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Imai T, Kubota S, Nishimoto A, Katsura-Fuchihata S, Uzawa N. Risk factors for impacted lower third molar root perforation through the undercut-shaped lingual plate: preoperative insights from panoramic radiography. Odontology 2024; 112:562-569. [PMID: 37910252 DOI: 10.1007/s10266-023-00865-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/08/2023] [Indexed: 11/03/2023]
Abstract
This study aimed to identify risk factors associated with perforation of the undercut (U)-shaped lingual plate (LP) by the lower third molar (LM3) root using panoramic radiography (PAN). We retrospectively examined 468 impacted LM3s from 468 individuals, categorizing LM3-LP associations and LP morphology in the coronal section of cone-beam computed tomography as perforation or nonperforation and U-type or non-U-type, respectively. The outcome was the combination of perforation and U-type, and study variables included patient demographics (age and sex) and PAN-associated features (Winter's classification, Pell-Gregory classification, and two major Rood signs). Multivariate logistic regression methods were used for analysis. Perforated and U-type LPs were observed in 205 (43.8%) and 212 (45.3%) cases, respectively. The double-positive outcome was observed in 126 LM3s (26.9%). In the multivariate model, age ≥ 26 years [odds ratio (OR), 2.66; p = 0.002], men (OR, 2.01; p = 0.002), mesioangular (OR, 2.74; p = 0.038) and horizontal impaction (OR, 3.05; p = 0.019), and root darkening (OR, 1.73; p = 0.039) were independently associated with the risk. Class III impaction (OR, 0.35; p = 0.021) and interruption of the white line (OR, 0.55; p = 0.017) were negatively correlated with the risk. In conclusion, this study highlights the importance of identifying the higher probability of U-type LP perforation by the LM3 root in men aged over their midtwenties with Class I/II impaction and mesioangularly or horizontally impacted LM3s, along with root darkening and no interruption of the white line on PAN.
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Affiliation(s)
- Tomoaki Imai
- Department of Oral and Maxillofacial Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibaharatyo, Toyonaka, Osaka, 560-8565, Japan.
- Department of Oral & Maxillofacial Oncology and Surgery, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Seiko Kubota
- Department of Oral & Maxillofacial Oncology and Surgery, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Ayano Nishimoto
- Department of Oral & Maxillofacial Oncology and Surgery, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Sho Katsura-Fuchihata
- Department of Oral & Maxillofacial Oncology and Surgery, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Narikazu Uzawa
- Department of Oral & Maxillofacial Oncology and Surgery, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Alqutaibi AY, Alghauli MA, Aboalrejal A, Mulla AK, Almohammadi AA, Aljayyar AW, Alharbi SO, Almuzaini ES, Alsaeedi AK, Arabi LF, Alhajj MN, Halboub E. Quantitative and qualitative 3D analysis of mandibular lingual concavities: Implications for dental implant planning in the posterior mandible. Clin Exp Dent Res 2024; 10:e858. [PMID: 38345362 PMCID: PMC10860544 DOI: 10.1002/cre2.858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE The purpose of this study is to investigate the type of ridge (degree of angulation of the lingual concavity) and the buccolingual dimensions in the area of the first and second molars in both genders of different ages and how this will affect implant placement in the posterior mandible. MATERIALS AND METHODS This retrospective cross-sectional study comprised cone beam computed tomography images of 150 dental patients (75 males and 71 aged ≥30). The following were measured/reported: type (morphology) of the ridge (convex [C], parallel [P], or undercut [U]), buccolingual width at the base and the crest of the ridge, and ridge height. The concavity angle, depth, and length of the U-shaped ridge were measured too. RESULTS The prevalence of type U ridge ranged from 32.7% in the first molar region to 62.7% in the second molar region. Almost all measurements and ridge type distributions were comparable amongst the age groups (p > .05). Very few significant differences were found when comparing #36 versus #37 and #46 versus #47 teeth, with no differences in the distribution of the ridge types (p > .05). Quite the inverse, all measurements were statistically different when comparing #36 versus #37 and #46 versus #47 teeth, and type U ridge was more frequent in second molar compared to the first molar regions, respectively (p < .05). Many measurements were statistically higher in females; the inverse was true for a few measurements (p < .05). Type U ridge in #36 and #37 was found more frequently among males (p < .001). In contrast, the ridge types in #37 and #47 were not statistically different gender-wise. CONCLUSIONS The U type of ridge was more prevalent in the investigated population, encountered more frequently in the second molars generally and in the first molars of males than females. Most posterior mandibular measurements are similar age- and side-wise but seem different gender- and tooth-wise.
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Affiliation(s)
- Ahmed Yaseen Alqutaibi
- Substitutive Dental Science Department, College of DentistryTaibah UniversityAl‐MadinahSaudi Arabia
- Department of Prosthodontics, Faculty of DentistryIbb UniversityIbbYemen
| | | | - Afaf Aboalrejal
- Oral Biology Department, College of DentistryIbb UniversityIbbYemen
| | | | | | | | | | | | | | - Lina F. Arabi
- College of DentistryTaibah UniversityAl MadinahSaudi Arabia
| | | | - Esam Halboub
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of DentistryJazan UniversityJazanSaudi Arabia
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Sun Y, Hu S, Xie Z, Zhou Y. Relevant factors of posterior mandible lingual plate perforation during immediate implant placement: a virtual implant placement study using CBCT. BMC Oral Health 2023; 23:76. [PMID: 36747164 PMCID: PMC9903431 DOI: 10.1186/s12903-022-02696-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/26/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To explore the influence of cross-sectional type and morphological parameters at the mandibular molar sites on lingual plate perforation (LPP) during the immediate implant placement (IIP). METHODS 181 implants were virtually placed in the mandibular molar sites on the cone beam computed tomography (CBCT). Each cross-section of the implantation site was divided into the Undercut (U)/Parallel (P)/Convex (C) types. Morphologically relevant parameters were measured on the cross-sections, including width of the upper end (Wb), width of the lower end (Wc), vertical height (V), angle between the natural crown axis and the alveolar bone axis (∠β), LC depth (LCD), LC height, and angle between the horizontal line and the line connecting the most prominent point and the most concave point of lingual plate (∠α). Besides, the distance from the end of the virtual implant and the lingual bone plate of the cross-section (DIL) was calculated. Relationships between all the morphologically relevant parameters and the DIL were further analyzed. RESULTS A total of 77 (42.5%) cross-sections were classified as U-type, which was the most common one, accounting for 63% of the second molar regions. All LPP cases and most of the nearly LPP (87.9%) cases occurred at the U-type cross-sections, and the relationship between the DIL and the morphological parameters can be expressed by a multivariate linear equation. CONCLUSIONS The occurrence rate of U-type cross-sections in the second molar region was very high, and the risk of LPP should be considered during IIP. Except for the U-type, significant large LCD, small Wc, and large ∠β were the important relevant factors. CBCT and multivariate linear equations could help to assess the LPP risk and provide a reference for implant placement design pre-surgery.
