Saat melakukan segala jenis prosedur bedah, ahli bedah perlu mengetahui kemungkinan variasi dalam konfigurasi anatomi kanalis mandibula dan nervus alveolaris inferior (IAN) [1,2,3] Hal ini terutama terjadi saat melakukan reseksi akar, pencabutan gigi bungsu atau pengambilan cangkok tulang autologus. .
Teknik yang berbeda dijelaskan untuk rekonstruksi area tulang yang hilang sebelum atau selama pe...
Fig. 6. Position of the right mental foramen
Fig. 5. Position of the left mental foramen
Fig. 4. Left (l) and right (r) mandibular bone thickness (bt) in the four age groups (group 1, 0–20 years old; group 2, 21–40 years old; group 3, 41–60 years old; group 4, 61 and older) in men (0) and women [1]
Fig. 3. Left (l) and right (r) mandibular bone thickness in all patients
Fig. 2. Definition of the position of the mental foramen
Fig. 1. Measurement of mandibular bone thickness, defined as the distance between the lateral wall of the mandibular canal and the lateral mandibular compact bone (solid turquoise line)
Age groupTotal1234SexMale41363930146Female44513538168Total 85877468314Table 1 Number of men and women in each age group (group 1, 0–20 years old; group 2, 21–40 years old; group 3, 41–60 years old; group 4, 61 and older)
Valdec, S., Borm, J.M., Casparis, S. et al. Vestibular bone thickness of the mandible in relation to the mandibular canal—a retrospective CBCT-based study.
Int J Implant Dent 5, 37 (2019). https://doi.org/10.1186/s40729-019-0189-z
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Received: 04 June 2019
Accepted: 30 September 2019
Published: 15 November 2019
DOI: https://doi.org/10.1186/s40729-019-0189...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
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Silvio Valdec and Jan Borm are equally contributing first authors.
The study was approved by the cantonal ethics committee of the canton of Zurich (KEK 2018-01691).
Not applicable.
Silvio Valdec, Jan Borm, Stephanie Casparis, Georg Damerau, Michael Locher and Bernd Stadlinger declare that they have no competing interests.
Silvio Valdec and Jan M. Borm contributed equally to this work.
Clinic of Cranio-Maxillofacial and Oral Surgery, Centre for Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
Silvio Valdec, Jan M. Borm, Stephanie Casparis, Georg Damerau, Michael Locher & Bernd Stadlinger
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This study was conducted without external funding.
The authors thank Jacquie Klesing, Board-Certified Editor in the Life Sciences (ELS), for editing assistance with the manuscript. Further, we thank Malgorzata Roos for supporting the statistical analysis.
Namano S, Behrend DA, Harcourt JK, Wilson PR. Angular asymmetries of the human face. Int J Prosthodont. 2000;13(1):41–6.
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Pyun JH, Lim YJ, Kim MJ, Ahn SJ, Kim J. Position of the mental foramen on panoramic radiographs and its relation to the...
Nucera R, Lo Giudice A, Bellocchio AM, Spinuzza P, Caprioglio A, Perillo L, et al. Bone and cortical bone thickness of mandibular buccal shelf for mini-screw insertion in adults. Angle Orthod. 2017;87(5):745–51.
Scomparin L, Soares MQ, Rubira CM, Yaedu RY, Imada TS, Centurion BS, et al. CBCT location of the fusion between the buccal and lingual cortical in the mandibular ramus: importance to sa...
Benninger B, Miller D, Maharathi A, Carter W. Dental implant placement investigation: is the anterior loop of the mental nerve clinically relevant? J Craniomaxillofac Surg. 2011;69(1):182–5.
Greenstein G, Tarnow D. The mental foramen and nerve: clinical and anatomical factors related to dental implant placement: a literature review. J Periodontol. 2006;77(12):1933–43.
Kuribayashi A, Watanabe...
Ozturk A, Potluri A, Vieira AR. Position and course of the mandibular canal in skulls. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113(4):453–8.
Agbaje JO, de Casteele EV, Salem AS, Anumendem D, Lambrichts I, Politis C. Tracking of the inferior alveolar nerve: its implication in surgical planning. Clin Oral Investig. 2017;21(7):2213–20.
Zahedi S, Mostafavi M, Lotfirikan N. Anatomic stud...
Bone thickness
Cone-beam computed tomography
Digital Imaging and Communications in Medicine
Inferior alveolar nerve
The original datasets supporting the findings are available.
The results of this study support the relevance of a preoperative CBCT to allow detailed planning of a surgical intervention that may potentially touch the area of the mandibular canal. This applies to surgical procedures like wisdom tooth removal, root resection, implant placement and bone block harvesting. A CBCT allows the exact determination of the horizontal bone thickness vestibular to the I...
In a study comparing measurements between cadavers and CT images, the distance between the upper edge of the mandibular canal and the alveolar ridge showed possible over- and underestimations. The quantification showed a possible overestimation of up to 1.05 mm and a possible underestimation of up to 1.36 mm [34]. This discrepancy is of relevance in preoperative planning. Intraoperatively, a r...
The IAN is an important anatomical structure whose course affects the preoperative planning of a bone graft or implant insertion in the mandible. Knowledge on the bone thickness between the lateral wall of the mandibular canal and the lateral mandibular compact bone as well as of the position of the mental foramen facilitates decision-making [24]. Furthermore, for many other surgical procedures, t...
The median age of the patients was 40.2 years (range 12.6–84.4 years). Patients were distributed almost evenly across the age groups (see Table 1).
Figure 3 clearly shows the median vestibular bone thicknesses (bt) at 2-mm intervals throughout the anterior to posterior course of the canal on both the right (bt2 r to bt66 r) and left (bt2 l to bt66 l) side of the mandible. The maximum di...
In addition, the position of the mental foramen was determined relative to the roots of the neighbouring teeth. This was assessed by defining regions of interest in the area of the first premolar, second premolar and first molar by extending the respective mesial and distal points of the cement-enamel junction caudally along the tooth axis. The position of the midpoint of the mental foramen was th...
Three hundred fourteen cone-beam computed tomograms (CBCTs) from 168 (53.5%) females and 146 (46.5%) males from the database of the Department of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Switzerland, from the years 2008 to 2013 were analysed. Patients were divided into 4 age groups: group 1 = 0–20 years, group 2 = 21–40 years, group 3...
The mandibular canal is a bilateral, intraosseous opening through which the IAN runs from the mandibular foramen to the mental foramen. The nerve innervates the teeth, the mucous membranes in the area of the mental foramen and the skin around the chin [14, 15]. Anatomical variations of the mandibular canal, such as bifid canals and an anterior loop of the mental nerve, are common [16, 17] and have...
When performing any kind of surgical procedure, a surgeon needs to be familiar with the possible variations in the anatomical configurations of both the mandibular canal and inferior alveolar nerve (IAN) [1,2,3]. This is particularly the case when performing root resections, removing wisdom teeth or harvesting autologous bone grafts.
Different techniques are described for reconstruction of missin...
Figure 5. at the time of placement) to 0.25 mm outside (the same width of the aforementioned) of the virtual implant.
Figure 5. Measurement site of the voxel values. The width of the measurement site was defined as 0.50 mm, i.e., from 0.25 mm inside (the to-be-compressed area at the time of placement) to 0.25 mm outside (the same width of the aforementioned) of the virtual implant.
Figure 4. rtual implant was placed in the implant cavity by simulation.
Figure 4. Setting the evaluation site. An implant placement simulation software (Osaka Landmarker ver. 5.0 with special specifications for study purposes, iCAT, Osaka, Japan) was used as the image analysis software. The virtual implant was placed in the implant cavity by simulation.
Figure 3. The special implant cavity-forming device. This device is able to adjust the up-and-down movement speed and the rotation speed of the drill.
Figure 3. The special implant cavity-forming device. This device is able to adjust the up-and-down movement speed and the rotation speed of the drill.
Figure 2. hanically polished surface.
Figure 2. The implants in this study. Two kinds of diameters (3.8 mm, 5.0 mm) and two kinds of lengths (7.0 mm, 12.0 mm) having a general threadlike shape with a mechanically polished surface.
Figure 1.
Figure 1. The bone model in this study (a pig's ilium). (a) The whole picture of the ilium. (b) The flat part of the posterior margin of the ilium. (c) The CT image of the ilium.
Dependent variable = ITVs
(n = 49)
Independent variables
Standardized partial regression coefficient (P value)
Thickness of the cor...
Dependent variable = ITVs
(n = 47)
Independent variables
Standardized partial regression coefficient (P value)
Thickness of the cor...
Bone factors/stability factors
Diameter (mm)
Length (mm)
r
P
n
Thickness of the cortical bone/ITVs
3.8
7
0.744**
Wada, M., Tsuiki, Y., Suganami, T. et al. The relationship between the bone characters obtained by CBCT and primary stability of the implants. Int J Implant Dent 1, 3 (2015). https://doi.org/10.1186/s40729-014-0003-x
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Received: 18 September 2014
Accepted: 20 November 2014
Published: 12 February 2015
DOI: https://doi.org/10.1186/s40729-014-0003-x
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0), which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and in...
Masahiro Wada, Yasutane Tsuiki, Tohru Suganami, Kazunori Ikebe, Motofumi Sogo, Ikuhisa Okuno and Yoshinobu Maeda declare that they have no competing interests.
MW drafted the article and collected the data. YT and TS collected the data. KI performed the data analysis and statistical analysis. MS interpreted the data. IO analyzed the data. YM designed the research and approved the article. All aut...
Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
Masahiro Wada, Yasutane Tsuiki, Tohru Suganami, Kazunori Ikebe, Motofumi Sogo, Ikuhisa Okuno & Yoshinobu Maeda
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This study was partially supported by GC Company.
Nkenke E, Hahn M, Weinzierl K, Radespiel-Troger M, Neukam FW, Engelke K. Implant stability and histomorphometry: a correlation study in human cadavers using stepped cylinder implants. Clin Oral Implants Res. 2003; 14:601–9.
Motoyoshi M, Yoshida T, Ono A, Shimizu N. Effect of cortical bone thickness and implant placement torque on stability of orthodontic mini-implants. Int J Oral Maxillofac Imp...
Lekholm U, Zarb G. Patient selection and preparation. In: Osseointegration in Clinical Dentistry. Chicago: Quintessence Publishing Co, Inc. 1985; p. 199–209
Misch CE. Contemporary Implant Dentistry. St. Louis: Mosby, 1993; p. 469–85.
Turkyilmaz I, Sennerby L, McGlumphy EA, Tozum TF. Biomechanical aspects of primary implant stability: a human cadaver study. Clin Implant Dent Relat Res. 2009; ...
Ottoni JM, Oliveira ZF, Mansini R, Cabral AM. Correlation between placement torque and survival of single-tooth implants.
Int J Oral Maxillofac Implants. 2005; 20:769–76.
Beer A, Gahleitner A, Holm A, Tschabitscher M, Homolka P. Correlation of insertion torques with bone mineral density from dental quantitative CT in the mandible.
Clin Oral Implants Res. 2003; 14(5):616–20.
Meredith N. Ass...
In this limited study, there was a correlation between the thickness of the cortical bone or the voxel values obtained from the CBCT scanning images prior to the implant placement and the implant stabilities. Besides, it was confirmed that the thickness of the cortical bone, the voxel value, and the length of the implant had positive correlations with the ITVs and that the thickness and length had...
Although this study is different from the previous studies in that the thickness of the cortical bone and bone density were determined from the voxel values calculated by CBCT, a significantly positive correlation of the thickness of the cortical bone and the voxel values with ITVs and ISQ values was confirmed as in the previous studies. Furthermore, the multiple regression analysis with the ITVs ...
