Hildebolt C, Scarfe WC. Position statement

of the American Academy of Oral and

Maxillofacial Radiology on selection

criteria for the use of radiology in dental

implantology with emphasis on cone beam

computed tomography. Oral Surg Oral Med

O r a l P a t h o l O r a l R a d i o l . 2 0 1 2

Jun;113(6):817-26.

5. Lamichane M, Anderson NK, Rigali PH,

Seldin EB, Will LA. Accuracy of

reconstructed images from cone-beam

computed tomography scans. Am J Orthod

Dentofacial Orthop. 2009; 136: 156-6.

6. Jaju PP. Suvarna PV. Dental CT third Eye in

dental implants. In: Jaju PP, Jaju SP, Suvarna

PV, Dedhia P (Eds). Dental CT in

Role of CBCT in Dental Implants: Current perspectivesVol-III, Issue - 1, Jan-Apr 2016

Implantology, 1st edition. New Delhi, India:

Jaypee Brothers Medical Publishers (P) Ltd;

2013.

7. Jaju PP,Jaju SP. Clinical utility of dental

CBCT: current perspectives.Clinical,

Cosmetic and Investigational dentistry

2014;6:29-43.

8. Drage NA, Palmer RM, Blake G, et al. A

comparison of bone mineral density in the

spine, hip and jaws of edentulous subjects.

Clin Oral Implants Res. 2007;18(4):496-500.

9. Lindh C, Obrant K, Petersson A. Maxillary

bone mineral density and its relationship to

the bone mineral density of the lumbar spine

and hip. Oral Surg Oral Med Oral Pathol Oral

Radiol Endod. 2004;98(1):102-9.

10. Orentlicher G, Abboud M. Guided surgery

for implant therapy. Dent Clin North Am.

2011;55(4)

Competing interest / Conflict of interest The author(s) have no competing interests for financial support, publication of this research, patents and royalties through this collaborative research. All authors were equally involved in discussed research work. There is no financial conflict with the subject matter discussed in the manuscript.Source of support: NIL

Copyright © 2014 JPMCP. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

50

Role of CBCT in Dental Implants: Current perspectivesVol-III, Issue - 1, Jan-Apr 2016