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Affiliation(s)
- Yingjia Sun
- grid.13402.340000 0004 1759 700XStomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310000 People’s Republic of China
| | - Sai Hu
- grid.13402.340000 0004 1759 700XThe Fourth Affiliated Hospital, Zhejiang University School of Medicine, N1 Shangcheng Road, Yiwu, 322000 Zhejiang People’s Republic of China
| | - Zhijian Xie
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310000, People's Republic of China.
| | - Yiqun Zhou
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310000, People's Republic of China.
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Ketabi AR, Piwowarczyk A, Schulz MC, Lauer HC, Hassfeld S. Evaluation of the contour of edentulous jaw sections in the transversal plane and the buccolingual vertical-level disparity in CBCT and panoramic radiography images: a retrospective comparative study. Int J Implant Dent 2023; 9:1. [PMID: 36595148 PMCID: PMC9810779 DOI: 10.1186/s40729-022-00466-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 12/20/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE This study investigates whether edentulous jaw sections in the planned implant position exhibit jaw contours funnel-shaped or exhibit pronounced retraction of the jaw (unusual jaw contours) in the transversal plane of the three-dimensional (3D) images, not visible in two-dimensional (2D) images. METHODS A total of 335 patients with an edentulous section of the jaw that required dental implants were selected. Anonymised radiologic patients' data were collected, comprising cone-beam computed tomography (CBCT) images of the edentulous jaw sections. In the first stage, unusual jaw contours were examined, including funnel-shaped or pronounced retraction of the jaw and hypodense regions with an undercut and/or bone deficit. In the second stage, the variation in the height of the alveolar ridge between the lingual and buccal contour in the edentulous jaw sections was assessed. RESULTS The CBCT images of an unusual jaw contour were observed in 8 cases (2.4%) in the maxilla on the left and 10 cases (3%) in the maxilla on the right. In the mandible, a jaw contour deviates in 39 cases (12.1%) on the left side and 39 cases (12.1%) on the right side. A height difference was detected in the upper jaw in 307 cases and the lower jaw in 265 cases. The discrepancy was 2.09 mm (± 2.25 mm) in the maxilla and 3.97 mm (± 3.45 mm) in the mandible. CONCLUSIONS The CBCT scan provides useful information to avoid complications in the preoperative planning phase and surgical planning in implant dentistry.
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Affiliation(s)
- Ali Reza Ketabi
- Department of Prosthodontics, School of Dentistry, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 45, 58455, Witten, Germany. .,Private Dental Office, Epplestraße 29 a, 70597, Stuttgart, Germany.
| | - Andree Piwowarczyk
- grid.412581.b0000 0000 9024 6397Department of Prosthodontics, School of Dentistry, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 45, 58455 Witten, Germany
| | - Matthias Christian Schulz
- grid.10392.390000 0001 2190 1447Department of Oral and Maxillofacial Surgery, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Osianderstraße 2-8, 72076 Tübingen, Germany
| | - Hans-Christoph Lauer
- grid.7839.50000 0004 1936 9721Department of Prosthodontics, Center for Dentistry and Oral Medicine (Carolinum), Goethe-University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany
| | - Stefan Hassfeld
- grid.412581.b0000 0000 9024 6397Department of Oral and Maxillofacial Surgery, Dortmund Hospital GmbH and Faculty of Health, Witten/Herdecke University, Muensterstr. 240, 44145 Dortmund, Germany
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Çimen T, Asar NV, Goyushov S, Duruel O, Tözüm TF. Effects of Crest Morphology on Lingual Concavity in Mandibular Molar Region: an Observational Study. J Oral Maxillofac Res 2023; 14:e3. [PMID: 37180407 PMCID: PMC10170663 DOI: 10.5037/jomr.2023.14103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/31/2023] [Indexed: 05/16/2023]
Abstract
Objectives The aim of this radiological study is to evaluate the lingual concavity dimensions and possible implant length in each posterior tooth region according to posterior crest type classification by using cone-beam computed tomography. Material and Methods According to inclusion criteria, 836 molar teeth regions from 209 cone-beam computed tomography images were evaluated. Posterior crest type (concave, parallel, or convex), possible implant length, lingual concavity angle, width, and depth were recorded. Results In each posterior tooth region, concave (U-type) crest was detected most frequently while convex (C-type) was the lowest. Possible implant length values were higher in second molar regions than first molars. Lingual concavity width and depth were decreasing from second molars to first molars for both sides. Additionally, lingual concavity angle showed higher values in second molar sites than first molars. In all molar teeth regions, lingual concavity width values were the highest in concave (U-type) crest type while they were the lowest in convex (C-type) crest type (P < 0.05). Lingual concavity angle values were recorded as the highest in concave (U-type) and the lowest in convex (C-type) crest type at the left first molar and right molars (P < 0.05). Conclusions The lingual concavity dimensions and possible implant length may vary according to crest type and edentulous tooth region. Due to this effect, the surgeons should examine crest type clinically and radiologically. All parameters in the present study are decreasing while moving from anterior to posterior as well as from concave (U-type) to convex (C-type) morphologies.