Ikumi used a MDCT scan for actual patients to calculate the CT values of the 1-mm surrounding area of the planned implant placement site using implant simulation software [25]. However, it is likely that the precise measurement cannot be performed in the case where the actual implant cavity was formed off the planned implant site because the density of the bone around the planned implant site was ...
A significant positive correlation was found between the thickness of the cortical bone and ITVs or ISQ values in all kinds of implants. In addition, a significant positive correlation was also found between the voxel values and ITVs. On the other hand, in the relationship between the voxel values and ISQ values, we cannot confirm a correlation of the implant of 5.0 mm in width and 12.0 mm in le...
The relationships of the thickness of the cortical bone and the voxel values with the ITVs and the ISQ values were analyzed using Pearson's correlation coefficient. Then, multiple regression analysis was performed using the ITVs or the ISQ values as the dependent variable and using the thickness of the cortical bone, the voxel value, and the length of the implant as the independent variables to ev...
All the procedures of forming an implant cavity were unified as follows according to protocols. Firstly, the implant cavity was constructed by using a 2.0-mm-depth drill after marking the implant site using a guide drill. Secondly, a 3.1-mm pilot drill and a 3.1-mm twist drill were used to form a cavity for an implant with 3.8-mm diameter, and a 4.3-mm pilot drill and a 4.3-mm twist drill were use...
A flat part of a pig's ilium was used as the implant placement site to secure as vertical implant placement and an equal depth of insertion to the bone surface as possible (Figure 1).
GXCB-500® (GENDEX, Des Plaines, IL, USA) was used as the CBCT device to obtain almost identical voxel values to the CT values that could be obtained from MDCT. Scanning conditions were as follows: the tube current...
It is therefore considered that MDCT is appropriate for the precise evaluation of bone density. However, since the use of CBCT is spreading rapidly among general practitioners, it is clinically of great significance to predict the primary stability after implant placement using the information obtained by CBCT. In addition, in late years, CBCT or the calibration software which can convert the voxe...
Some of the methods to evaluate the bone quality that influences the primary implant stability have already been applied in a clinical practice. Lekholm and Zarb classified bone density into four types in terms of radiography, with the thickness of the cortical bone and the density of the spongy bone as the indexes [14]. This classification method is accepted most commonly at present but is proble...
The primary stability of an implant at the time of placement is considered as one of the key factors for clinical success of implant treatment [1-6]. Orenstein et al. reported that implants that were appropriately stabilized without any mobility at the time of placement had a significantly high survival rate compared with those that were not [7].
The evaluation of the primary implant stability is...
The aim of this study is to investigate the correlation between the thickness of the cortical bone or the voxel values that are obtained by cone beam CT (CBCT) and the insertion torque values (ITVs) or the implant stability quotient (ISQ) values.
A pig's ilium was used as the implant placement site. The implants used in this study were two kinds of diameters (3.8 mm, 5.0 mm) and two kinds of le...
Figure 5. Flow diagram of CBCT imaging and measurements to calculate bone thickness buccally of implants.
Figure 5. Flow diagram of CBCT imaging and measurements to calculate bone thickness buccally of implants.
Figure 4.
Figure 4. Implant measurements. Measurements were performed at each millimeter along the axis of the implant for 5 mm, beginning at the neck of the implant.
Figure 3. Implant position. Due to the alienation of the patients’ DICOM files by MIRIT, the exact position of the implant was defined. As such, the measurements could take place in the exact correct buccal direction.
Figure 3. Implant position. Due to the alienation of the patients’ DICOM files by MIRIT, the exact position of the implant was defined. As such, the measurements could take ...
Figure 2. Conventional intra-oral radiograph of same patient with implant-supported restoration at position 21.
Figure 2. Conventional intra-oral radiograph of same patient with implant-supported restoration at position 21.
Figure 1. Clinical photograph of implant-supported restoration at position 21.
Figure 1. Clinical photograph of implant-supported restoration at position 21.
Slagter, K.W., Raghoebar, G.M., Vissink, A. et al. Inter- and intraobserver reproducibility of buccal bone measurements at dental implants with cone beam computed tomography in the esthetic region. Int J Implant Dent 1, 8 (2015). https://doi.org/10.1186/s40729-015-0007-1
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Received: 24 December 2014
Accepted: 19 February 2015
Published: 18 April 2015
DOI: https://doi.org/10.11...
Kirsten W. Slagter, Gerry M. Raghoebar, Arjan Vissink, Henny JA. Meijer declare that they have no competing interests.
KWS, GMR, AV, and HJAM provided substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data for the work; drafted the paper or revised it critically; gave final approval of the version to be published; and agreed to b...
Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700RB, Groningen, The Netherlands
Kirsten W Slagter, Gerry M Raghoebar, Arjan Vissink & Henny J A Meijer
Department of Fixed and Removable Prosthodontics, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700RB, Groningen, The Netherlands
He...
Miyamoto Y, Obama T. Dental cone beam computed tomography analyses of postoperative labial bone thickness in maxillary anterior implants: comparing immediate and delayed implant placement. Int J Periodontics Restorative Dent. 2011;31:215–25.
Kamburoglu K, Murat S, Kilic C, Yuksel S, Avsever H, Farman A, et al. Accuracy of CBCT images in the assessment of buccal marginal alveolar peri-implant de...
Den Hartog L, Slater JJ, Vissink A, Meijer HJ, Raghoebar GM. Treatment outcome of immediate, early and conventional single-tooth implants in the aesthetic zone: a systematic review to survival, bone level, soft-tissue, aesthetics and patient satisfaction. J Clin Periodontol. 2008;35:1073–86.
De Rouck T, Collys K, Cosyn J. Single-tooth replacement in the anterior maxilla by means of immediate im...
three-dimensional
cone beam computed tomography
computerized tomography
Digital Imaging and Communications in Medicine
field of view
Hounsfield unit
Multimodality Image Registration using Information Theory
When applying 3D image-based software programs according to the set-up used in this study, CBCTs are suitable for reliable and reproducible measurements of buccal bone thickness at implants.
Intraobserver and interobserver agreement was very high with measurements on CBCTs of bone buccally of dental implants. Apparently, the method is clear and measurements can be performed reproducibly. Moreover, measurements are not observer dependent, meaning that results of different observers in different studies can be compared with each other.
In previous studies, buccal bone thickness was als...
The mean buccal bone thickness measured by observers 1 and 2 was 2.42 mm (sd: 0.50) and 2.41 mm (sd: 0.47), respectively. Interobserver intraclass correlation coefficient was 0.96 (95% CI 0.93 to 0.98). The mean buccal bone thickness of the first measurement and the second measurement of observer 1 was 2.42 mm (sd: 0.50) and 2.53 mm (sd: 0.49), respectively, with an intraobserver intraclass co...
The implant and patient dataset were exactly aligned by the MIRIT method, so that the distance from the central axis of the implant to the outer contour of the buccal bone could be measured. Area of interest was the upper 5 mm section of the implant, beginning at the neck of the implant towards the apical direction. Exact dimensions along the implant axis of each implant configuration used in the...
Ten patients with a dental implant in the esthetic zone (regions 13 to 23) were included (Figures 1 and 2). Research was carried out in compliance with the Helsinki Declaration. Patients were part of a randomized controlled trial on esthetics; the study was approved by the Medical Ethic Board of the University Medical Center Groningen, University of Groningen (METC 2010.246) as well as that writt...
Single-tooth implant placement in the esthetic zone is a highly reliable treatment option for replacing a failing tooth [1-4]. Yet, research interest has shifted from implant survival towards optimal preservation of soft and hard tissues [5-7]. Especially in the esthetic region, buccal bone and its preservation is one of the key factors in esthetic outcome [8].
Computerized tomography (CT) scans ...
Sufficient buccal bone is important for optimal esthetic results of implant treatment in the anterior region. It can be measured with cone beam computed tomography (CBCT), but background scattering and problems with standardization of the measurements are encountered. The aim was to develop a method for reliable, reproducible measurements on CBCTs.
Using a new method, buccal bone thickness was me...
Fig. 6. Radiographic examination: The relationship between changes in the maxillary sinus floor associated with a reduction in the grafted bone and the implant tip (a immediately after surgery, b 5 years after surgery)
Fig. 6. Radiographic examination: The relationship between changes in the maxillary sinus floor associated with a reduction in the grafted bone and the implant tip (a immediat...
Fig. 5. Radiographic examination (long-term changes in bone height surrounding the implant) n = 20 Number of implants. A total of 5 CBCT scans were taken prior to surgery, immediately after surgery, 6 months after surgery, 1–2 years after surgery, and 3–5 years after surgery
Fig. 5. Radiographic examination (long-term changes in bone height surrounding the implant) n = 20 Numbe...
Fig. 4. Clinical findings of the second surgery on biopsy at 6 months. The degree of residual grafting materials varied depending on the patient. a most of the β-TCP remained. b Replacement of the β-TCP by new bone had progressed
Fig. 4. Clinical findings of the second surgery on biopsy at 6 months. The degree of residual grafting materials varied depending on the patient. a most of the ...
Fig. 3. Radiographic examination of the height of the bone surrounding the implant (BH): Measurement of changes in the height of the implant tip to the bone fixation part over time in the frontal plane: the distance measured from the intersecting point of the long axis of the implant and the maxillary sinus floor to the implant tip: +maxillary side, −alveolar crest side. The liner valuables: r...
Fig. 2. Radiographic examination of the volume of the bone graft (BV): Calculation of area on the frontal plane prior to and immediately after surgery using polygon tool. The polygon tool is included in the CT device, which was dragged around the perimeter of the target site to measure area. Graft volume calculation method (sum of the area and calculation of volume). Volume cm3 = area cm2 ...
Fig. 1. Treatment protocol for the present study. Postoperative CBCT was performed a minimum of three times, i.e., immediately, 6 months, and 2.5 years after implant placement
Fig. 1. Treatment protocol for the present study. Postoperative CBCT was performed a minimum of three times, i.e., immediately, 6 months, and 2.5 years after implant placement
Coefficient
Standard error
95 % CI
P value
Time (months)
−0.087
...
Parameter
Mean (mm)
SD (mm)
RBH
4.48
1.51
...
NoneTable 6 Radiographic examination of BH (changes in bone height surrounding the implant)
BV
Mean
Reduction rate
Immediately after surgery (n = 30)
1206 ...
CBCT examination (year)
Number of patients
0–1
0
1–2
14
...
Implant site
Number of implants
4
6
5
16
6
24
7
12
Total: 58 implants
Table 3 The number of implants according to site
Observation period (months)
Number of patients
12–18
11
19–24
4
...
Age group (years)
Number of patients
40–49
7
50–59
10
...
Okada, T., Kanai, T., Tachikawa, N. et al. Long-term radiographic assessment of maxillary sinus floor augmentation using beta-tricalcium phosphate: analysis by cone-beam computed tomography.
Int J Implant Dent 2, 8 (2016). https://doi.org/10.1186/s40729-016-0042-6
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Received: 25 November 2015
Accepted: 23 March 2016
Published: 01 April 2016
DOI: https://do...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Tsuneji Okada, Toru Kanai, Noriko Tachikawa, Motohiro Munakata, and Shohei Kasugai declare that they have no competing interests.
TO performed the data acquisition, both of surgical and prosthodontic treatments, the data analysis, statistical analysis, and wrote the manuscript. TK performed the treatment plan, making of pictures, and collecting of references. NT and MM performed the data acquisit...
