The impact of CBCT imaging when placing dental implants in the anterior edentulous mandible: a before–after study

Abstract

Objectives: To evaluate the impact of CBCT imaging when placing dental implants in the anterior edentulous mandible, using a "before-after" study design. Methods: Eight dental practitioners, who regularly place dental implants in independent dental practice in the North West of England, were presented with realistic simulations of four edentulous cases. The practitioners were asked to assess case difficulty, select implants and then drill osteotomies in preparation for dental implants in the lower canine regions to support a complete overdenture. In the "before" part of the study, a panoramic and a transsymphyseal view were available. In the "after" part of the study, a CBCT image was added. Perception of case difficulty, implant selection and the incidence of perforations or "near miss perforations" of the lingual cortical plate were recorded. Two cases were regarded as "regular" and two as "challenging". Results: In challenging cases, the availability of CBCT led practitioners to select narrower implants and to assess cases as more difficult. In the challenging cases only, there were fewer perforations of the lingual cortical plate after the availability of CBCT, but this difference was not statistically significant. There were no perforations in the regular cases either before or after the availability of CBCT. Conclusions: Perception of case difficulty and implant selection are of importance only if they change the outcome for the patient. This study provided weak evidence that CBCT is helpful in avoiding perforations in challenging cases. The availability of CBCT had no impact in regular cases.

Use of cone beam computed tomography in implant dentistry: current concepts, indications and limitations for clinical practice and research

“…In panoramic‐based surgery, the prediction of implant length was poor. There have been similar studies in recent years that at least partially confirm these findings but also emphasize the importance of subjective factors, such as observer opinion or experience .…”

Presurgical evaluation of bony implant sites using panoramic radiography and cone beam computed tomography—influence of medical education

“…Although the inferior alveolar nerve can be identified more precisely using CBCT, this is mainly needed in special settings such as dental implantation close to the respective nerve only. 12,18 Moreover, the three areas of interest were rated differently by the participants. MS were significantly more in favour of "no adequate visibility" for PAN in the MX and MD posterior areas than other groups.…”

“…7,9,10 There are only a few publications addressing the additional benefit of CBCT in surgical planning of implant procedures. [11][12][13][14][15] In a clinical survey on 108 patients with 365 dental implants, Guerrero et al 11 concluded that CBCT for implant planning results in a higher degree of prediction, especially for implant length, when compared with PAN only. Similarly, Fortin et al 13 stated that the use of PAN in the maxilla leads to a pre-operative overestimation for sinus augmentation, which may be avoided by 3D planning.…”

“…Others, on the other hand, found a weak evidence that availability of CBCT reduces bone perforations and increases the rate of safe implant placement in the anterior edentulous mandible. 12 An attempt for a systematic review on the importance of CBCT in dental implant procedures was not possible owing to the high number of variables in this specific indication of implant placement. 15 Even so, a high number of dentists, oral surgeons (OS) as well as maxillofacial surgeons (MS) have access to CBCT and use it routinely mainly for dental implant procedures.…”

Planificacion de tratamiento con software para cirugía guiada en implantologia oral

“…La CBCT permite valorar adecuadamente las características anatómicas del maxilar superior y de la mandíbula para la planificación de la cirugía de implantes (Figuras 1 y 2) [12][13] . En el maxilar superior, la CBCT puede identificar un reborde alveolar insuficiente para la colocación de los implantes de 4 mm de diámetro.…”