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Affiliation(s)
- Tansu Çimen
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Alanya Alaaddin Keykubat University, AntalyaTurkey
| | - Neset Volkan Asar
- Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IllinoisUSA
- Department of Prosthetic Dentistry, Faculty of Dentistry, Gazi University, AnkaraTurkey
| | - Samir Goyushov
- Department of Periodontology, Faculty of Dentistry, Istanbul Aydin University, IstanbulTurkey
| | - Onurcem Duruel
- Private practice limited in periodontology and oral implantology, AnkaraTurkey
| | - Tolga Fikret Tözüm
- Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IllinoisUSA
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Alshenaiber R, Barclay C, Silikas N. The Effect of Mini Dental Implant Number on Mandibular Overdenture Retention and Attachment Wear. BIOMED RESEARCH INTERNATIONAL 2023; 2023:7099761. [PMID: 37168235 PMCID: PMC10164865 DOI: 10.1155/2023/7099761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 09/02/2022] [Accepted: 04/05/2023] [Indexed: 05/13/2023]
Abstract
Purpose Evaluate the effect of different mini-implant numbers on overdenture retention and evaluate attachment wear following one year of simulated placement/removal. Material and Methods. Nine models simulating atrophic mandibles held 27 mini dental implants in three groups of 2, 3, and 4 mini-implants. A total of 1080 simulated placement/removal cycles were carried out, and a digital force gauge was used to measure the overdenture dislodgment force. The means of the retention forces were analyzed using SPSS with one-way ANOVA and post hoc (p < 0.05). The inner diameter of attachment inserts was evaluated using a light microscope before and after testing. A paired t-test was used to compare the mean of inner ring diameters (p < 0.05). Results The retention was significantly reduced regardless of the mini dental implant number, but the number affected overdenture retention. The placement of 4 mini dental implants provided higher retention and less reduction in retentiveness. However, no significant difference was found when 3 mini dental implants were compared to 2 mini dental implants (p = 0.21). Microscopic examination showed abrasion wear in all inserts following testing. However, the inserts of the 4 mini dental implants showed less wear than those used for 2 or 3 mini dental implants with p ≤ 0.001 and p ≤ 0.001, respectively. Conclusion Mini dental implant overdenture retention force and attachment wear could improve by increasing the mini dental implants to 4. However, there was no difference in retention force or attachment wear when 2 or 3 mini dental implant overdentures were compared.
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Affiliation(s)
- Rafif Alshenaiber
- Prosthetic Dental Sciences Department at College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Craig Barclay
- Oral Rehabilitation, University Dental Hospital of Manchester, Manchester, UK
| | - Nick Silikas
- Division of Dentistry, Faculty of Biology, Medicine and Health, University of Manchester, Coupland 3 Building, UK Manchester M13 9PL
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Madhok S, Kiruthika S, Prabhu K, Abraham S, Kabilan P, Nithyapriya S. Mylohyoid Ridge as a Predictor of Available Bone for Implant Placement: A Cone-Beam Computed Tomography (CBCT) Retrospective Observational Study. Cureus 2022; 14:e27470. [PMID: 36060375 PMCID: PMC9421098 DOI: 10.7759/cureus.27470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/29/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction: The posterior mandibular region, due to the presence of vital structures, poses a high risk during implant placement because of its susceptibility to neurovascular injury and perforation of the lingual cortex. A breach in implant length and available bone height may lead to serious intraoperative and postoperative complications. Prediction of the exact location of the inferior alveolar nerve and submandibular fossa anatomy is a prerequisite for ideal implant placement, which is always not possible with conventional radiographic and clinical techniques. Materials and methods: One hundred ten cone-beam computed tomographies (CBCTs) of patients were acquired from the radiological archives of a radiological center in Chennai. DICOM files from CBCT were exported to Bly Sky Plan software. Cross-sections of the second molar and first molar were extracted following the inclusion criteria. The linear dimension between the mandibular canal and mylohyoid ridge and anatomic variables of the submandibular fossa were measured digitally on the left and right sides using software measuring tools. Descriptive statistics were done. The unilateral and bilateral site and gender differences were evaluated. Bone height superior to the mandibular canal was correlated with the submandibular fossa parameters; depth of undercut in the vertical and horizontal directions; and angle of the undercut. Results: The mandibular canal was on average 5.5 mm and 4 mm inferior to the Mylohyoid ridge in the second molar region and first molar region, respectively, with the right and left sides showing no statistically significant difference. The depth of fossa undercut in vertical and horizontal dimensions was higher in the second molar region compared to the first molar region. The height of the deepest point of the undercut in the vertical dimensions showed a positive correlation with the bone available between the mandibular canal and the mylohyoid ridge. Conclusion: Keeping 2 mm of safety factor in consideration, implants can be safely placed up to the mylohyoid ridge in 100% of cases and 2 mm below the mylohyoid ridge in 78.9% of cases in the mandibular second molar region. In keeping with a safety factor of 2 mm, implants can be safely placed up to the mylohyoid ridge in 82.6% of cases and 2 mm below the mylohyoid ridge in 43.1% of cases in the first molar region. A more pronounced undercut was seen in the second molar region than in the first molar region. Deeper fossa undercuts in vertical dimension are associated with more inferior positioning of the mandibular canal.
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3D-based buccal augmentation for ideal prosthetic implant alignment—an optimized method and report on 7 cases with pronounced buccal concavities. Clin Oral Investig 2022; 26:3999-4010. [PMID: 35066689 PMCID: PMC9072447 DOI: 10.1007/s00784-022-04369-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 12/31/2021] [Indexed: 02/07/2023]
Abstract
Objectives Screw-retained restoration of implants is advantageous for biological and esthetic reasons. Due to buccal concavities, however, this preferred type of restoration can only be used in about half of the anterior indications. Based on case series, an optimized method for the treatment of such indications is to be described; the clinical reliability is to be ascertained by means of measurements (before and after augmentation) and assigned to the current literature. Material and methods A case series of seven cases with buccal concavities of the anterior alveolar ridge were treated with optimized method, which is presented step-by-step until the prosthetic restoration. The depths of the bone concavities were measured and related to the bone gain after augmentation procedure respectively after implantation. Results Linear measurements of the buccal concavities showed an average undercut of 4 mm [SD ± 1.13]. After healing period of six months, the buccal concavities could be compensated bony to such an extent that implants could be inserted in correct position and angulation. On average, there was a horizontal bone gain of 3.7 mm [SD ± 0.59]. Even after implantation and another six months of healing, stable bone dimensions could be assumed with an average of 4.3 [SD ± 0.83] mm of bone gain compared to baseline. In six of the seven cases, the favorite screw-retained, one-piece full-ceramic restoration could be fixed on the implants. Due to the implant axis, one case had to be treated with a cemented two-part full-ceramic system. Conclusions With the described optimized method the most favorable screw-retained restoration can also be used in situations with unfavorable concavities of buccal bone. Especially for this indication, a special form of the horizontal deficit, the customized bone regeneration with titanium meshes is highly reliable in terms of healing and extent of augmentation. However, long-term results and a study/control group are required to evaluate the effectiveness of the presented protocol. Clinical relevance. Since these situations require an augmentation that is up to 5 mm thick and a procedure that is as minimally invasive as possible appears to be necessary in the visible area, an optimized method is described in this publication.