Clinic for Implant Dentistry, Dental Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
Tsuneji Okada, Toru Kanai & Noriko Tachikawa
Oral Implantology Department of Prosthodontic Dentistry for Function of TMJ and Occlusion, Kanagawa Dental University, 82, Inaokachou, Yokosuka-shi, 238-8580, Kanagawa, Japan
Motohiro Munakata
Oral Implantology and...
The bone grafting agent, β-TCP (OSferion), was kindly supplied by Olympus Terumo Biomaterials Corp.
Boyne PJ, James RA. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Maxillofac Surg. 1980;38:613–6.
Jensen OT, Shulman LB, Block MS, et al. Report of the sinus consensus conference of 1996. Int J Oral Maxillofac Implants. 1998;13:11–45.
Artzi Z, Weinreb M, Givol N, et al. Biomaterial resorption rate and healing site morphology of inorganic bovine bone and β-tri...
Chanavaz M. Maxillary sinus: anatomy, physiology, surgery, and bone grafting related to implantology: eleven years of surgical experience (1979–1990). J Oral Implantol. 1990;16:199–209.
Misch CE. Maxillary sinus lift and elevation with subantral augmentation. In: Misch CE, editor. Contemporary implant dentistry. St. Louis, MO: Mosby; 1993. p. 545–74.
Sharan A, Madjar D. Maxillary sinus pne...
Maxillary sinus graft augmentation using β-TCP is clinically effective.
Analysis by CBCT provides superior spatial resolution and allows for extremely accurate postoperative evaluation of maxillary sinus floor augmentation and bone volume measurements.
On the basis of CBCT examinations, although maxillary sinus pneumatization continues to progress ≥1 year after surgery, it stabilizes 3 year...
During the observation period, there was no clinical implant failure and the suvival rate for implantation and maxillary sinus floor augmentation was 100 %. Histological examination in a previous report on maxillary sinus augmentation using β-TCP (Cerasorb®), Szabo et al. compared bilateral maxillary sinus augmentation in the same patients using β-TCP and iliac bone at 6 months after surgery ...
As grafting materials for maxillary sinus floor augmentation, autogenous bone, which is considered as the gold standard and reported first by Boyne et al. using iliac bone graft, has been used as the first-choice material. In terms of osteogenic, osteoinductive, and osteoconductive properties, autogenous bone is considered ideal; however, the use of autogenous bone places great physical stress on ...
Change in height of bone surrounding the implant (height from the maxillary sinus floor to the implant tip): Immediately after surgery, all patients had grafted bone between the implant tip and the maxillary sinus floor, with a mean of 2.00 ± 1.51 mm. This height decreased to 0.73 ± 1.33 mm at 6 months after surgery and −0.72 ± 1.11 mm at 2.5 years after surgery (Fig. 5). 41...
The mean age of the 30 patients was 57.4 (40–75) years, and the male/female ratio was 4:26. The mean postoperative observation period was 3 years and 8 months (the maximum period was 5 years and 0 months; the minimum period was 2 years and 2 months). Total of 58 implants were placed at premolar and molar region. There were no dropouts, such as participants not visiting the clinic, during t...
Residual bone height (RBH): existing bone height to the maxillary sinus at the implant site
Implant length (IL): the length of the part of the implant that projects into the maxillary sinus
Width of sinus (SW): the width of the maxillary sinus from lateral wall to medial wall at the height of the center of the IL
In the present study, the radiographic examinations were statistically analyzed fo...
In the present study, we used the superior spatial resolution of CBCT to measure changes over time in (a) the volume of the bone graft (BV) and (b) the height of the bone surrounding the implant (BH).
The method of calculating the volume of the implant site is shown below (Fig. 2).
The slice thickness (voxel value) was resized (0.146 mm → 1 mm) to derive the volume of the grafting agent...
This study is a prospective observational study. The subjects included patients who had undergone maxillary sinus floor augmentation using β-TCP and implant placement at the Clinic for Implant Dentistry, Dental Hospital, Tokyo Medical and Dental University during the 3-year period from January 2009 to December 2011. All patients underwent maxillary sinus floor augmentation at the same time as imp...
Radiographic examinations to determine changes in bone mass in maxillary sinus floor augmentation have been conducted primarily using panoramic radiography [8–12], which allows for the assessment of the height of the maxillary sinus in only two dimensions. In addition, it does not allow for detailed examination or measurement of the interior of the maxillary sinus without factoring in magnificat...
The maxillary sinus gradually expands after birth and becomes fully pneumatized with the eruption of all permanent teeth. Although the physiological cause and maxillary sinus pneumatization are largely unknown, it is believed that genetics, atmospheric pressure, and hormones are involved in it. This sinus is closely related to the root apex of the premolar and molar teeth, and it is either separat...
The long-term stability of maxillary sinus floor augmentation with β-TCP remains largely unknown. We report the long-term assessment of volumetric changes in maxillary sinus floor augmentation with β-TCP by cone-beam computed tomography (CBCT).
The subjects included 30 patients who underwent maxillary sinus floor augmentation using β-TCP and 58 implant placement for unilateral maxillary defect...
Fig. 7. ing a trephine bur. a Overview image of coronal-apical cut through the entire core biopsy showing formation of new bone (NB) next to old bone of the extraction socket (B). easy-graft CRYSTAL particles (Gr) are embedded in well perfused connective tissue (CT) and new bone (NB) (Azur II and Pararosanilin, original magnification ×50). b Integration of easy-graft CRYSTAL particle (Gr) into ...
Fig. 6. ntegration and preservation of ridge without collapse of the buccal or lingual cortical plates also showing the cross sections in the grafted area
Fig. 6. a–c Four-month postoperative CBCT showing graft integration and preservation of ridge without collapse of the buccal or lingual cortical plates also showing the cross sections in the grafted area
Fig. 5. CBCT images of the extraction site. a Preoperative CBCT showing fractured and un-restorable teeth #45 and #46 planned to be extracted. b–d Cross sectional views
Fig. 5. CBCT images of the extraction site. a Preoperative CBCT showing fractured and un-restorable teeth #45 and #46 planned to be extracted. b–d Cross sectional views
Fig. 4. excellent width of keratinized tissue which was also preserved. b Implant crowns placed and loaded after 3 months of placement
Fig. 4. a Second stage surgery followed by impression making. Note the excellent width of keratinized tissue which was also preserved. b Implant crowns placed and loaded after 3 months of placement
Fig. 3. Postoperative X ray showing the implant positions in the mandible where the teeth were extracted and ridge preservation was accomplished
Fig. 3. Postoperative X ray showing the implant positions in the mandible where the teeth were extracted and ridge preservation was accomplished
Fig. 2. ssue approximation. A good width of keratinized tissue is visible along with ridge preservation. Ready for implant placement in the grafted areas. b Implant placed in 45 area. Core biopsy sample taken from area 46. Note the integration of graft particles in the preserved alveolar ridge also inside the osteotomy site of 46. c Two Xive (Dentsply) implants placed in the preserved ridge. d. ...
Fig. 1. ft tissue and no flap reflection on the surgical site. c Graft material condensed into the extraction sockets showing good initial graft stability. d Black silk sutures placed with tissue approximation and no releasing incision in the flaps
Fig. 1. a Clinical occlusal view with fractured 45 and 46. b Post-extraction view of the socket. Note minimal trauma to the soft tissue and no fla...
Patient no.
Gender
Patient’s age
Tooth no.
Time post extraction [month]
% New bone
...
Patient no.
Tooth no.
Ridge width baseline [mm]
Ridge width implant placement [mm]
Ridge width changes [mm]
...
ISQ level at implant placement
ISQ level at loading
Patient no.
Tooth no.
Buccal
Palatal
...
Kakar, A., Rao, B.H.S., Hegde, S. et al. Ridge preservation using an in situ hardening biphasic calcium phosphate (β-TCP/HA) bone graft substitute—a clinical, radiological, and histological study.
Int J Implant Dent 3, 25 (2017). https://doi.org/10.1186/s40729-017-0086-2
Download citation
Received: 31 December 2016
Accepted: 25 May 2017
Published: 22 June 2017
DOI: htt...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Correspondence to
Ashish Kakar.
Yenepoya University Dental College, University Road, Mangalore, 575018, India
Ashish Kakar, Bappanadu H. Sripathi Rao & Shashikanth Hegde
Dental Foundations and Research Centre, Malad, Mumbai, 400064, India
Nikhil Deshpande
Department of Oral and Maxillofacial Surgery, Center for Dental Medicine, Medical Center—University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
Annette ...
We acknowledge Sunstar Suisse SA, Etoy, Switzerland, for partly supporting this clinical study with a study grant. The authors declare that there is no conflict of interest regarding the publication of this paper.
Ashish Kakar, Bappanadu H. Sripathi Rao, Shashikanth Hegde, Nikhil Deshpande, Annette Lindner, Heiner Nagursky, Aditya Patney, and Harsh Mahajan declare that they have no competing inte...
Lang NP, Pun L, Lau KY, Li KY, Wong MC. A systematic review on survival and success rates of implants placed immediately into fresh extraction sockets after at least 1 year. Clin Oral Implants Res. 2012;23 Suppl 5:39–66.
Smukler H, Landi L, Setayesh R. Hostomorphometric evaluation of extraction sockets and deficient alveolar ridges treated with allografts and barrier membrane. A pilot study. In...
Nair PNR, Luder H-U, Maspero FA, Fischer JH, Schug J. Biocompatibility of beta-tricalcium phosphateroot replicas in porcine tooth extraction sockets—a correlativehistological, ultrastructural, and x-ray microanalytical pilotstudy. J Biomater Appl. 2006;20(4):307–24.
Jensen SS, Terheyden H. Bone augmentation procedures in localized defects in the alveolar ridge: clinical results with different...
Araujo MG, Sukekava F, Wennstrom J, Lindhe J. Ridge alterations following implant placement in fresh extraction sockets: an experimental study in the dog. J Clin Periodontol. 2005;32:645–52.
Van der Weijden F, Dell'Acqua F, Slot DE DE. Alveolar bone dimensional changes of post-extraction sockets in humans: a systematic review. J Clin Periodontol. 2009;36(12):1048–58.
Schropp L, Wenzel A, Kos...
The results of this clinical study support the use of a biphasic in situ hardening alloplastic bone graft substitute for ridge preservation in intact post-extraction sites without the use of a dental membrane. Therefore, grafting of sockets without primary wound closure or using dental membranes or a soft tissue punch can be an effective minimally invasive method of preserving the contour and arch...
Likewise, the reported amount of residual grafting material in the defect site was similar. In average, only 26.2 ± 9.4% of the defect was occupied with residual graft material in this study which is well in line with 26.6 ± 5.2% reported for BCP but below the 37.7 ± 8.5% reported for xenograft [14].
All 15 implants could be placed without the need for additional bone augmentation....
As previously reported, secondary intention soft tissue healing of grafted post-extraction sites can be well achieved when using an in situ hardening and in situ stabilizing bone graft substitutes without the need of a dental membrane [18, 20]. Findings of the present report corroborate these results. The authors found that all sites healed uneventfully with coverage of soft tissue and no local co...
Ridge preservation following dental extractions is fundamental, preserving the ridge profile for subsequent implant placement and providing a sustained function and esthetics. This clinical trial reports on the successful application of an in situ hardening biphasic alloplastic bone graft substitute for ridge preservation and subsequent implant placement in 15 healthy patients. A routine but minim...
