Reliability of two different presurgical preparation methods for implant dentistry based on panoramic radiography and cone-beam computed tomography in cadavers

Abstract

Purpose: Special care is necessary to avoid invading important anatomic structures during surgery when presurgical planning is made based on radiographs. However, none of these types of radiography represents a perfect modality. The purpose of this study was to determine the reliability of presurgical planning based on the use of two types of radiographic image (digital panoramic radiography [DPR] and cone-beam computed tomography [CBCT]) by beginner dentists to place implants, and to quantify differences in measurements between radiographic images and real specimens.

Methods: Ten fresh cadavers without posterior teeth were used, and twelve practitioners who had no experience of implant surgery performed implant surgery after 10 hours of basic instruction using conventional surgical guide based on CBCT or DPR. Two types of measurement error were evaluated: 1) the presurgical measurement error, defined as that between the presurgical and postsurgical measurements in each modality of radiographic analysis, and 2) the measurement error between postsurgical radiography and the real specimen.

Results: The mean presurgical measurement error was significantly smaller for CBCT than for DPR in the maxillary region, whereas it did not differ significantly between the two imaging modalities in the mandibular region. The mean measurement error between radiography and real specimens was significantly smaller for CBCT than for DPR in the maxillary region, but did not differ significantly in the mandibular region.

Conclusions: Presurgical planning can be performed safely using DPR in the mandible; however, presurgical planning using CBCT is recommended in the maxilla when a structure in a buccolingual location needs to be evaluated because this imaging modality supplies buccolingual information that cannot be obtained from DPR.

Keywords: Complications; Cone-beam computed tomography; Dental Implantation; Panoramic radiography.

Figure 1

Measurement of D1. D1 was the difference between the distance from the implant platform to the anatomic structure (e.g., inferior wall of the maxillary sinus or superior border of the mandibular canal) in presurgical cone-beam computed tomography and the distance from the implant platform to the implant apex. M: mandibular canal.

Figure 2

Measurement of D2. D2 was the distance from the implant apex to the anatomic structure in postsurgical cone-beam computed tomography. M: mandibular canal.

Figure 3

Measurements of D3 and D6. D3 was the distance from the implant apex to the anatomic structure in the real specimen using cone-beam computed tomography as a guide. D6 was same distance in the real specimen using digital panoramic radiography as a guide.

Figure 4

Measurement of D4. D4 was the difference between the distance from the alveolar ridge to the anatomic structure in presurgical digital panoramic radiography and the planned implant length.

Figure 5

Measurement of D5. D5 was the distance from the implant apex to the anatomic structure in postsurgical digital panoramic radiography.

Figure 6

Some critical errors. (A) Maxillary-sinus invasion, (B) mandibular-canal invasion, and (C) lingual-plate perforation.