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Kim KJ, Park JH, Chang NY, Seo HY, Chae JM. A cone-beam computed tomography evaluation of posterior available space in both arches relative to various skeletal patterns. Am J Orthod Dentofacial Orthop 2022; 161:798-808. [DOI: 10.1016/j.ajodo.2021.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/01/2021] [Accepted: 01/01/2021] [Indexed: 11/01/2022]
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Kong ZL, Wang GG, Liu XY, Ye ZY, Xu DQ, Ding X. Influence of bone anatomical morphology of mandibular molars on dental implant based on CBCT. BMC Oral Health 2021; 21:528. [PMID: 34654414 PMCID: PMC8518329 DOI: 10.1186/s12903-021-01888-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/27/2021] [Indexed: 12/02/2022] Open
Abstract
Background To apply CBCT to investigate the anatomical relationship between the mandibular molar and alveolar bone, aimed to provide clinical guidelines for the design of implant restoration. Methods 201 CBCT data were reevaluated to measure height of the alveolar process (EF), width of the alveolar process (GH), width of the basal bone (IJ), the angle between the long axis of the first molar and the alveolar bone (∠a) and the angle between the long axis of the alveolar bone and basal bone (∠b). The angle and width were measured to determine the implant-prosthodontic classification of the morphology in the left lower first molar (36) and right lower first molar (46). All measurements were performed on the improved cross-sectional images. Results EF, GH and IJ were measured as (10.83 ± 1.31) mm, (13.93 ± 2.00) mm and (12.68 ± 1.96) mm for 36, respectively; and (10.87 ± 1.24) mm, (13.86 ± 1.93) mm and (12.60 ± 1.90) mm for 46, respectively. No statistical significance was observed in EF, GH, IJ, ∠a and ∠b between 36 and 46 (all P > 0.05). The morphology was divided into three categories including the straight (68.7–69.2%), oblique (19.9–20.4%) and concave types (11%). Each type was consisted of two subcategories. Conclusions The proposed classification could provide evidence for appropriate selection and direction design of the mandibular molar implant in clinical. The concave type was the most difficult to implant with the highest risk of lingual perforation. The implant length, width, direction required more attention.
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Affiliation(s)
- Zhuo-Lin Kong
- Department of Stomatology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Ouhai District, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Ge-Ge Wang
- Department of Stomatology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Ouhai District, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Xue-Ying Liu
- Department of Stomatology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Ouhai District, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Zhang-Yan Ye
- Department of Stomatology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Ouhai District, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Dong-Qian Xu
- Department of Stomatology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Ouhai District, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Xi Ding
- Department of Stomatology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Ouhai District, Wenzhou, 325000, Zhejiang, People's Republic of China.
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Chen H, Wang W, Gu X. Three-dimensional alveolar bone assessment of mandibular molars for immediate implant placement: a virtual implant placement study. BMC Oral Health 2021; 21:478. [PMID: 34579702 PMCID: PMC8474897 DOI: 10.1186/s12903-021-01849-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/16/2021] [Indexed: 12/20/2022] Open
Abstract
Background To elucidate the anatomical features of the mandibular molar region to allow safe immediate implant placement. Methods Cone-beam computed tomography images of 150 patients (600 teeth) were reviewed retrospectively. The virtual implants were placed in the mandibular first and second molar region. The anatomic structures of the mandible and inter-radicular septum were both categorized into three types. The relationship between implant and inferior alveolar nerve (IAN), and the horizontal distance from the implant surface to the bone wall were analyzed. Variables were compared using a student’s t-test, or Mann–Whitney U test. Results Type U (39.0%) and type S (56.0%) were the most common in the first molar, while type U (67.7%) and type M (54.7%) had the highest prevalence rate in the second molar. The mean distance from the level where the virtual implant was completely surrounded by bone to IAN was 7.06 mm. The mean horizontal widths from the implant to the mesial and distal socket wall were 1.59 mm and 1.89 mm. The widths of the inter-radicular septum and the distances from implant to the buccal and lingual plate on different sections were significantly associated with tooth position (P < .05). Conclusions In the first molar region, the implant is suggested to be placed in the center of the inter-radicular septum, while in the second molar region, the mesial root socket could be considered. Immediate implant placement in the mandibular second molar sockets shows a high risk of IAN injury, lingual perforation, and inadequate primary stability.
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Affiliation(s)
- Haida Chen
- Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Wei Wang
- Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Xinhua Gu
- Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China.
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Tan WY, Ng JZL, Ajit Bapat R, Vijaykumar Chaubal T, Kishor Kanneppedy S. Evaluation of anatomic variations of mandibular lingual concavities from cone beam computed tomography scans in a Malaysian population. J Prosthet Dent 2021; 125:766.e1-766.e8. [PMID: 33752904 DOI: 10.1016/j.prosdent.2021.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 10/21/2022]
Abstract
STATEMENT OF PROBLEM Lingual plate perforation can be life-threatening when vital structures are damaged during implant placement. Knowledge of the anatomy of lingual concavities is imperative for safe implant surgery. PURPOSE The purpose of this clinical study was to determine the prevalence of type of posterior mandibular ridge morphology in a Malaysian population and to evaluate the buccolingual width of the alveolar ridge (Wb and Wc); alveolar ridge height (Vcb); and concavity angle, length, and depth for both left and right first and second molars in different age groups and sexes by using cone beam computed tomography (CBCT). MATERIAL AND METHODS Bilateral posterior mandibular lingual concavities at the first and second molars were retrospectively studied in cross-sectional views of 150 CBCT scans (n=600 sites evaluated). The sample size was calculated at a power of 80%, confidence interval of 95%, and margin of error of .05. The buccolingual width from the base and crest of the ridge and the ridge height were measured to determine the type of ridge. For the U-shaped ridge, the concavity angle, length, and depth were assessed. The independent t test was used to compare mean values of CBCT measurements between sexes and tooth type, while the ANOVA and Pearson chi-squared test were used to determine the correlations with age groups and types of ridge morphology, respectively. To compare the left and right readings for first and second molars in the same patient, the paired t test was performed (α=.05 for all tests). RESULTS The Pearson correlation showed a strong agreement between the 2 examiners with an interobserver reliability of 87.3%. Significant difference was noted in all dimensional measurements when comparing right and left first and second molars (P<.001). The degree of concavity was significantly different (P<.05), except for the depth of the concavity at the left molars (P=.075). The type C ridge (51.7%) was the most prevalent ridge among a Malaysian population. Only dimensional measurements were significantly different when compared among age groups (P<.05). Ridge width and height were significantly greater in men (P<.05). Men exhibited greater concavity depth than women in the left second molar region (P=.03). CONCLUSIONS Lingual concavity was found in the mandible in 32.8% of a Malaysian population. Significant differences were found in dimensional measurements and degree of concavity between left and right first and second molars, with deeper concavity depth found in second molars. Significant age and sex-related variations were found in the dimensional measurements of the mandible between left and right sides with no significant difference in degree of concavity.