Cone beam computer tomography (CBCT) was performed before tooth extraction and at the time point of implant placement. Mean ridge width reduction before tooth extraction to implant placement was calculated to effect in 0.79 ± 0.73 mm horizontal bone loss (Table 2). Primary implant stability was achieved in all 15 cases, showed in average high ISQ levels 70.3 ± 9.7 (buccal/palatal), and...
Fifteen patients (4 females and 11 males) with a mean age of 51.3 + 14.8 years (range: 27 to 75 years) participated in this randomized clinical trial. The site specific areas and teeth numbers for the study are shown in Table 1.
In all cases, the postoperative healing was uneventful. Clinically, the soft tissue healing pattern observed was very similar in all cases. The soft tissue on all ...
Bone biopsies were harvested using a trephine bur at the site of implant placement. The trephine burs including the bone biopsies were fixed in 4% formalin for 5–7 days, rinsed in water, and dehydrated in serial steps of ethanol (70, 80, 90, and 100%), remaining for 1 day in each concentration. Specimens were then infiltrated, embedded, and polymerized in resin (Technovit 9100, Heraeus Kulzer,...
Antibiotic therapy consisting of 1 g amoxicillin every 12 h for 4 days and mouth rinsing with 0.2% chlorhexidine every 8 h for 10 days were prescribed. The suture was removed 1 week postoperatively. After 3 to 8 months (average 5.2 ± 2 months), the sites (Fig. 2a) were reentered for implant placement. A site-specific full thickness mucoperiosteal flap was elevated to expose the regen...
This study was approved by the Yenepoya University Ethics committee, Mangalore, India (Approval Number YOEC83/8/3/2014). Fifteen patients who required extraction of a maxillary or mandibular tooth and subsequent single-tooth implant placement and who met the inclusion and exclusion criteria were included in this prospective single-arm clinical study. The patients (4 females and 11 males) had a mea...
To our knowledge, this is the first systematic clinical, radiographic, and histological evaluation that assesses bone formation and ridge width preservation after socket grafting using an in situ hardening biphasic bone graft substitute in healthy patients.
Following tooth extraction, the alveolar ridge will decrease in volume and change its morphology [1, 2]. These changes are clinically significant [3] and can complicate the placement of a conventional bridge or an implant-supported crown. Post-extraction maintenance of the alveolar ridge following the principles of ridge preservation using bone graft substitutes minimizes ridge resorption and, thu...
Post-Extraction ridge preservation using bone graft substitutes is a conservative technique to maintain the width of the alveolar ridge. The objective of the present study was to evaluate an in situ hardening biphasic (HA/β-TCP) bone graft substitutes for ridge preservation without primary wound closure or a dental membrane.
A total of 15 patients reported for tooth extraction were enrolled in t...
Fig. 7. image of coronal-apical cut through the entire core biopsy showing formation of new bone (NB) next to old bone of the extraction socket (B). easy-graft CRYSTAL particles (Gr) are embedded in well perfused connective tissue (CT) and new bone (NB) (Azur II and Pararosanilin, original magnification ×50). b Integration of easy-graft CRYSTAL particle (Gr) into newly formed bone (NB) and conn...
Fig. 6. graft integration and preservation of ridge without collapse of the buccal or lingual cortical plates also showing the cross sections in the grafted area
Fig. 6. a–c Four-month postoperative CBCT showing graft integration and preservation of ridge without collapse of the buccal or lingual cortical plates also showing the cross sections in the grafted area
Fig. 5. CBCT images of the extraction site. a Preoperative CBCT showing fractured and un-restorable teeth #45 and #46 planned to be extracted. b–d Cross sectional views
Fig. 5. CBCT images of the extraction site. a Preoperative CBCT showing fractured and un-restorable teeth #45 and #46 planned to be extracted. b–d Cross sectional views
Fig. 4. lant crowns placed and loaded after 3 months of placement
Fig. 4. a Second stage surgery followed by impression making. Note the excellent width of keratinized tissue which was also preserved. b Implant crowns placed and loaded after 3 months of placement
Fig. 3. Postoperative X ray showing the implant positions in the mandible where the teeth were extracted and ridge preservation was accomplished
Fig. 3. Postoperative X ray showing the implant positions in the mandible where the teeth were extracted and ridge preservation was accomplished
Fig. 2. ximation. A good width of keratinized tissue is visible along with ridge preservation. Ready for implant placement in the grafted areas. b Implant placed in 45 area. Core biopsy sample taken from area 46. Note the integration of graft particles in the preserved alveolar ridge also inside the osteotomy site of 46. c Two Xive (Dentsply) implants placed in the preserved ridge. d. Postoperat...
Fig. 1. traction sockets showing good initial graft stability. d Black silk sutures placed with tissue approximation and no releasing incision in the flaps
Fig. 1. a Clinical occlusal view with fractured 45 and 46. b Post-extraction view of the socket. Note minimal trauma to the soft tissue and no flap reflection on the surgical site. c Graft material condensed into the extraction sockets sho...
Patient no.
Gender
Patient’s age
Tooth no.
Time post extraction [month]
% New bone
...
Patient no.
Tooth no.
Ridge width baseline [mm]
Ridge width implant placement [mm]
Ridge width changes [mm]
...
ISQ level at implant placement
ISQ level at loading
Patient no.
Tooth no.
Buccal
Palatal
...
Kakar, A., Rao, B.H.S., Hegde, S. et al. Ridge preservation using an in situ hardening biphasic calcium phosphate (β-TCP/HA) bone graft substitute—a clinical, radiological, and histological study.
Int J Implant Dent 3, 25 (2017). https://doi.org/10.1186/s40729-017-0086-2
Download citation
Received: 31 December 2016
Accepted: 25 May 2017
Published: 22 June 2017
DOI: htt...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Correspondence to
Ashish Kakar.
Yenepoya University Dental College, University Road, Mangalore, 575018, India
Ashish Kakar, Bappanadu H. Sripathi Rao & Shashikanth Hegde
Dental Foundations and Research Centre, Malad, Mumbai, 400064, India
Nikhil Deshpande
Department of Oral and Maxillofacial Surgery, Center for Dental Medicine, Medical Center—University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
Annette ...
We acknowledge Sunstar Suisse SA, Etoy, Switzerland, for partly supporting this clinical study with a study grant. The authors declare that there is no conflict of interest regarding the publication of this paper.
Ashish Kakar, Bappanadu H. Sripathi Rao, Shashikanth Hegde, Nikhil Deshpande, Annette Lindner, Heiner Nagursky, Aditya Patney, and Harsh Mahajan declare that they have no competing inte...
Lang NP, Pun L, Lau KY, Li KY, Wong MC. A systematic review on survival and success rates of implants placed immediately into fresh extraction sockets after at least 1 year. Clin Oral Implants Res. 2012;23 Suppl 5:39–66.
Smukler H, Landi L, Setayesh R. Hostomorphometric evaluation of extraction sockets and deficient alveolar ridges treated with allografts and barrier membrane. A pilot study. In...
Nair PNR, Luder H-U, Maspero FA, Fischer JH, Schug J. Biocompatibility of beta-tricalcium phosphateroot replicas in porcine tooth extraction sockets—a correlativehistological, ultrastructural, and x-ray microanalytical pilotstudy. J Biomater Appl. 2006;20(4):307–24.
Jensen SS, Terheyden H. Bone augmentation procedures in localized defects in the alveolar ridge: clinical results with different...
Araujo MG, Sukekava F, Wennstrom J, Lindhe J. Ridge alterations following implant placement in fresh extraction sockets: an experimental study in the dog. J Clin Periodontol. 2005;32:645–52.
Van der Weijden F, Dell'Acqua F, Slot DE DE. Alveolar bone dimensional changes of post-extraction sockets in humans: a systematic review. J Clin Periodontol. 2009;36(12):1048–58.
Schropp L, Wenzel A, Kos...
The results of this clinical study support the use of a biphasic in situ hardening alloplastic bone graft substitute for ridge preservation in intact post-extraction sites without the use of a dental membrane. Therefore, grafting of sockets without primary wound closure or using dental membranes or a soft tissue punch can be an effective minimally invasive method of preserving the contour and arch...
Likewise, the reported amount of residual grafting material in the defect site was similar. In average, only 26.2 ± 9.4% of the defect was occupied with residual graft material in this study which is well in line with 26.6 ± 5.2% reported for BCP but below the 37.7 ± 8.5% reported for xenograft [14].
All 15 implants could be placed without the need for additional bone augmentation....
As previously reported, secondary intention soft tissue healing of grafted post-extraction sites can be well achieved when using an in situ hardening and in situ stabilizing bone graft substitutes without the need of a dental membrane [18, 20]. Findings of the present report corroborate these results. The authors found that all sites healed uneventfully with coverage of soft tissue and no local co...
Ridge preservation following dental extractions is fundamental, preserving the ridge profile for subsequent implant placement and providing a sustained function and esthetics. This clinical trial reports on the successful application of an in situ hardening biphasic alloplastic bone graft substitute for ridge preservation and subsequent implant placement in 15 healthy patients. A routine but minim...
Cone beam computer tomography (CBCT) was performed before tooth extraction and at the time point of implant placement. Mean ridge width reduction before tooth extraction to implant placement was calculated to effect in 0.79 ± 0.73 mm horizontal bone loss (Table 2). Primary implant stability was achieved in all 15 cases, showed in average high ISQ levels 70.3 ± 9.7 (buccal/palatal), and...
Fifteen patients (4 females and 11 males) with a mean age of 51.3 + 14.8 years (range: 27 to 75 years) participated in this randomized clinical trial. The site specific areas and teeth numbers for the study are shown in Table 1.
In all cases, the postoperative healing was uneventful. Clinically, the soft tissue healing pattern observed was very similar in all cases. The soft tissue on all ...
Bone biopsies were harvested using a trephine bur at the site of implant placement. The trephine burs including the bone biopsies were fixed in 4% formalin for 5–7 days, rinsed in water, and dehydrated in serial steps of ethanol (70, 80, 90, and 100%), remaining for 1 day in each concentration. Specimens were then infiltrated, embedded, and polymerized in resin (Technovit 9100, Heraeus Kulzer,...
Antibiotic therapy consisting of 1 g amoxicillin every 12 h for 4 days and mouth rinsing with 0.2% chlorhexidine every 8 h for 10 days were prescribed. The suture was removed 1 week postoperatively. After 3 to 8 months (average 5.2 ± 2 months), the sites (Fig. 2a) were reentered for implant placement. A site-specific full thickness mucoperiosteal flap was elevated to expose the regen...
This study was approved by the Yenepoya University Ethics committee, Mangalore, India (Approval Number YOEC83/8/3/2014). Fifteen patients who required extraction of a maxillary or mandibular tooth and subsequent single-tooth implant placement and who met the inclusion and exclusion criteria were included in this prospective single-arm clinical study. The patients (4 females and 11 males) had a mea...
To our knowledge, this is the first systematic clinical, radiographic, and histological evaluation that assesses bone formation and ridge width preservation after socket grafting using an in situ hardening biphasic bone graft substitute in healthy patients.
Following tooth extraction, the alveolar ridge will decrease in volume and change its morphology [1, 2]. These changes are clinically significant [3] and can complicate the placement of a conventional bridge or an implant-supported crown. Post-extraction maintenance of the alveolar ridge following the principles of ridge preservation using bone graft substitutes minimizes ridge resorption and, thu...
Post-Extraction ridge preservation using bone graft substitutes is a conservative technique to maintain the width of the alveolar ridge. The objective of the present study was to evaluate an in situ hardening biphasic (HA/β-TCP) bone graft substitutes for ridge preservation without primary wound closure or a dental membrane.
