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Clinical Case

   

3D Accuitomo

The clinical image below was taken on a 17-year old male patient who suffered trauma as the result of a car accident. The CBCT scan shows lateral luxation  of the upper central incisors and fractured buccal cortical plates. 
Veraviewepocs 3D R100 Implantology
Clinical case provided by: Dr. Ricardo Urzúa, Radiology Professor, Dental School, Medicine Faculty, Clínica Alemana-Universidad del Desarrollo
Images taken with 3D Accuitomo.

 

Clinical Case

CBCT Imaging for Implant Treatment Planning in the Anterior Maxilla

Figure 1A: Coronal CBCT slice through the alveolar socket of the missing right central incisor and the neighboring teeth. (*) Nasal openings (foramina of Stenson) of the nasopalatine canal

Figure 1B: Sagittal CBCT slice
   
Figure 1C: Axial CBCT slice Figure 1D: Volume rendered data set

Figure 1: Visualization of the nasopalatine canal in a patient
referred for dental implant treatment planning in the anterior maxilla (right central incisor). The canal consists of two parallel bony channels.

 
   

Relevant clinical questions

Is a correct 3-dimensional (3D) implant positioning possible? Besides reestablishing function, the esthetic result of the implant rehabilitation is of great importance in the anterior maxilla. Therefore, the clinician needs to achieve a correct oro-facial, mesio-distal, and corono-apical position of the prospective implant shoulder.

Can we achieve good primary stability of the implant in the desired position? If primary stability of an inserted dental implant is not achievable, the clinician has to decide between site development using guided bone regeneration (GBR) or an alternative treatment concept without dental implants.

When GBR is needed, can we use a simultaneous approach with implant insertion or do we need a staged approach?

When GBR is not indicated, can we place the implant using a flapless approach?

Anatomic structures of interest

Anatomical structures and boundaries that need to be considered, when planning a dental implant in the anterior maxilla include:

Nasal floor

Nasopalatine canal (Figure 1)1

Anterior superior alveolar canal and canalis sinuosus (Figure 2)

1. Bornstein MM, Balsiger R, Sendi P, von Arx T: Morphology of the nasopalatine canal
and dental implant surgery: A radiographic analysis of 100 consecutive patients using
limited cone beam computed tomography. Clin Oral Implants Res 2011;22:295-3

 

Figure 2: Patient referred for dental implant treatment planning exhibiting a visible canalis sinuosus (+) on the left in the coronal CBCT slice. From the canalis sinuosus, an anterior maxillary canal (*) runs to the anterior palate in the vicinity of the canine.

 

Clinical case provided by: Prof. Dr. med. dent. Daniel Buser &
Prof. Dr. med. dent. Michael Bornstein.
Images taken with 3D Accuitomo 170.

 
Figure 2A: Coronal CBCT slice
Figure 2B: Sagittal CBCT image
Figure 2C: Axial CBCT image
     
     

Clinical Case

   

Veraviewepocs 3D R100 - Implantology

The patient was seen for a routine follow-up visit following implant placement in the area of the left maxillary lateral incisor. The implant had been placed 3 months earlier. The coronal, sagittal, and axial planes revealed a large, round, well defined, non-corticated, low density area associated with the apical aspect of the implant. The high resolution images also shows absence of the buccal cortical plate confirming a poor prognosis for the case due to peri-implantitis.
Veraviewepocs 3D R100 Implantology
Clinical case provided by: Dr. Bruno Azevedo, Assistant Professor, University of Louisville School of Dentistry
Images taken with Veraviewepocs R100 Pan/Ceph