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Affiliation(s)
- Wan Yee Tan
- Predoctoral student, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia.
| | - Jacklyn Zhi Ling Ng
- Predoctoral student, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Ranjeet Ajit Bapat
- Senior Lecturer, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
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Bernaerts A, Barbier L, Abeloos J, De Backer T, Bosmans F, Vanhoenacker FM, Casselman J. Cone Beam Computed Tomography Imaging in Dental Implants: A Primer for Clinical Radiologists. Semin Musculoskelet Radiol 2020; 24:499-509. [PMID: 33036038 DOI: 10.1055/s-0040-1701496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
With the introduction of cone beam computed tomography (CBCT) into dentistry in the 1990s, radiologists have become more frequently involved in dental implant planning. This article describes the information that should be included in a radiology report to achieve a successful implantation. The justification to use CBCT during the preoperative planning phase is based on the need to evaluate patient-specific anatomy in detail (general condition of the jaw, bone quantity, and bone quality), the application of more advanced surgical techniques (maxillary sinus augmentation procedure, zygomatic implants), and the integrated presurgical planning and virtual patient approach. Postoperatively, CBCT is used when implant retrieval is anticipated and two-dimensional radiographs have not provided sufficient information, for evaluation of graft healing, or to assess complications, mostly related to neurovascular trauma.
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Affiliation(s)
- Anja Bernaerts
- Department of Radiology, GZA Hospitals, Antwerp, Belgium
| | - Lieven Barbier
- Training Center for Dental Students of the KU Leuven, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Johan Abeloos
- Department of Maxillo-Facial Surgery, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Tom De Backer
- Department of Maxillo-Facial Surgery, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Frederik Bosmans
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Filip M Vanhoenacker
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium.,Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jan Casselman
- Department of Radiology, GZA Hospitals, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Radiology, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
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Assessing the frequency of deep lingual concavities in 826 posterior mandible sockets. J Craniomaxillofac Surg 2020; 48:1045-1051. [PMID: 33012600 DOI: 10.1016/j.jcms.2020.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/30/2020] [Accepted: 09/07/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the frequency of deep lingual concavities in the lower jaw, which can cause surgical complications while inserting dental implants. METHODS Cross-sections of the mandible alveolar ridge at the edentulous sockets were obtained via cone-beam computed tomography. Measurements were carried out using the freeware 'IC Measure' and based on the basic definitions of a previous study. RESULTS Most (767/826 = 93%) sockets had concavities of various degrees (30-90°), while 59 (7%) sockets had no concavity. However, the majority of the concavities (71%) were mild, with angles > 60°. The other 220 (26%) sockets had deeper concavities of <60°; among these, 12 (1%) had extremely deep concavities of <40°. CONCLUSIONS Only a few cases have deep lingual concavities that pose a high risk for lingual plate perforation during dental implantation.
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Hämmerle CHF, Tarnow D. The etiology of hard- and soft-tissue deficiencies at dental implants: A narrative review. J Periodontol 2019; 89 Suppl 1:S291-S303. [PMID: 29926950 DOI: 10.1002/jper.16-0810] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 11/07/2017] [Accepted: 12/11/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The objective of the present paper was to review factors and conditions that are associated with hard and soft-tissue deficiencies at implant sites. IMPORTANCE Hard- and soft-tissue deficiencies at dental implants are common clinical findings. They can lead to complications and compromise implant survival and, hence, may require therapeutic interventions. It is, therefore, important to understand the etiology of hard and soft-tissue deficiencies. Based on this understanding, strategies should be developed to correct hard and soft-tissue deficiencies with the aim of improving clinical outcomes of implant therapy. FINDINGS A large number of etiological factors have been identified that may lead to hard and soft-tissue deficiencies. These factors include: 1) systemic diseases and conditions of the patients; 2) systemic medications; 3) processes of tissue healing; 4) tissue turnover and tissue response to clinical interventions; 5) trauma to orofacial structures; 6) local diseases affecting the teeth, the periodontium, the bone and the mucosa; 7) biomechanical factors; 8) tissue morphology and tissue phenotype; and 9) iatrogenic factors. These factors may appear as an isolated cause of hard and soft-tissue defects or may appear in conjunction with other factors. CONCLUSIONS Hard- and soft-tissue deficiencies at implant sites may result from a multitude of factors. They encompass natural resorption processes following tooth extraction, trauma, infectious diseases such as periodontitis, peri-implantitis, endodontic infections, growth and development, expansion of the sinus floor, anatomical preconditions, mechanical overload, thin soft tissues, lack of keratinized mucosa, malpositioning of implants, migration of teeth, lifelong growth, and systemic diseases. When more than one factor leading to hard and/or soft-tissue deficiencies appear together, the severity of the resulting condition may increase. Efforts should be made to better identify the relative importance of these etiological factors, and to develop strategies to counteract their negative effects on our patient's wellbeing.