A total of 15 patients reported for tooth extraction were enrolled in t...
Fig. 8. The association between mean osseus sinus volume of the maxillary sinus and gender. Men have a statistically significant higher mean osseus volume than women (p = 0.007)
Fig. 8. The association between mean osseus sinus volume of the maxillary sinus and gender. Men have a statistically significant higher mean osseus volume than women (p = 0.007)
Fig. 7. The association between the mean osseus sinus volume and age. No significant association between these parameters was found (p = 0.2)
Fig. 7. The association between the mean osseus sinus volume and age. No significant association between these parameters was found (p = 0.2)
Fig. 6. No statistical significant association between a patient’s age and the presence of obliteration of at least one maxillary sinus was found (p = 0.92). For better visibility, the diagram has been jittered along the y-axis
Fig. 6. No statistical significant association between a patient’s age and the presence of obliteration of at least one maxillary sinus was found (p = 0.92...
Fig. 5. The association between the obliterated volume and sinus pathology. The presence of a pathology significantly increased the obliterated volume of a maxillary sinus (p
Fig. 4. The association between the osseus volume and the dentition. Edentulous, partly edentulous, and dentate patients showed no relevant difference in the size of the osseus sinus volume (p = 0.52)
Fig. 4. The association between the osseus volume and the dentition. Edentulous, partly edentulous, and dentate patients showed no relevant difference in the size of the osseus sinus volume ...
Fig. 3. 3D view of osseus sinus volumes. Surface area (cm2) and volume (cm3) were calculated by the software
Fig. 3. 3D view of osseus sinus volumes. Surface area (cm2) and volume (cm3) were calculated by the software
Fig. 2. View from the coronal plane. The marked curves define the osseus and mucous boundaries of the maxillary sinuses. The hatched surface illustrates the measured remaining pneumatized cavity of an obliterated sinus and the filled (yellow) surface highlights the calculated obliterated volume
Fig. 2. View from the coronal plane. The marked curves define the osseus and mucous boundaries of t...
Fig. 1. Calculation of the sinus body by interpolating 15–25 curves at a distance of 2 mm, depending upon the size of the maxillary cavity
Fig. 1. Calculation of the sinus body by interpolating 15–25 curves at a distance of 2 mm, depending upon the size of the maxillary cavity
Frequency of pathologies
n
(%)
Absence of alteration
73
(57.0)
Mucosal thickening
...
Mean
Median
Minimum
Maximum
SD
Osseus sinus surface area (cm2)
...
Luz, J., Greutmann, D., Wiedemeier, D. et al. 3D-evaluation of the maxillary sinus in cone-beam computed tomography.
Int J Implant Dent 4, 17 (2018). https://doi.org/10.1186/s40729-018-0128-4
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Received: 30 January 2018
Accepted: 20 March 2018
Published: 05 June 2018
DOI: https://doi.org/10.1186/s40729-018-0128-4
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
JL and CR are residents at the Clinic of Cranio-Maxillofacial and Oral Surgery, University of Zurich, University Hospital Zurich, Switzerland.
DG is a master student at the Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
MR is the Chairman of the Clinic for Cranio-Maxillofacial and Oral Surgery, University of Zurich, University Hospital Zurich, Zurich, Switzerland.
DW is t...
Correspondence to
Julia Luz.
Clinic of Cranio-Maxillofacial and Oral Surgery, University of Zurich, University Hospital Zurich, Zurich, Switzerland
Julia Luz, Dominique Greutmann, Claudio Rostetter, Martin Rücker & Bernd Stadlinger
Statistical Services, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
Daniel Wiedemeier
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Uchida Y, Goto M, Katsuki T, Akiyoshi T. A cadaveric study of maxillary sinus size as an aid in bone grafting of the maxillary sinus floor. J Oral Maxillofac Surg. 1998;56(10):1158–63.
Uchida Y, Goto M, Katsuki T, ...
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Brook I. Sinusitis of odontogenic origin. Otolaryngology Head Neck Surgery. 2006;135(3):349–55.
Nunes CA, Guedes OA, Alencar AH, Peters OA, Estrela CR, Estrela C. Evaluation of periapical lesions and their association with maxillary sinus abnormalities on cone-beam computed tomographic ...
Mozzo P, Procacci C, Tacconi A, Martini PT, Andreis IAB. A new volumetric CT machine for dental imaging based on the cone-beam technique: preliminary results. Eur Radiol. 1998;8(9):1558–64.
Price JB, Thaw KL, Tyndall DA, Ludlow JB, Padilla RJ. Incidental findings from cone beam computed tomography of the maxillofacial region: a descriptive retrospective study. Clin Oral Implants Res. 2012;23(11...
The present study showed the volume software to be a suitable tool for the measurement of the dimensions of the maxillary sinus. The results show that the osseus volume of the maxillary sinus varies on the base of gender and that the obliterated volume varies on the base of a present pathology. No statistically significant association between the patient’s age and the sinus volume or a present s...
Velasco-Torres et al. [19] showed a larger sinus volume for dentate patients compared to edentulous and partially edentulous patients. This may be explained through the loss of posterior teeth in the maxilla, leading to the reduction of mechanical stimulation of the maxillary sinus. As a consequence, the sinus could expand (pneumatization) due to increased pressure and ostoclastic activity of the ...
The aim of this study was to analyze volume parameters of the maxillary sinus based on CBCT data. Further, neighboring anatomical structures and related pathologies were recorded. Overall, the applied volume software used in this study allowed the calculation of the surface area and volume of maxillary sinuses.
In clinics, the radiographic evaluation of the maxillary sinus is obligatory prior to ...
No relationship was observed between a patient’s age and the presence of partial or complete obliteration of at least one maxillary sinus (Fig. 6, p = 0.92). Patient’s age and the mean osseus sinus volume were also not associated significantly (Fig. 7, p = 0.20). Both maxillary sinuses (osseus borders) of each patient were quite similar in size (mean difference between left and right...
In total, 128 maxillary sinuses were analyzed. The mean surface area was found to be 39.7 cm2 and the mean volume 17.1 cm3. The mean surface area of the remaining pneumatized cavities of obliterated sinuses was found to be 36.4 cm2 and the mean volume 15 cm3 (Table 1). 42.2% of all sinuses showed an obliteration, and the mean volume of the obliterated sinuses was 5.1 cm3. If there was an obl...
Patient-specific variables like gender, date of birth, and date of CBCT were recorded. The date of the CBCT image was further divided into either being in autumn/winter (1 January 2013–19 March 2013; 22 September 2013–31 December 2013) or spring/summer (20 March 2013–21 September 2013). The maxillary sinus was classified into obliterated or nonobliterated. It was also documented if there was...
In the present study, 64 CBCT images (128 maxillary sinuses), taken between 1 January 2013 and 31 December 2013 at the Department of Cranio-Maxillofacial and Oral Surgery at the University of Zurich, were included. The inclusion criterion of each CBCT scan was the presence of two complete maxillary sinuses; the osseus borders of both sinuses had to be entirely visible.
The scans were performed us...
The precise assessment of the maxillary sinus is important in oral and maxillofacial surgery in cases of traumatology, sinusitis, and dental implantology. After the introduction of cone-beam computed tomography (CBCT) in dental medicine in 1998 [1], the number of clinicians using CBCTs increased constantly. Whereas in 2004, there were only three CBCTs registered in Switzerland, the current number ...
There are few studies measuring the dimensions of the maxillary sinus, being mostly based on computed tomography imaging and rarely being based on cone-beam computed tomography (CBCT). The aim of this study was to measure the 3D osseous and soft tissue defined volume and surface area of the maxillary sinus. Further, possible associations with patient-specific and sinus-related variables were evalu...
Fig. 4. Cross-sectional images of areas 1–3 of a 39-year-old female. The visibility ratios for the superior wall in areas 1, 2, and 3 were 0.2, 0.9, and 0.9, respectively, whereas those of the inferior wall were 0.7, 0.9, and 1.0, respectively
Fig. 4. Cross-sectional images of areas 1–3 of a 39-year-old female. The visibility ratios for the superior wall in areas 1, 2, and 3 were 0.2, 0.9...
Fig. 3. Visibility ratios of the superior and inferior walls in three areas. The Friedman test and Scheffe’s test were used for the statistical analysis
Fig. 3. Visibility ratios of the superior and inferior walls in three areas. The Friedman test and Scheffe’s test were used for the statistical analysis
Fig. 2. Visibilities of the superior and inferior walls of the mandibular canal. a Both walls are visible. b Only the inferior wall is visible. c Neither of the walls is visible
Fig. 2. Visibilities of the superior and inferior walls of the mandibular canal. a Both walls are visible. b Only the inferior wall is visible. c Neither of the walls is visible
Fig. 1. Cross-sectional images in the range of 30 mm just distal to the mental foramen were used for evaluation. The range was divided into three areas, each of which was 10 mm in length, designated as area 1, area 2, and area 3, from anterior to posterior. (The mental foramen was identified on another section and was not visualized on this image)
Fig. 1. Cross-sectional images in the range...
Number of cases
Mandibular canal wall
Area 1
Area 2
Area 3
Superior wall
...
NoneTable 2 Mean visibility ratio ± SD
Mandibular canal wall
Area 1
Area 2
Area 3
Superior wall
0.7795
...
Ishii, H., Tetsumura, A., Nomura, Y. et al. Diagnostic ability of limited volume cone beam computed tomography with small voxel size in identifying the superior and inferior walls of the mandibular canal.
Int J Implant Dent 4, 18 (2018). https://doi.org/10.1186/s40729-018-0133-7
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Received: 20 December 2017
Accepted: 23 April 2018
Published: 26 July 2018
D...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
All procedures followed were in accordance with the ethical standards of the responsible committees on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. The study was approved by an institutional review board of our university (approval No. D2016-061). The requirement for informed consent from each patient was waived in this retrospect...
Correspondence to
Akemi Tetsumura.
Department of Oral and Maxillofacial Radiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
Hiroko Ishii, Akemi Tetsumura, Yoshikazu Nomura, Shin Nakamura & Tohru Kurabayashi
URA, Research Administration Division, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
Masako Akiyama
Yo...
The datasets during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Bertl K, Heimel P, Reich KM, Schwarze UY, Ulm C. A histomorphometric analysis of the nature of the mandibular canal in the anterior molar region. Clin Oral Investig. 2014;18:41–7.
Starkie C, Stewart D. The intra-mandibular course of the inferior dental nerve. J Anat. 1931;65:319–23.
Carter RB, Keen EN. The intramandibular course of the inferior alveolar nerve. J Anat. 1971;108:433–40.
Nai...
Faul F, Erdfelder E, Lang A-G, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39:175–91.
Kundel HL, Polansky M. Measurement of observer agreement. Radiology. 2003;228:303–8.
Alhassani AA, AlGhamdi AS. Inferior alveolar nerve injury in implant dentistry: diagnosis, causes, prevention, and managem...
Tyndall DA, Price JB, Tetradis S, Ganz SD, Hildebolt C, Scarfe WC. Position statement of the American Academy of Oral and Maxillofacial Radiology on selection criteria for the use of radiology in dental implantology with emphasis on cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113:817–26.
Weckx A, Agbaje JO, Sun Y, Jacobs R, Politis C. Visualization techniques...
Cone beam computed tomography
Field of view
In conclusion, we evaluated the visibility of the mandibular canal walls on limited volume CBCT images with a small voxel size. Evaluation was performed in the range of 30 mm in length just posterior to the mental foramen, which was divided into three equal areas (areas 1, 2, and 3, from anterior to posterior). The superior wall was significantly more poorly visualized than the inferior wall in a...
