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ITALIAN JOURNAL OF MAXILLOFACIAL SURGERY
A Journal on Maxillofacial Surgery
Official Journal of the Italian Society of Maxillofacial Surgery
Italian Journal of Maxillofacial Surgery 2009 April;20(1):31-9
Radiographic evaluation of implant sites: decision-making criteria on the necessity for cross-section imaging for treatment planning in implant dentistry. Report of 868 consecutively treated cases and literature review
Bertolai R. 1, Acocella A. 1, Sacco R. 2
1 Department of Maxillo-Facial Surgery Faculty of Medicine, University of Florence, Florence, Italy
2 Department of Odontostomathology Faculty of Medicine-University of Sassari, Sassari, Italy
Aim. The aim of this study was to investigate in which clinical situations CT cross-section imaging or standard X-ray examinations should be utilized for dental implant planning and to provide guidelines for the correct use of ionizing radiation in implant dentistry.
Methods. The study included 868 partially and totally edentulous patients who had consecutively received 2604 implants. Patients who presented sufficient width (recorded clinically) and height (recorded on the panoramic radiographs) were classified as safe patients and underwent a standard implant insertion procedure. Patients who presented a narrow alveolar ridge at the clinical examination and/or insufficient height measured with the panoramic radiograph were classified as unsafe patients and underwent a CT to assess the necessity of bone augmentation procedures. Intraopera-tive observations, change of treatment plan and outcome data were evaluated.
Results. Cumulative survival rate of implants was, totally, 97.3%. In 91.3% of cases within the group of safe patients, implants were placed according to panoramic radiographs and clinical evaluation. In 8.7% of the cases, implant diameter or length were changed during surgery. In 37% of the cases within the group of unsafe patients, after CT examination, residual bone was judged sufficient to receive implants. In the left 67% cases, implants were placed after bone grafting procedure.
Conclusion. In standard cases, clinical examination and panoramic radiography can be considered appropriate tools to evaluate the bone status prior the implant insertion. Considering the high levels of radiations and adjunctive costs, CT is an additional tool to be reserved for the planning of complex cases.