Role of Cone Beam Computed Tomography in Rehabilitation of a Traumatised Deficient Maxillary Alveolar Ridge Using Symphyseal Block Graft Placement

Abstract

Deficiencies in the alveolar ridges cause multiple problems in achieving aesthetic and functional outcome of implant therapy and are commonly restored by using onlay graft from intraoral source. Careful assessment of the recipient as well as the donor site using cone beam computed tomography (CBCT) is a prerequisite to ideal treatment planning. This paper highlights the critical role of CBCT in planning a successful rehabilitation of traumatised deficient anterior maxillary alveolar ridge using autogenous block graft from mandibular symphysis, followed by implant placement. A 21-year-old male reported with missing right maxillary lateral incisor due to traumatic avulsion 6 months back. A concavity was found on the labial aspect of edentulous area. Serial transplanar images on CBCT revealed gross irregular radiolucency in place of labial cortical plate. Using CBCT, size of the required block was estimated, and mandibular symphyseal area was evaluated for the feasibility of harvesting a graft of suitable dimension. Onlay block graft was harvested from mandibular symphysis and placed at the edentulous site to augment the alveolar ridge. Implants were placed 5 months later and loaded successfully after osseointegration. After 1 year of followup, implant-based prosthesis is working well, without any complications.

Influence of basis images and skull position on evaluation of cortical bone thickness in cone beam computed tomography

“…Of the previous studies investigating CBCT measurements, several have reported the importance of CBCT on the evaluation of buccal and lingual cortical bone thickness for mini-implant placement, to re-establish the buccal bone wall after immediate implant placement, and to detect bone defects. 2,3,13,17,[25][26][27][28] However, the use of CBCT for these applications should be optimized by balancing diagnostic image quality with radiation dose. The current results show that a 360-degree protocol may not show a distinct advantage over a 180-degree protocol, implying that the latter would be preferred because of its lower radiation dose (approximately 50% reduction).…”

“…Accurate information regarding the presence of cortical bone may prevent multiple aesthetic and functional problems in the outcome of implant therapy, independent of the bone thickness present. 17 Many image quality factors should be considered to explain the limitation of CBCT for this application. The spatial resolution can be considered the minimum distance necessary to distinguish 2 objects located closely together.…”

“…In such cases, a measurement error could lead to a misdiagnosis of bone loss. 14,17,18 Evaluation of cortical bone is related to several image quality factors. 19,20 Several CBCT units are available on the market, each one manufactured with individual characteristics in relation to acquisition parameters and image visualization.…”

Custom-Made Computer-Aided-Design/Computer-Aided-Manufacturing Biphasic Calcium-Phosphate Scaffold for Augmentation of an Atrophic Mandibular Anterior Ridge

“…Strategies used to overcome mandibular atrophy include various techniques developed to increase bone volume, such as onlay/inlay bone grafting [ 6 – 8 ], GBR [ 9 , 10 ], ridge expansion [ 11 ], and distraction osteogenesis [ 7 , 12 ]. Although it has been shown that it is possible to augment bone with all these different techniques, each of these options poses a risk of complications or potential for dimensional graft loss [ 4 , 5 , 13 , 16 ].…”

“…Different surgical techniques have been used to overcome alveolar ridge atrophy, including onlay/inlay bone grafting [ 6 – 8 ], guided bone regeneration (GBR) [ 9 , 10 ], ridge split technique/ridge expansion [ 11 ], and distraction osteogenesis [ 7 , 12 ].…”