Our study had some limitations that should be addressed. First, in our study, antero-posterior location of the mandibular canal was defined by the distance from the mental foramen. Tooth positions could not be used as a reference, because premolars and molars were totally or partially missing in considerable number of the cases. Although areas 1–3 were considered mostly to correspond to the area...
Jung and Cho [6] reported that the mandibular canal was clearly visible in 50% of CBCT images in the first molar and in 58% in the second molar region. Similarly, Oliveira-Santos et al. [5] reported that it was visible in 63, 66, and 67% of second premolar, first molar, and second molar regions, respectively. As described above, these studies did not discriminate between the superior and the infer...
In this study, we only used CBCT images of the mandible obtained with the smallest FOV, 40 × 40 mm. On those images, the range of 30 mm in length in the mandible just posterior to the mental foramen was divided into three equal areas, each of which was 10 mm in length. They were designated as areas 1, 2, and 3, from anterior to posterior. After that, the visibilities of the superior and in...
It is very important to know the location of the mandibular canal prior to dental implant surgery to avoid surgical complications including vascular trauma or nerve damage.
CBCT is widely accepted to be the imaging method of choice for obtaining this information [1, 2]. However, it is well known that the mandibular canal cannot usually be identified over its entire course even when CBCT is used. ...
Interobserver agreement was substantial or almost perfect agreement (Table 1).
The mean values of the visibility ratio of the superior and inferior walls in each area are shown in Table 2 and Fig. 3. In all areas, the ratio of the superior wall was significantly lower than that of the inferior wall (p = 0.0000). As for variance among the three areas, the ratio was highest in the most poste...
The ratio ranged from 0 to 1.
Sample size was determined using the free software G* Power 3.1 [11]. We evaluated 30 patients, and the effect size was calculated from the mean, standard deviation, and correlation. Wilcoxon signed-rank sum test was chosen, and the significance level was set to 0.05. The result showed that a sample size of 26 to 75 patients would provide a power of at least 0.8 for ...
This study was approved by an institutional review board of our university (D2016-061).
Among the patients whose mandibles were examined by CBCT at our dental hospital between April 2012 and August 2016, 96 patients who fulfilled the following two conditions were selected.
On CBCT imaging:
The smallest field of view (FOV) of the device, 40 × 40 mm, was used.
The mental foramen and the ma...
The mandibular canal is an important anatomical structure that contains the neurovascular bundle, i.e., the inferior alveolar nerve and artery. The location of the mandibular canal must be correctly identified prior to dental implant surgery to avoid complications including intraoperative and postoperative hemorrhage and neurosensory loss. Cone beam computed tomography (CBCT) is considered the ima...
The aim of this study was to evaluate the visibility of the superior and inferior walls of the mandibular canal separately using limited volume cone beam computed tomography (CBCT) with small voxel size.
CBCT cross-sectional images of 86 patients obtained by 3D Accuitomo FPD and reconstructed with a voxel size of 0.08 mm were used for the evaluation. A 30-mm range of the mandible just distal to ...
Fig. 9. The comparison of two groups at average voxel values for each part. The comparison of voxel values by insertion torque. All specimens were classified into two groups by insertion torque
Fig. 8. The relationship between average voxel value and insertion torque (averaged over the entire treatment area). The comparison of average voxel value among IT groups. Average voxel value was 384.0 ± 154.6 in the low IT group, 387.7 ± 147.7 in the medium IT group, and 619.2 ± 200.4 in the high IT group
Fig. 8. The relationship between average voxel value and insertion torqu...
Fig. 7. The average voxel value between the maxilla and mandible. There was no difference between the maxilla (430.9 ± 211.6) and the mandible (475.6 ± 211.5) in the average voxel value. Also, no difference was found in each part
Fig. 7. The average voxel value between the maxilla and mandible. There was no difference between the maxilla (430.9 ± 211.6) and the mandible (475.6...
Fig. 6. The relationship between ISQ and insertion torque. Percentage of specimens showing ISQ ≥ 73 compared with groups by week. In all groups, a period of rapidly increasing percentages was observed (8–12 weeks in the low IT group, 4–6 weeks in the medium and high IT groups). In the medium and high IT Group, a statistically significant difference was observed between ISQ ≥ 73 a...
Fig. 5. The comparison of ISQ values by the insertion torque. Time-lapse migration of ISQ values was compared with IT groups. Each IT group displayed similar migration. A significant difference in The ISQ was found in the low IT group after 8 weeks
Fig. 5. The comparison of ISQ values by the insertion torque. Time-lapse migration of ISQ values was compared with IT groups. Each IT group displ...
Fig. 4. The classification of the insertion torque. All specimens classified into three groups according to insertion torque. Criteria for the classification are shown in the figure and in the “Methods” section
Fig. 4. The classification of the insertion torque. All specimens classified into three groups according to insertion torque. Criteria for the classification are shown in the figur...
Fig. 3. The evaluation of the average ISQ. Time-lapse migration of average ISQ. Average ISQ of all specimens increased in a time-dependent manner (results indicated by a line). A significant difference was observed by 6 weeks after surgery
Fig. 3. The evaluation of the average ISQ. Time-lapse migration of average ISQ. Average ISQ of all specimens increased in a time-dependent manner (results...
Fig. 2. The measurement of the voxel values. A case of bone quality diagnosis before treatment. Width and height of the bone were measured to select the proper size of the implant body. The selected implant body was simulated on the bone images as a symbol, and then the voxel value was calculated as described in the “Methods” section
Fig. 2. The measurement of the voxel values. A case of ...
Fig. 1. Genesio® Plus implant with Aanchor surface. Scheme of the dental implant body for the Genesio® Plus implants with Aanchor surface used. a Overview picture of Genesio® Plus implants with Aanchor surface. b Image from scanning electron microscopy. Both pictures were provided by GC Corporation. To obtain osseointegration from an early stage, the dental implant body was treated with sandb...
Number of implants
Insertion torque value (N cm)
Implant stability quotient value
0 week
2 weeks
...
Number of implants
Treatment area (FDI)
Size of implant (mm)
Length
Diameter
1
...
Homma, S., Makabe, Y., Sakai, T. et al. Prospective multicenter non-randomized controlled study on intraosseous stability and healing period for dental implants in the posterior region.
Int J Implant Dent 4, 10 (2018). https://doi.org/10.1186/s40729-018-0122-x
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Received: 05 September 2017
Accepted: 25 January 2018
Published: 29 March 2018
DOI: https://doi...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
This research was conducted in accordance with the Helsinki Declaration of 1964 and subsequent ethical standards, with the approval of Tokyo Dental University and Fukuoka Dental College Ethics Committee (World Medical 2013). The surgeon explained the contents of the research to each patient, who then consented to participate in the present study.
All participants consented to publish their inform...
Correspondence to
Shinya Homma.
Department of Oral and Maxillofacial Implantology, Tokyo Dental College, 2-9-18 Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
Shinya Homma, Yasushi Makabe & Yasutomo Yajima
Section of Oral Implantology, Department of Oral Rehabilitation, Fukuoka Dental College, 2-15-1 Tamura, Sawara-ku, Fukuoka-City, Fukuoka, 814-0175, Japan
Takuya Sakai, Kenzou Morinaga & Hirofumi Kido
Center for Oral ...
Nedir R, Bischof M, Szmukler-Moncler S, Bernard JP, Samson J. Predicting osseointegration by means of implant primary stability. Clin Oral Implants Res. 2004;15(5):520–8.
Ito Y, Sato D, Yoneda S, Ito D, Kondo H, Kasugai S. Relevance of resonance frequency analysis to evaluate dental implant stability: simulation and histomorphometrical animal experiments. Clin Oral Implants Res. 2008;19(1):9–...
Boronat López A, Balaguer Martínez J, Lamas Pelayo J, Carrillo García C, Peñarrocha DM. Resonance frequency analysis of dental implant stability during the healing period. Med Oral Patol Oral Cir Bucal. 2008;13(4):E244–7.
Gapski R, Wang HL, Mascarenhas P, Lang NP. Critical review of immediate implant loading. Clin Oral Implants Res. 2003;14(5):515–27.
Esposito M, Hirsch JM, Lekholm U, Th...
Schulte W, Lukas D. The Periotest method. Int Dent J. 1992;42(6):433–40.
Meredith N, Book K, Friberg B, Jemt T, Sennerby L. Resonance frequency measurements of implant stability in vivo. A cross-sectional and longitudinal study of resonance frequency measurements on implants in the edentulous and partially dentate maxilla. Clin Oral Implants Res. 1997;8(3):226–33.
Meredith N. Assessment of i...
Aparicio C, Rangert B, Sennerby L. Immediate/early loading of dental implants. A report from the Sociedad Española de Implantes World Congress consensus meeting in Barcelona, Spain 2002. Implant Dent Relat Res. 2003;5:57–60.
Cochran DL, Moeton D, Weber HP. Consensus statements and recommended clinical procedures regarding loading protocols for endosseous dental implants. Int J Oral Maxillofac ...
Cone beam CT
Computed tomography
Digital Imaging and Communications in Medicine
Implant stability quotient
Insertion torque
Multi-slice CT
The purpose of this study was to evaluate the relationship between the insertion torque value and the ISQ value at the implant treatment using the current rough-surfaced implant. As a result, no significant relationship was found between the insertion torque value and the ISQ value. Also, it was suggested that the ISQ value was considered to be an important indicator for observing the treatment st...
As accurate CT attenuation was not measured due to the lower spatial resolution of CBCT compared with MSCT, a CBCT was recognized as unsuitable for evaluating bone quality. However, several groups have recently reported the potential use of CBCT systems as an apparatus for estimating bone quality. Isoda et al. described a high correlation between voxel values obtained by CBCT and IT of the implant...
In this study, we could not find a significant relationship between insertion torque value and ISQ value. However, insertion torque value is an important indicator for predicting the progress of implant treatment, and ISQ value is considered to be an important indicator for observing the treatment state of the implant. Currently, the insertion torque value is used as the major decision index for t...
Increases or decreases of ISQ values are explained as follows: The inserted dental implant body is supported by mechanical interdigitating force after surgery, but this interdigitating force will be reduced time-dependently by the effects of osteoclasts activation at the initial stage of the bone remodeling process, then osseointegration will be completed by an increasing contact area between the ...
The insertion torque value in this study showed broader (10 to 50 N cm) than the previous publication (Table 2) [22, 32], and the cause of reasons for the difference are as follows: Primary stability may be affected by the bone quantity and bone quality in the treatment area, the micro- and macro-level design of the implant body, and the accuracy of the surgical technique [18, 25]. In this stud...
According to the previous literature, the obtaining osseointegration is integral to the intraosseous stability of the implant body during the healing period [24]; moreover, the importance of postoperative assessment of the intraosseous stability of the implant has also been reported [10]. Intraosseous stability of the implant body is evaluated immediately after the implant insertion and during the...
Average ISQ tended to increase during the healing period in all IT groups (Fig. 5). Average ISQ of the low IT group was 59.81 at 0 week, increasing significantly after ≥ 8 weeks (P
A total of 33 implant bodies (8 in the maxilla, 25 in the mandible) were inserted into the 27 participants (11 men, 16 women), with the average age of 54.6 ± 12.2 years (range, 32–78 years). The average IT value was 32.7 ± 9.2 N cm (32.5 ± 11.6 N cm in the maxilla, 32.8 ± 8.5 N cm in the mandible). The diameter of the implant body was 4.4 mm in 20 (60.6%) and 3.8 mm...
