IMAGING IN IMPLANTOLOGY
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INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
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INTRODUCTION Success in implant.....??? IMAGING must provide a database that facilitates the safe placement of adequately sized fixtures in appropriate positions.
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IMAGING OBJECTIVES Phase I
Pre-prosthetic implant imaging
Phase II Surgical and interventional implant imaging Phase III Post-prosthetic imaging www.indiandentalacademy.com
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
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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
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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 www.indiandentalacademy.com
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 www.indiandentalacademy.com
ANALOG IMAGING MODALITIES
Periapical radiography Panoramic radiography Occlusal radiography Cephalometric radiography Xeroradiography Radiovisiography (RVG) www.indiandentalacademy.com
3-D IMAGING MODALITIES Cross-sectional tomography Computed tomography Magnetic resonance imaging TACT www.indiandentalacademy.com
ANALOG IMAGING MODALITIES
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PERIAPICAL RADIOGRAPHY Indicated for single implant site Provides good detail with minimal
geometric distortion Exact positioning of mental foramina Amount of bone loss and periimplantitis can be visualized Subtle variations in bone activity is clearly seen www.indiandentalacademy.com
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Limitations: Small size Not three dimensional They do not give information regarding the bucco-lingual dimension Difficult to locate the inferior alveolar canal www.indiandentalacademy.com
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 www.indiandentalacademy.com
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Limitations: 2-dimensional in nature
Distortion of maxilla owing to technique Not very reliable in establishing bony dimensions
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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
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Limitations: ď śImage resolution is less when compared to intra oral radiographs
ď ś6-15% image magnification can occur
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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.,
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Limitations: Superimposition Positioning errors are more likely
Resolution is comparatively less 10-20% magnification occurs- which is not uniform
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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 www.indiandentalacademy.com
Limitations: Slower speed Patient discomfort
Manipulative difficulties Fragility of the thermo conductor
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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 www.indiandentalacademy.com
Limitations: Its not as flexible like a film
Difficult to place in shallow palate Gagging may occur due to its thickness
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3-DIMENSIONAL IMAGING MODALITIES
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CROSS-SECTIONAL TOMOGRAPHY
Exact imaging of the implant site can be done
Little superimposition of other anatomic structures
They are least slightly magnified www.indiandentalacademy.com
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Limitations: Equipment cost
Limited contrast and resolution Trained oral radiologist must be
available to perform the procedure www.indiandentalacademy.com
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 www.indiandentalacademy.com
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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 www.indiandentalacademy.com
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 www.indiandentalacademy.com
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 www.indiandentalacademy.com
RECENT ADVANCES Cone beam CT Micro-tomograph Multi slice helical CT www.indiandentalacademy.com
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
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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 www.indiandentalacademy.com
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RADIOGRAPHIC PLANNING START
ADEQUATE HEIGHT
YES NO UNCERTAIN
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ADEQUATE WIDTH
SUMMARY There are large number of imaging modalities available for: PLANNING SURVEILLANCE MANAGEMENT Clinicians, however, must recognize that each technique has advantages and limitations. www.indiandentalacademy.com
TO CONCLUDE…....
“One who sees the invisible....... can do the impossible”…….!!!
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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
www.indiandentalacademy.com
www.indiandentalacademy.com Leader in continuing dental education
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