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Affiliation(s)
- Christoph H F Hämmerle
- Chairman of the Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Switzerland
| | - Dennis Tarnow
- Director of Implant Education, Columbia University College of Dental Medicine, New York, NY, USA
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Magat G. Radiomorphometric analysis of edentulous posterior mandibular ridges in the first molar region: a cone-beam computed tomography study. J Periodontal Implant Sci 2019; 50:28-37. [PMID: 32128271 PMCID: PMC7040440 DOI: 10.5051/jpis.2020.50.1.28] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/31/2019] [Accepted: 09/09/2019] [Indexed: 11/09/2022] Open
Abstract
Purpose The aim of our study was to determine the prevalence and degree of lingual concavities in the first molar region of the mandible to reduce the risk of perforating the lingual cortical bone during dental implant insertion. Methods A total of 163 suitable cross-sectional cone-beam computed tomography images of edentulous mandibular first molar regions were evaluated. The mandibular morphology was classified as a U-configuration (undercut), a P-configuration (parallel), or a C-configuration (convex), depending on the shape of the alveolar ridge. The characteristics of lingual concavities, including their depth, angle, vertical location, and additional parameters, were measured. Results Lingual undercuts had a prevalence of 32.5% in the first molar region. The mean concavity angle was 63.34°±8.26°, and the mean linear concavity depth (LCD) was 3.03±0.99 mm. The mean vertical distances of point P from the alveolar crest (Vc) and from the inferior mandibular border were 9.39±3.39 and 16.25±2.44, respectively. Men displayed a larger vertical height from the alveolar crest to 2 mm coronal to the inferior alveolar nerve (Vcb) and a wider LCD than women (P<0.05). Negative correlations were found between age and buccolingual width at 2 mm apical to the alveolar crest, between age and Vcb, between age and Vc, and between age and LCD (P<0.05). Conclusions The prevalence of lingual concavities was 32.5% in this study. Age and gender had statistically significant effects on the lingual morphology. The risk of lingual perforation was higher in young men than in the other groups analyzed.
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Affiliation(s)
- Guldane Magat
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Necmettin Erbakan University, Konya, Turkey
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17
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Avanesov AM, Sedov YG, Mordanov OS. [Morphology of mandibular lingual concavities]. STOMATOLOGII︠A︡ 2019; 98:113-117. [PMID: 31701940 DOI: 10.17116/stomat201998051113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM The literature review on assessment of lingual concavities in posterior mandibula with CBCT to prevent complications such as perforations during dental implant placement. METHODS The electronic search of full-text articles on lingual concavity studies with CBCT was performed. The data on the prevalence, depth and angle of concavities was analyzed. RESULTS The analysis included 5 articles from 2011 to 2016 years. Totally 1713 mandibular concavities were evaluated in 1232 patients. The prevalence was 46.7-68%; mean depth was from 2.4 mm to 5.4 mm; and the mean angle varied from 143 to 156.6 degrees. CONCLUSION Though morphologic data of lingual concavities showed similar pattern it is necessary to provide CBCT evaluation prior to dental implant placement to define available bone and its morphology. It is recommended to use guided surgery if U-type is evident.
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Affiliation(s)
- A M Avanesov
- Peoples' Friendship University of Russia, Moscow, Russia
| | - Yu G Sedov
- Peoples' Friendship University of Russia, Moscow, Russia
| | - O S Mordanov
- Peoples' Friendship University of Russia, Moscow, Russia
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Analysis of the Pterygomaxillary Fissure for Surgical Approach to Sphenopalatine Ganglion by Radiological Examination of Cone Beam Computed Tomography. J Craniofac Surg 2019; 31:e95-e99. [PMID: 31688267 DOI: 10.1097/scs.0000000000006044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The pterygopalatine fossa (PPF) is a complex and paired anatomical structure located at the skull base. A clinically and surgically relevant structure located in the pterygopalatine fossa is the sphenopalatine ganglion. Electrical stimulation of the sphenopalatine ganglion is one possible method of treating cluster headache. The pterygomaxillary fissure (PMF) defines the pterygopalatine fossa laterally and determines the surgical approach. As part of preoperative surgical planning, each patient undergoes a preoperative head computed tomography or a cone beam computed tomography. In our study cone beam computed tomography images of 90 male and 110 female PMF were analyzed. Generally, males have a wider fissure than females. Moreover, a significant inter-subject difference could be shown between males and females. The analysis of the right and left PMF according to gender and age does not show any significant intra-subject differences. Following an established protocol for high-resolution CT images the measurements were classified into four fissure types and also analyzed according to gender and age. Fissure type I is significantly more often present in males, whereas the smaller fissure types (II, III, and IV) are significantly more often found in females. Older patients presented statistically significant more often with type I, whereas the younger patients showed more often the narrower types II and IV. Due to the fact that narrow fissures smaller than 2 mm could limit the insertion of neurostimulator implants in the PPF, special attention should be paid to females and younger patients during preoperative planning.
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Hämmerle CHF, Tarnow D. The etiology of hard- and soft-tissue deficiencies at dental implants: A narrative review. J Clin Periodontol 2019; 45 Suppl 20:S267-S277. [PMID: 29926502 DOI: 10.1111/jcpe.12955] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 11/07/2017] [Accepted: 12/11/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The objective of the present paper was to review factors and conditions that are associated with hard and soft-tissue deficiencies at implant sites. IMPORTANCE Hard- and soft-tissue deficiencies at dental implants are common clinical findings. They can lead to complications and compromise implant survival and, hence, may require therapeutic interventions. It is, therefore, important to understand the etiology of hard and soft-tissue deficiencies. Based on this understanding, strategies should be developed to correct hard and soft-tissue deficiencies with the aim of improving clinical outcomes of implant therapy. FINDINGS A large number of etiological factors have been identified that may lead to hard and soft-tissue deficiencies. These factors include: 1) systemic diseases and conditions of the patients; 2) systemic medications; 3) processes of tissue healing; 4) tissue turnover and tissue response to clinical interventions; 5) trauma to orofacial structures; 6) local diseases affecting the teeth, the periodontium, the bone and the mucosa; 7) biomechanical factors; 8) tissue morphology and tissue phenotype; and 9) iatrogenic factors. These factors may appear as an isolated cause of hard and soft-tissue defects or may appear in conjunction with other factors. CONCLUSIONS Hard- and soft-tissue deficiencies at implant sites may result from a multitude of factors. They encompass natural resorption processes following tooth extraction, trauma, infectious diseases such as periodontitis, peri-implantitis, endodontic infections, growth and development, expansion of the sinus floor, anatomical preconditions, mechanical overload, thin soft tissues, lack of keratinized mucosa, malpositioning of implants, migration of teeth, lifelong growth, and systemic diseases. When more than one factor leading to hard and/or soft-tissue deficiencies appear together, the severity of the resulting condition may increase. Efforts should be made to better identify the relative importance of these etiological factors, and to develop strategies to counteract their negative effects on our patient's wellbeing.