The CBCT was performed using a 3DX Multi-Image Micro CT FPD 8 system (J. MORITA MFG., Kyoto, Japan) (tube voltage, 80 kV; imaging area, 80 × 80 mm), and voxel values were measured with coDiagnostix™ 9.7 (dental wings, Montreal, Canada). The voxel values were calculated based on CT images for bone quality diagnosis. Voxel values were measured three times at 12 locations covering the mesial...
Implant treatment was performed in accordance with the procedure recommended by the manufacturer, without bone augmentation. A healing abutment was connected to the implant bodies after insertion (implant insertion in one stage method). A total of 17 dentists (treatment experience, 5–35 years; average, 11.5 years) performed all implant treatments in this study. All dentists who performed the i...
This prospective study was conducted jointly by Tokyo Dental College (Tokyo, Japan) and Fukuoka Dental College (Fukuoka, Japan) from January to December 2015. All study protocols were conducted in accordance with the Declaration of Helsinki [21] and were approved by the ethics committees of Tokyo Dental College (approval #416) and Fukuoka Dental College (approval #213).
Participants comprised pat...
The purpose of this study is to evaluate the relationship between IT and ISQ at implant treatment using the current rough surfaced implant. We evaluated the implant treatment sites with implant stability quotient (ISQ) values, IT values, and voxel values. We assumed that there is relevance between the insertion torque value and the ISQ value.
Dental implant treatments have improved in both convenience and predictability with refinements in implant bodies and treatment procedures as compared to about 50 years ago when clinical applications were started. Currently, an implant body surface is treated with “rough processing” by sandblasting and acid etching for the purposes of obtaining more reliable osseointegration and shortening tr...
A current implant body surface was treated with “rough processing” by sandblasting and acid etching for the purposes of obtaining more reliable osseointegration and shortening the treatment period. Various reports have examined the healing period with the use of these implant bodies, but a consensus opinion has not yet been obtained. The purpose of this study is to evaluate the relationship be...
A current implant body surface was treated with “rough processing” by sandblasting and acid etching for the purposes of obtaining more reliable osseointegration and shortening the treatment period. Various reports have examined the healing period with the use of these implant bodies, but a consensus opinion has not yet been obtained. The purpose of this study is to evaluate the relationship be...
Authors
Year of study
Method of study
Results
Tos and Mogesen et al.
1979
...
Factor
Difference
95% CI
p value
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Female
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...
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Fig. 3. Demonstration of the method used to measure the angle designated by the buccal and lingual walls of the sinus angle for each of the three fixed points in a given height
Fig. 3. Demonstration of the method used to measure the angle designated by the buccal and lingual walls of the sinus angle for each of the three fixed points in a given height
Fig. 2. Demonstration of the method used to measure the thickness of the Schneiderian membrane in the cross-sectional images for each of the three fixed points
Fig. 2. Demonstration of the method used to measure the thickness of the Schneiderian membrane in the cross-sectional images for each of the three fixed points
Fig. 1. Demonstration of the method used in the panoramic image to divide the sinus in four equal parts and find three fixed points for the measurements. Also, these fixed points in the horizontal plane with and without sections
Fig. 1. Demonstration of the method used in the panoramic image to divide the sinus in four equal parts and find three fixed points for the measurements. Also, these ...
Kalyvas, D., Kapsalas, A., Paikou, S. et al. Thickness of the Schneiderian membrane and its correlation with anatomical structures and demographic parameters using CBCT tomography: a retrospective study.
Int J Implant Dent 4, 32 (2018). https://doi.org/10.1186/s40729-018-0143-5
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Received: 29 January 2018
Accepted: 27 August 2018
Published: 19 October 2018
...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
Patient recruitment and data collection for this study took place at National and Kapodistrian University of Athens, School of Dentistry, Greece. The research was approved by the Ethics Committee of the National and Kapodistrian University of Athens, Greece, and all activities were conducted in full accordance with ethical principles, including the World Medical Association Declaration of Helsinki...
Department of Oral and Maxillofacial Surgery, School of Dentistry, National and Kapodistrian University of Athens, Greece, Thivon 2 str, 11527, Athens, Greece
Demos Kalyvas, Andreas Kapsalas & Sofia Paikou
Oral Diagnosis & Radiology Clinic, School of Dentistry, National and Kapodistrian University of Athens, Greece, Thivon 2 str, 11527, Athens, Greece
Konstantinos Tsiklakis
You can also sea...
The data will not be shared, but are available upon request.
Wen S-C, Lin Y-H, Yang Y-C, Wang H-L. The influence of sinus membrane thickness upon membrane perforation during transcrestal sinus lift procedure. Clin. Oral Impl. Res. 2015;26:1158–64.
Insua A, Monje-Gil F, García-Caballero L, Caballé-Serrano J, Wang HL, Monje A. Mechanical characteristics of the maxillary sinus Schneiderian membrane ex vivo. Clin Oral Investig. 2017; https://doi.org/10.100...
Cagici CA, Yilmazer C, Hurcan C, Ozer C, Ozer F. Appropriate interslice gap for screening coronal paranasal sinus tomography for mucosal thickening. Eur Arch Otorhinolaryngol. 2009;266(4):519–25.
Eggesbø HB. Radiological imaging of inflammatory lesions in the nasal cavity and paranasal sinuses. Eur Radiol. 2006;16:872–88.
Lozano-Carrascal N, Salomó-Coll O, Gehrke SA, Calvo-Guirado JL, Hern...
Testori T. Maxillary sinus surgery: Anatomy and advanced diagnostic imaging. J Implant and Reconstructive Dent. 2011;2:6-14.
Sargi ZB, Casiano RR. Surgical anatomy of the paranasal sinuses. In: Kountakis SE, Onerci TM, editors. Rhinologic and sleep apnea surgical techniques. New York: Springer; 2007. p. 17–26.
Bergh van den JPA, Bruggenkate ten CM, Disch FJM, Tuinzing DB. Anatomical aspects of...
In conclusion, the present study demonstrated that male patients tend to have a thicker membrane than female patients. The angles of the sinus seemed to increase in width from mesial to distal, and they have no significant correlation with any of our parameters. Thickness of the mucosa and width of the maxillary sinus did not seem to correlate. Future studies including larger groups of participant...
In the present study, it was also concluded that the width of the sinus increases from mesial to distal. Male sinuses had higher prevalence of high angle values compared to female sinuses, but the majority of angle values and widths was characterized as moderate.
In an attempt to correlate the membrane biotype regarding thickness with the sinus width, it was proven that there is no correlation be...
Comparing the thickness of the membrane between the two genders, males seem to have thicker membranes than females. Vallo et al. 2010, Janner et al. 2011, Ji-Young Yoo et al. 2011, Cakur et al. 2013, and Jildirim et al. 2017 [9, 11, 12, 16, 17] also come to this conclusion. Our study assumed that this difference is of the order of 40%. On the contrary, Pazera et al. 2010 concluded that there is no...
It is very important to pre-operatively evaluate the thickness of the Schneiderian membrane to plan the surgical procedure in the region that involves the membrane, such as a sinus lift augmentation, which increases the possibility of membrane perforation or other complications.
The present study assumed that the average thickness of the Schneiderian membrane is 1.60 ± 1.20 mm.
There are m...
The mean value of the overall average thickness is 1.60 ± 1.20 mm (males 1.95 ± 1.28 mm and females 1.24 ± 1.02 mm) (Table 1).
The average thickness of the membrane also showed no tendency for differentiation by age group (p = 0.878) (Table 2).
The statistical analysis also shows a clear tendency towards lower values when checking from point AR to point CR and from point ...
These three cross-sectional images, in which the thickness of the Schneiderian membrane was previously measured, were also used for the measurement of the angle of the maxillary sinus. A segment DG (point D is the deepest point of the floor of the maxillary sinus) is created, vertical to the horizontal plane with stable length equal to 9.9 mm. The mean of 9.9 mm was chosen, because of a limitati...
The study sample included 76 patients, of which 39 were females and 37 were males. In total, 120 sinuses (44 both left- and right-sided, 21 right-sided, and 11 left-sided) were evaluated as suitable for the present study and were measured. The total sample was classified in four age groups (below 45 years, 45–54 years, 54–64 years, and over 65 years of age). The mean age value of the sampl...
The maxillary sinus is the largest of the paranasal air-filled spaces, and it develops firstly in utero [1, 2]. Anatomically, the maxillary sinus is a pyramid-shaped cavity located in the facial skull with a mean volume of 12.5 mL (min 5 mL and max 22 mL) [2,3,4,5,6]. The size, the shape, and the wall thickness of every maxillary sinus not only vary among the population, but also between the tw...
The aims of the present study were to determine the thickness of the Schneiderian membrane and identify the width of the maxillary sinus, which is indicated by the buccal and lingual walls of the sinus angle between. Furthermore, to investigate the possibility of a correlation between the aforementioned structures and also other anatomical and demographic parameters using CBCTs for dental implant ...
Fig. 3. Treatability refers to OPG/CBCT and to residents in oral surgery and orthodontics
Fig. 3. Treatability refers to OPG/CBCT and to residents in oral surgery and orthodontics
Fig. 2. Accuracy of diagnostic answers given by residents in orthodontics (R right, F false, NS not sufficient)
Fig. 2. Accuracy of diagnostic answers given by residents in orthodontics (R right, F false, NS not sufficient)
Fig. 1. Accuracy of diagnostic answers from residents in oral surgery (R right, F false, NS not sufficient)
Fig. 1. Accuracy of diagnostic answers from residents in oral surgery (R right, F false, NS not sufficient)
Variable
p value
Odds ratio (95% CI)
Specialisation: oral surgery vs orthodontics
4 year
0.045*
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OPG (%)
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OS (%)
ORTH (%)
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Radic, J., Patcas, R., Stadlinger, B. et al. Do we need CBCTs for sufficient diagnostics?-dentist-related factors.
Int J Implant Dent 4, 37 (2018). https://doi.org/10.1186/s40729-018-0147-1
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Received: 06 July 2018
Accepted: 08 October 2018
Published: 16 November 2018
DOI: https://doi.org/10.1186/s40729-018-0147-1
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
The study was approved by the cantonal ethics committee of the canton of Zurich (KEK 2016-00070).
Not applicable
Josipa Radic, Raphael Patcas, Bernd Stadlinger, Daniel Wiedemeier, Martin Rücker and Barbara Giacomelli-Hiestand declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Correspondence to
Barbara Giacomelli-Hiestand.
Clinic of Cranio-Maxillofacial and Oral Surgery, Centre of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
Josipa Radic, Bernd Stadlinger, Martin Rücker & Barbara Giacomelli-Hiestand
Clinic for Orthodontics and Paediatric Dentistry, Centre of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
Raphael Patcas
Statistical S...
Ren H, Chen J, Deng F, Zheng L, Liu X, Dong Y. Comparison of cone-beam computed tomography and periapical radiography for detecting simulated apical root resorption. Angle Orthod. 2013;83(2):189–95. https://doi.org/10.2319/050512-372.1 published Online First: Epub Date]|.
Tantanapornkul W, Okouchi K, Fujiwara Y, Yamashiro M, Maruoka Y, Ohbayashi N, et al. A comparative study of cone-beam comput...
Hasani A, Ahmadi Moshtaghin F, Roohi P, Rakhshan V. Diagnostic value of cone beam computed tomography and panoramic radiography in predicting mandibular nerve exposure during third molar surgery. Int J Oral Maxillofac Surg. 2017;46(2):230–5. https://doi.org/10.1016/j.ijom.2016.10.003 published Online First: Epub Date]|.
