03/02/2017
TABLE 7.1 Radiology for treatment planning in implant industry
SINGLE IMPLANT
Anterior maxilla
Periapical radiograph. If cross-sectional information is needed possibly use limited-volume CBCT.
Premolar maxilla
Periapical and/or panoramic radiograph. If cross-sectional information is needed, possibly use limited-volume CBCT.
Molar maxilla
Periapical and/or panoramic radiograph. If cross-sectional information is needed, possibly use limited-volume CBCT especially to visualise the antral floor.
Anterior mandible
Periapical radiograph. If cross-sectional information is needed possibly use limited-volume CBCT to show lingual fossae.
Post-foraminal mandible
Periapical and/or panoramic radiograph. To show three dimensional position of the inferior dental canal and to investigate concavities of lingual/submandibular fossae, possibly use limited-volume CBCT.
MULTIPLE IMPLANTS
Multiple exposures using the above guidance can become unwieldy and carry significant radiation exposure. A good panoramic radiograph with magnification markers can often give excellent information. Where cross-sectional information is needed, CT, limited or full-volume CBCT should be used, if the exposure is likely to improve the outcome for patient and surgeon.
MRI could be considered as it entails no exposure to ionising radiation.
IF REQUIRED DURING SURGERY
Periapical radiographs should be used, with radiographic measurement markers. For ease of use during surgery, the use of a digital system should be considered.
POST-OPERATIVE
Periapical and/or panoramic radiographs may be used.
GENERAL GUIDANCE AND POST-TREATMENT REVIEW
Periapical and panoramic radiographs give good two-dimensional information, but the surgeon must be aware of potential magnification and patient positioning errors. The use of sectional imaging is appropriate in complex and anatomically challenging cases, but the surgeon should be aware of the need to reduce the dose by using CBCT and MRI rather than conventional CT. In all cases, the technique employed should justify the radiation dose. Post-operative review protocols appear to be the subjective opinion of authors. A radiograph at completion of the restoration and 12 months later may be considered essential in
gaining baseline data and assessment of any changes in bone levels due to factors such as remodelling, function or inflammation. An ongoing review interval of one, three, or up to five years is suggested, to verify stability of bone levels or to detect progressive bone loss. A careful clinical examination should be able to indicate a stable situation, but it is advisable to obtain radiographic evidence of bone levels if signs are present that may suggest deterioration, eg. increased probing depth, bleeding, exudate, mobility.