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Affiliation(s)
- Christoph H F Hämmerle
- Chairman of the Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Switzerland
| | - Dennis Tarnow
- Director of Implant Education, Columbia University College of Dental Medicine, New York, NY, USA
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Ramanauskaite A, Becker J, Sader R, Schwarz F. Anatomic factors as contributing risk factors in implant therapy. Periodontol 2000 2019; 81:64-75. [DOI: 10.1111/prd.12284] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Ausra Ramanauskaite
- Department of Oral Surgery and Implantology Carolinum, Johann Wolfgang Goethe‐University Frankfurt Frankfurt Germany
| | - Jürgen Becker
- Department of Oral Surgery Universitätsklinikum Düsseldorf Germany
| | - Robert Sader
- Department for Oral, Cranio‐Maxillofacial and Facial Plastic Surgery Medical Center of the Goethe University Frankfurt Frankfurt am Main Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology Carolinum, Johann Wolfgang Goethe‐University Frankfurt Frankfurt Germany
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21
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Lago L, Da Silva L, Fernández-Formoso N, Rilo B. Implant Planning in a Case With Sotos Syndrome. J ORAL IMPLANTOL 2019; 45:235-238. [DOI: 10.1563/aaid-joi-d-18-00181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Laura Lago
- Department of Prosthodontics, Faculty of Medicine and Dentistry, Santiago de Compostela University, Santiago de Compostela, Spain
| | - Luis Da Silva
- Department of Prosthodontics, Faculty of Medicine and Dentistry, Santiago de Compostela University, Santiago de Compostela, Spain
| | - Noelia Fernández-Formoso
- Department of Prosthodontics, Faculty of Medicine and Dentistry, Santiago de Compostela University, Santiago de Compostela, Spain
| | - Benito Rilo
- Department of Prosthodontics, Faculty of Medicine and Dentistry, Santiago de Compostela University, Santiago de Compostela, Spain
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22
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Geometrical parameters of the mandible in 3D CBCT imaging. Biocybern Biomed Eng 2019. [DOI: 10.1016/j.bbe.2018.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Significance of mandibular molar replacement with a dental implant: a theoretical study with nonlinear finite element analysis. Int J Implant Dent 2018; 4:4. [PMID: 29484524 PMCID: PMC5826906 DOI: 10.1186/s40729-018-0117-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 01/08/2018] [Indexed: 11/27/2022] Open
Abstract
Background Dental implants are frequently applied to unilateral defects in the mandible. However, implant placement in the molar region of the mandible can be difficult due to anatomical structure. The aim of this study was to evaluate the distribution of occlusal force in a mandibular shortened dental arch (SDA) with implants. Methods Three-dimensional finite element (FE) models of the mandible with varying numbers of teeth and implants were constructed. Models Im6 and Im67 contained one and two implants in the defect of the left molar region, respectively. Models Im456 and Im4567 contained three and four implants in the defect of the left premolar and molar regions, respectively. Model MT67 contained a defect in the molar region with no implant placed. Model MT7 represented natural dentition without a left second molar, as a control. Modification of the condition of occlusal contacts assuming the intercuspal position was performed before analysis under load 400 N; therefore, the load condition as total force on the occlusal surface was 400 N. FE analyses were subsequently performed under load conditions of loads 100, 200, and 800 N. The distribution of reaction forces on the occlusal surface and the mandibular condyle was investigated. Results Force distribution in models Im67 and Im4567 appeared to be symmetrical under all load conditions. Occlusal force distribution in models Im6 and Im456 was similar to that in model MT7. However, the occlusal force at the second premolars on the defect side in those models was larger under loads 100 and 200 N. Conversely, the occlusal force on the first molars was much larger than that in model MT7 under load 800 N. Conclusions Within the limitations of this theoretical study, we demonstrated that restoration with the same number of implants as missing teeth will show almost symmetric occlusal force distribution, and it will produce less biomechanically stress for a unilateral defect of the mandible. However, if restoration of a missing second molar with an implant is impossible or difficult, then an SDA with implants may also be acceptable except for individuals with severe bruxism.
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Rahpeyma A, Khajehahmadi S. Submandibular fossa augmentation in implant dentistry. J Indian Soc Periodontol 2018; 21:207-209. [PMID: 29440787 PMCID: PMC5803876 DOI: 10.4103/jisp.jisp_392_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background There are two limiting factors for determining the dental implant fixture length in mandibular posterior edentulous region: Inferior dental canal and submandibular fossa. Purpose Submandibular fossa augmentation is a suggested way to overcome the problem of lingual undercut beneath the mylohyoid ridge in implant dentistry. Materials and Methods Patients with lingual posterior bony undercut that interferes with the placement of a standard implant with a length of 10 mm were enrolled in this study. Results This method was used for eight patients in 10 sites. Increased implant length and decreasing the chance of sublingual hematoma due to lingual cortical plate perforation are the results of this study. Conclusions Submandibular fossa augmentation is a new technique to improve the maneuver of oral surgeons to increase dental implant length in the presence of deep lingual bony undercut.
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Affiliation(s)
- Amin Rahpeyma
- Oral & Maxillofacial Diseases Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
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25
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Herranz-Aparicio J, Marques J, Almendros-Marqués N, Gay-Escoda C. Retrospective study of the bone morphology in the posterior mandibular region. Evaluation of the prevalence and the degree of lingual concavity and their possible complications. Med Oral Patol Oral Cir Bucal 2016; 21:e731-e736. [PMID: 27694785 PMCID: PMC5116115 DOI: 10.4317/medoral.21256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/27/2016] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND In order to choose the appropriate implant size and to prevent complications, an oral surgeon must know the size and shape of the mandible. In the posterior mandibular region, a lingual undercut is often found and could represent a difficulty hard to manage if a lingual or buccal perforation occur. A large series of computed tomography (CT) images of the mandibular first molar was evaluated and the bone morphology, the prevalence and the degree of the lingual concavity in the first molar region were studied. MATERIAL AND METHODS One hundred and fifty-one computed tomography (CT) examinations of patients were retrospectively evaluated to determine anatomical variations in bone morphology in the submandibular fossa region. RESULTS A total of 151 subjects were included, consisting of 64 males (M) (42.4%) and 87 females (F) (57.6%). The under-cut type ridge was present in 64.2% of the cases. The concavity angle was 66.6 ± 8.9° (M) and 71.6 ± 8.4° (F) and the linear concavity depth 4.5 ± 2.3 mm (M) and 3.1 ± 1.7 mm (F) (p>0.05). CONCLUSIONS Mandibles with any lingual concavity present a potential increased risk of lingual cortical perforation during implant placement surgery. CT imaging allows characterizing the anatomy of the submandibular fossa and provides other important information for the preoperative assessment of the posterior mandible for dental implants placement.
