Dental CT can depict the occurrence, position, and size of the lingual vascular canals of the mandible. Radiologists should be aware of this anatomic feature and its possible implications.
The objective of this study was to evaluate the feasibility and accuracy of a novel surgical computer-aided navigation system for the placement of endosseous implants in patients after ablative tumour surgery. Pre-operative planning was performed by developing a prosthetic concept and modifying the implant position according to surgical requirements after high-resolution computed tomography (HRCT) scans with VISIT, a surgical planning and navigation software developed at the Vienna General Hospital. The pre-operative plan was transferred to the patients intraoperatively using surgical navigation software and optical tracking technology. The patients were HRCT-scanned again to compare the position of the implants with the pre-operative plan on reformatted CT-slices after matching of the pre- and post-operative data sets using the mutual information-technique. A total of 32 implants was evaluated. The mean deviation was 1.1 mm (range: 0-3.5 mm). The mean angular deviation of the implants was 6.4 degrees (range: 0.4 degrees - 17.4 degrees, variance: 13.3 degrees ). The results demonstrate, that adequate accuracy in placing endosseous oral implants can be delivered to patients with most difficult implantologic situations.
The evaluation showed the treatment concept described to ensure stable oral rehabilitation and recovery of the stomatognathic system even during the juvenile growth period.
This study examined multidimensional osteodistraction as a treatment method for correction of implant malposition and as an alternative to augmentation procedures. The prosthetically unfavourable implant positions were due to growth-related implant malposition (in the context of treatment of young patients with oligodontia) or primary bone-driven implant insertions. The radiographical and clinical findings obtained with this osteodistraction technique are presented and discussed. A tooth-supported osteodistractor for multidimensional distraction with custom-fabricated distraction abutments was used for treatment of 8 patients with a total of 9 maxillary and mandibular edentulous segments including single-tooth gaps. All patients underwent an osteotomy at a minimum distance of 1 mm from the implant surface. Following primary wound healing, distraction was carried out by 1 mm in vertical direction and 0.5 mm in the demanded transverse direction daily until the prosthetically optimized position was achieved. During and after the 12-week retention phase, the patients were evaluated clinically and radiographically. Multidimensional osteodistraction was carried out successfully in all 8 patients. The distraction distances were 3 to 11 mm in vertical direction and a maximum of 5 mm in buccolingual/buccopalatal direction. The malpositioned implants were brought into a prosthetically optimized position in all cases. The results of this study show that this multidimensional osteodistraction technique allows both augmentation of edentulous segments with a clearly compromised implant host site and correction of unfavourable implant positions.
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