Alqerban A, Jacobs R, Fieuws S, Willems G. Comparison of two cone beam comp...
Mason C, Papadakou P, Roberts GJ. The radiographic localization of impacted maxillary canines: a comparison of methods. Eur J Orthod. 2001;23(1):25–34.
Maverna R, Gracco A. Different diagnostic tools for the localization of impacted maxillary canines: clinical considerations. Prog Orthod. 2007;8(1):28–44.
Neves FS, Passos CP, Oliveira-Santos C, Cangussu MC, Campos PS, Nascimento RJ, et al. C...
Three-dimensional
Cone beam computed tomography
Digital Imaging and Communications in Medicine
Orthopantomography
Odds ratio
Resident in orthodontics
Resident in oral surgery
This study analysed (i) whether pathologies are accurately diagnosed in three different imaging modalities (OPG, CBCT, 3D model). Diagnostic accuracy was decent with OPG and was improved with CBCT. Next, the study assessed (ii) whether each case was classified as treatable on the basis of the present imaging modality. This result was influenced by the professional background, which influenced whet...
Certain limitations affect the generalizability of this study’s results. First, only nine cases were assessed with a limited range of pathologies (five retained teeth (canines and molars), two tooth resorptions, one odontoma and one supernumerary tooth). Moreover, the assessment was performed by a small amount of residents of the local university. The fact that all residents shared a similar aca...
In 81.6% of the cases, further imaging was requested after the OPG. Caution should be applied in the interpretation of this number, as the residents’ decision was theoretical and did not imply additional costs or radiation exposure. Nevertheless, it is striking that in the majority of the cases, further imaging was requested. One possible explanation might be the diagnostic difficulty of the cho...
Moreover, another valuable and novel observation is the divergence seen in the importance of printed 3D models. For residents in oral surgery, printed 3D models caused more uncertainties and led to a decrease of diagnostic accuracy (if assessed in sequential order after OPG and CBCT). In contrast, residents in orthodontics seemed to benefit of an additional assessment of printed 3D models, which r...
The aim of this study was twofold: (i) to analyse the diagnostic accuracy of pathologies in three different imaging modalities of the same case and (ii) to analyse the need for further imaging in order to enable treatment. Further, aspects like the impact of specialisation, gender and dental experience were analysed. In contrast to the plethora of scientific literature available dealing with CBCT ...
Overall, the majority of the questions were answered correctly, independently to the imaging modality. The percentages of correct answers given by OS were 66.3% for OPG, 83.4% for CBCT and 76.4% for 3D model; and differed slightly to those given by ORTH with 63.7% for OPG, 78.0% for CBCT and 78.7% for 3D model (Figs. 1 and 2). Both OS and ORTH alike answered to around 20% of the questions that th...
Statistical analysis and plots were performed using the statistical software R [12]. To evaluate the differences in the proportions of correct diagnostic answers between OS and ORTH and between different imaging modalities, Fisher’s exact tests were used and odds ratios (OR) including confidence intervals (CI) were computed for every question separately. Likewise, Fisher’s exact tests were app...
Each resident was shown the region of interest to which the questions related to
Allowed setup change of OPG: zoom
Allowed setup change of CBCT: brightness, contrast, zoom, scroll in all three levels (coronal, axial and sagittal
3D model: no restrictions
The OPGs of this study were taken either in-house (CRANEX D, Kw73, 10 mA) or extramural. All CBCTs were taken at the Centre of Dental Medici...
Fourteen residents were recruited for this survey [7 residents in oral surgery (OS) and 7 residents in orthodontics (ORTH), respectively; m = 6, f = 8]. Their characteristics are listed in Table 1. Every resident assessed individually nine separate patient cases, each containing a distinct dentoalveolar pathology, as defined in the study planning process (Table 2).
For each patient case...
Finally, the request for a CBCT should always be guided by the pursuit of improved diagnostic accuracy and the prospect of an enhanced treatment plan. Preferably, the indications for a CBCT should be based entirely on case-related factors. Yet, dentist-related factors might influence the request for a CBCT as well.
The aim of this study was therefore (i) to assess whether pathologies are accurate...
Along with the clinical examination, radiological imaging is essential for a complete diagnosis in dental medicine [1, 2]. Orthopantomography (OPG), a two-dimensional panoramic radiograph, is widely used across all dental disciplines including oral surgery and orthodontics [3,4,5] to address basic diagnostic queries. An OPG contains an abundance of information on the teeth, mandible, maxilla, incl...
The aim of this study was to assess the diagnostic accuracy of various dentoalveolar pathologies based on panoramic radiography (OPG), cone beam computed tomography (CBCT) and printed 3D models in consecutive order; and to evaluate the impact of specialisation of residents in oral surgery (OS) versus residents in orthodontics (ORTH).
Fourteen residents were recruited to evaluate nine selected cas...
Number of implants
Insertion torque value (N cm)
Implant stability quotient value
0 week
2 weeks
4 weeks
6 weeks
8 weeks
12 weeks
1
25
33.0
75.0
77.0
78.3
79.7
77.0
2
40
68.0
70.3
70.0
72.0
75.7
75.3
3
40
78.3
77.0
78.0
78.7
80.0
80.0
4
35
74.0
43.0
61.0
73.0
75.7
80.0
5
45
85.3
85.7
84.0
83.3
84.0
83.0
6...
Number of implants
Treatment area (FDI)
Size of implant (mm)
Length
Diameter
1
14
10
3.8
2
14
10
3.8
3
14
10
3.8
4
16
8
3.8
5
16
10
4.4
6
16
8
4.4
7
16
8
4.4
8
17
10
4.4
9
36
10
3.8
10
36
10
4.4
11
36
8
3.8
12
36
10
3.8
13
36
12
4.4
14
36
10
4.4
15
36
10
4.4
...
Figure 9. The comparison of two groups at average voxel values for each part. The comparison of voxel values by insertion torque. All specimens were classified into two groups by insertion torque
Figure 8. The relationship between average voxel value and insertion torque (averaged over the entire treatment area). The comparison of average voxel value among IT groups. Average voxel value was 384.0 ± 154.6 in the low IT group, 387.7 ± 147.7 in the medium IT group, and 619.2 ± 200.4 in the high IT group
Figure 7. The average voxel value between the maxilla and mandible. There was no difference between the maxilla (430.9 ± 211.6) and the mandible (475.6 ± 211.5) in the average voxel value. Also, no difference was found in each part
Figure 6. The relationship between ISQ and insertion torque. Percentage of specimens showing ISQ ≥ 73 compared with groups by week. In all groups, a period of rapidly increasing percentages was observed (8–12 weeks in the low IT group, 4–6 weeks in the medium and high IT groups). In the medium and high IT Group, a statistically significant difference was observed between ISQ ...
Figure 5. The comparison of ISQ values by the insertion torque. Time-lapse migration of ISQ values was compared with IT groups. Each IT group displayed similar migration. A significant difference in The ISQ was found in the low IT group after 8 weeks
Figure 4. The classification of the insertion torque. All specimens classified into three groups according to insertion torque. Criteria for the classification are shown in the figure and in the “Methods” section
Figure 3. The evaluation of the average ISQ. Time-lapse migration of average ISQ. Average ISQ of all specimens increased in a time-dependent manner (results indicated by a line). A significant difference was observed by 6 weeks after surgery
Figure 2. The measurement of the voxel values. A case of bone quality diagnosis before treatment. Width and height of the bone were measured to select the proper size of the implant body. The selected implant body was simulated on the bone images as a symbol, and then the voxel value was calculated as described in the "Method" section
Figure 1. Genesio® Plus implant with Aanchor surface. Scheme of the dental implant body for the Genesio® Plus implants with Aanchor surface used. a Overview picture of Genesio® Plus implants with Aanchor surface. b Image from scanning electron microscopy. Both pictures were provided by GC Corporation. To obtain osseointegration from an early stage, the dental implant body was treated...
According to the measurement of the average voxel values in this study, a significant difference was seen between the high IT group and the low/medium IT group, but no significant difference was found between the low and medium IT groups (Fig. 7). Specimens showing IT ≥ 40 N cm were thought to have a good bone quality, and voxel values at each part of the implant (neck, middle apex) were...
A bone quality of the treated area may affect primary stability as described above, preoperative analysis of bone quality is important for clarifying the primary stability of dental implants. This study analyzed bone quality using voxel values obtained using Digital Imaging and Communications in Medicine (DICOM) data from CBCT. According to the result of that analysis, it was...
A significant difference was observed between 0 and ≥ 8 weeks (Fig. 5). The ISQ did not change significantly during the experimental period in the medium or high IT groups, but the percentage of high ISQ (≥ 73) specimens was significantly higher at 4 to 6 weeks compared to other time periods in both groups (Figs. 5 and 6). The results in this study suggest that if the...
Other studies have suggested that ISQ immediately after implant insertion should be about 60, with ISQ subsequently decreasing over weeks 0–4 and increasing over weeks 4–8 after surgery. ISQ values 57–70 may indicate that intraosseous stability of the implant body is constant.
Increases or decreases of ISQ values are explained as follows: The inserted dental implant bo...
The insertion torque value in this study showed broader (10 to 50 N cm) than the previous publication (Table 2), and the cause of reasons for the difference are as follows: Primary stability may be affected by the bone quantity and bone quality in the treatment area, the micro- and macro-level design of the implant body, and the accuracy of the surgical technique. In this ...
Discussion
According to the previous literature, the obtaining osseointegration is integral to the intraosseous stability of the implant body during the healing period; moreover, the importance of postoperative assessment of the intraosseous stability of the implant has also been reported. Intraosseous stability of the implant body is evaluated immediately after the implant ...
Average ISQ tended to increase during the healing period in all IT groups (Fig. 5). Average ISQ of the low IT group was 59.81 at 0 week, increasing significantly after ≥ 8 weeks (P
Methods
Research design and study participants
This prospective study was conducted jointly by Tokyo Dental College (Tokyo, Japan) and Fukuoka Dental College (Fukuoka, Japan) from January to December 2015. All study protocols were conducted in accordance with the Declaration of Helsinki and were approved by the ethics committees of Tokyo Dental College (approval #416) and Fukuoka Dental Colle...
Results
Study overview
A total of 33 implant bodies (8 in the maxilla, 25 in the mandible) were inserted into the 27 participants (11 men, 16 women), with the average age of 54.6 ± 12.2 years (range, 32–78 years). The average IT value was 32.7 ± 9.2 N cm (32.5 ± 11.6 N cm in the maxilla, 32.8 ± 8.5 N cm in the mandible). The diameter of the implant body wa...
Methods
Research design and study participants
This prospective study was conducted jointly by Tokyo Dental College (Tokyo, Japan) and Fukuoka Dental College (Fukuoka, Japan) from January to December 2015. All study protocols were conducted in accordance with the Declaration of Helsinki and were approved by the ethics committees of Tokyo Dental College (approval #416) and Fuku...
Background
Dental implant treatments have improved in both convenience and predictability with refinements in implant bodies and treatment procedures as compared to about 50 years ago when clinical applications were started. Currently, an implant body surface is treated with “rough processing” by sandblasting and acid etching for the purposes of obtaining more reliable osseo...
Abstract
Background
A current implant body surface was treated with “rough processing” by sandblasting and acid etching for the purposes of obtaining more reliable osseointegration and shortening the treatment period. Various reports have examined the healing period with the use of these implant bodies, but a consensus opinion has not yet been obtained. The purpose of this study is to eval...