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Nickenig HJ, Wichmann M, Zöller JE, Grandoch A, Eitner S, Kreppel M. Three-dimensional cone beam computed tomography analysis of maxillary sinus and alveolar bone anatomy in the restorative axis of dental implants using radiopaque drill guides. Int J Oral Maxillofac Surg 2016; 45:1485-1489. [PMID: 27614906 DOI: 10.1016/j.ijom.2016.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 07/07/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
Abstract
The objectives were to assess the sinus anatomy and alveolar ridge dimensions and to identify clinical factors and morphological relationships that may predict the characteristics of the sinus anatomy. A total 336 edentulous molar and 168 edentulous premolar regions were analyzed. The mediolateral maxillary sinus (5mm and 10mm above alveolar bone), lateral maxillary sinus wall, ostium height, and alveolar ridges were measured. Measurement regions were defined by radiopaque simulation of the restoration goal. Mean molar mediolateral dimensions were >10mm: first molar, 11.8mm (range 3.8-21.1mm); second molar, 12.2mm (range 7.9-20.1mm). The extent of the sinus differed significantly between premolars and molars (P<0.001). The first molar region had the highest mean value for the lateral sinus wall (2.4mm, range 0.2-7.9mm) and the greatest distance between the alveolar crest and simulated restorative goal (8.1mm, range 1.1-16.3mm). Septum prevalence was 46% in the molar region and 27% in the premolar region. A lower alveolar ridge height was associated with a wider transverse extent of maxillary sinus and consequently longer distances between the crest and restorative goal. Systematic three-dimensional analysis of the maxillary sinus yields precise preoperative information about sinus configurations. There were significant variations and relationships among characteristics of the maxillary sinus, ridge, and the restorative goal.
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Affiliation(s)
- H-J Nickenig
- Department of Oral and Maxillofacial Plastic Surgery and Interdisciplinary, Department of Oral Surgery and Implantology, University of Cologne, Cologne, Germany
| | - M Wichmann
- Department of Prosthodontics, University Hospital Erlangen, Erlangen, Germany
| | - J E Zöller
- Department of Oral and Maxillofacial Plastic Surgery and Interdisciplinary, Department of Oral Surgery and Implantology, University of Cologne, Cologne, Germany
| | - A Grandoch
- Department of Oral and Maxillofacial Plastic Surgery and Interdisciplinary, Department of Oral Surgery and Implantology, University of Cologne, Cologne, Germany
| | - S Eitner
- Department of Prosthodontics, University Hospital Erlangen, Erlangen, Germany
| | - M Kreppel
- Department of Oral and Maxillofacial Plastic Surgery and Interdisciplinary, Department of Oral Surgery and Implantology, University of Cologne, Cologne, Germany.
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The Relevance of the Use of Radiographic Planning in Order to Avoid Complications in Mandibular Implantology: A Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8175284. [PMID: 27294136 PMCID: PMC4880709 DOI: 10.1155/2016/8175284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/17/2016] [Accepted: 04/11/2016] [Indexed: 11/17/2022]
Abstract
The aim of this retrospective radiological study was to evaluate the variability of the mandibular anatomy in the presence and absence of teeth and to consider how it could influence implant planning. 187 mandibular CT DentaScans were selected from our department archive according to the inclusion criteria. The axial height, vertical height, angulation of the bone crest, and the bone available for ideal implant placement were measured. The analysis of the data shows that the mandible contour presents a constant degree of angulation. The variation of angulation in the absence of teeth was statistically significant only in the region between the canine and the first premolar and in that between the second premolar and the first molar. The difference between the crest height and the available distance to place the implant was greater in the region of the second molar while in the other regions the implant planning was made complex by postextraction resorption. Alveolar bone resorption after tooth loss can be considered as a risk factor for lingual cortical perforation during the insertion of an implant. To avoid potential intra/postoperative complications, 3D radiographic examination is recommended in order to study the mandibular anatomy and identify the risk areas.
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Nickenig HJ, Wichmann M, Terheyden H, Kreppel M. Oral health-related quality of life and implant therapy: A prospective multicenter study of preoperative, intermediate, and posttreatment assessment. J Craniomaxillofac Surg 2016; 44:753-7. [PMID: 27033149 DOI: 10.1016/j.jcms.2016.02.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 02/16/2016] [Accepted: 02/29/2016] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Loss of teeth is associated with a significant reduction in quality of life. The aim of this prospective multicenter study was to assess the impact of dental implants on oral health-related quality of life (OHRQoL). MATERIAL AND METHODS Patients with various kinds of indications for dental implants ranging from single-tooth loss to edentulous jaws were included. Quality of life related to dental implants was assessed through the Oral Health Impact Profile (OHIP-G 21), which has a score from 0 to 20 in healthy patients. RESULTS In total, 8689 patients from 17 centers from 2009 to 2014 were enrolled in the study. The sex distribution was almost even (53.3% men, 46.7% women). The most frequent indications for the insertion of dental implants were free-end gaps (30.6%) and posterior single-tooth gaps (27%). In all, 12.4% of patients had an edentulous jaw. For all indications, patients reported significant changes in mean OHIP scores after prosthetic reconstruction. The most significant improvements in the OHIP score occurred in the groups of patients with edentulous jaws (pretreatment score: 42.3) after prosthodontic reconstruction (score: 24.8) and in the patient group with an anterior single-tooth gap (pretreatment score: 36.4) after prosthodontic reconstruction (score: 24.8). CONCLUSION The insertion of dental implants and prosthodontic rehabilitation led to an improved OHRQoL for patients with all indications for dental implants, with the most significant improvements in patients with edentulous jaws and anterior single-tooth gaps.
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Affiliation(s)
- Hans-Joachim Nickenig
- Department for Oral and Maxillofacial Plastic Surgery and Interdisciplinary Department of Oral Surgery and Implantology, University of Cologne, Germany
| | | | - Hendrik Terheyden
- Department for Oral and Maxillofacial Surgery, Red Cross Hospital Kassel, Germany
| | - Matthias Kreppel
- Department for Oral and Maxillofacial Plastic Surgery and Interdisciplinary Department of Oral Surgery and Implantology, University of Cologne, Germany.
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A new, highly precise measurement technology for the in vitro evaluation of the accuracy of digital imaging data. J Craniomaxillofac Surg 2015; 43:1335-9. [DOI: 10.1016/j.jcms.2015.06.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 05/24/2015] [Accepted: 06/17/2015] [Indexed: 12/31/2022] Open
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