Ministry of higher education and scientific research

Dijlah University
Department of dentistry

Radiographic imaging for dental implant assessment

Presented by :
Hussien ali ghaib
Hussien ali muhsan

Supervised By:
Assistant lecturer
Dr. Safa Hasan
 Supervisor Certification

This is to certify that this dissertation was organized and prepared by the
students hussien ali and hussien ali muhsan under my supervision in The
Department of Dentistry of Dijlah University College, as a requirement for
bachelor degree in Dentistry.

Supervisor’s signature:
Ass. Dr safa
2022
 Dedication

This study is wholeheartedly dedicated to our beloved

parents, who have been our source of inspiration and gave us
strength when we thought of giving up, who continually
provide their moral, spiritual, emotional, and financial
support. To our brothers, sisters, relatives, mentor, friends,
and classmates who shared their words of advice and
encouragement to finish this study. And lastly, we dedicated
this book to the Almighty God, thank you for the guidance,
strength, power of mind, protection and skills and for giving
us a healthy life. All of these, we offer to you
 Acknowledgement

I would like to express my thanks to my principal/Supervisor (dr

safa) for giving me a great opportunity to excel in my learning
through this project. have achieved a good amount of knowledge
through the research & the help that got from my Project Teacher
(dr saafa) Apart from this, I would like to express special thanks to
my parents who have supported me and helped me out in my project
despite their busy schedules.
ABSTRACT

The introduction of digital x-ray receivers which replaced conventional films was a
significant radiographic development that is commonly used in daily dental
practice. Dental implant therapy (DIT) is a sought after dental therapeutic
intervention and dental radiography is an essential component contributing to the
success of treatment. Dental radiographs taken in daily practice are generally
conventional two-dimensional images and/or three-dimensional images. Ideally,
the choice of radiographic technique should be determined after a thorough clinical
examination and comprehensive consideration of the advantages, indications, and
drawbacks.
Digital three-dimensional modalities that have emerged over the last decade have
been incorporated into DIT with the assumption that treatment outcomes will be
improved. These modalities are constantly being reassessed and improved but there
is a paucity of published information regarding the assessment of variables such as
dosages and dimensional accuracy, suggesting that further research in these matters
is necessary. This is crucial in order to obtain evidence-based information that may
influence future radiographic practices.
Table of Contents

1. Implant 1

1.1 Structure of implant 3

1.2 Osseointegration 5

2. Current maxillofacial radiographic 6

technologies

2.1 Conventional two dimensional techniques 10

2.1.1 Intraoral periapical radiograph 10

2.1.2 Lateral cephalometric radiography 12

2.1.3 Panoramic radiographs 13

2.2 Three dimensional radiographic techniques 14

2.2.1 Magnetic resonance imaging 14

2.2.2 Computed tomography 15

2.2.3 Cone beam computed tomography 17

3. Phases of dental implant therapy where 18

radiographic modilites are indicated

3.1 Radiographic examination: Planning phase 19

3.2 Radiographic examination:surgical phase 22

3.3 Radiographic examination: Restorative phase 23

3.4 Radiographic examination: maintenance phase 24

c

List of figures
Number Title Page
of
figures
Fig.(1) (a, b, and c) show diagrammatic representation of the biological 2
differences between an implant and a tooth in longitudinal section
Fig.(2) Structure of the dental implant 4
Fig.(3) Difference between teeth and implants; Good blood flow and nerves 5
in interface of teeth but not so around titanium that shows
condensation of bone instead
Fig.(4) Intraoral periapical radiograph showing implant 11
Fig.(5) Lateral cephalometric radiography 12
Fig.(6) Postoperative panoramic radiograph following sinus 13
augmentation along with the placement of dental implants
Fig.(7) Post-implantation assessment. Post implantation assessment of 14
zirconia and titanium implants in porcine mandible specimen,
comparing magnetic resonance imaging (MRI) and micro-CT
maging.
Fig.(8) Coronal section of computed tomography 16
scan demonstrating dental implant protruding approximately 5 to 6
mm into
right maxillary sinus. Opacification of right maxillary and ethmoid
sinus are also seen
Fig.(9) Dental Implants Displaced into the Mandibular Corpus 17
Fig.(10) The implant planning process is 21
performed using panoramic radiography
(PAN) (A) and cone-beam computed
tomography (CBCT). (B) Images of a
32-year-old woman. After careful eval-
uation of the 3D data, an appropriate
is treatment plan is developed, as seen in
the cross-sectional images. The bone
width is not evident on the PAN image,
whereas a possible fenestration can be
predicted thanks to the availability of
CBCT.
Fig.(11) Surgical phase. Panoramic radiographs (A) of the ameloblastoma at 22
the right side of the mandible, (B) of the ameloblastoma after
mandibulotomy and
nerve repositioning, and (C) of the reconstructed mandible with the
distractor. (D) Recurrence of the ameloblastoma. (E) Panoramic
radiograph of the mandible after
implant placement. (F) Lateral view of the mandible. There was no
available space due to the overgrown mucosa. Poor oral hygiene was
 observed at the healing.
Fig.(12) Restorative phase. (A) Casted abutments and bar attachments. (B) 23
Metal framework try-in. (C) Occlusal view of the implant
superstructures. (D) Frontal
view of the definitive prosthesis. (E) Occlusal view of the implant -
assisted removable partial denture (F) Panoramic radiograph at the
3-year follow-up visit.
List of abbreviation

 DIT: Dental implant therapy

 CT: computed tomography
 CBCT:cone beam computed tomography
 IPR : intraoral periapical radiography
 LCR: lateral cephalometric radiography
 PAN: panoramic radiography
 MRI: magnetic resonance imaging
 AAOMR: American academy of oral and maxilofacial radiology
 E.A.O: European association for osseointegraio
Introduction

Dental implant therapy (DIT) is a valuable and highly successful dental

intervention that intends to replace missing teeth.( Moraschini , 2015)( Tyndall,
Brooks ;2000)
This therapy has become increasingly popular and substantial numbers of dental
implants are placed and restored every year.( Boyce, Klemons ; 2015)

The discovery of X-rays in 1895 by Wilhelm Röntgen, ( Shah et al , 2014 ) has

revolutionized dental and medical therapies and imaging during various phases of
dental implant therapy has a vital role in its success.(Tyndall ,Brooks ,2000),
( Nagarajan et al , 2014),(Gupta , et al ,2015 ).

Different imaging techniques are used during DIT which have various advantages
and disadvantages. The authors present the most common dental radiographic
modalities that are currently used during DIT.

1-Implant

Modern implant dentistry started more than 50 years ago when Dr. PI. Bränemark,
a Professor from the University of Gothenburg (Sweden), discovered in
rabbit studies that titanium chambers placed in the fibula became firmly
anchored
in bone and could not be removed. Later, this direct bone-to-implant contact was
termed osseointegration (bonanthaya et al. 2021). He demonstrated that
titanium was structurally integrated into living bone with a high degree of
predictability and without long-term soft-tissue inflammation or fixture rejection.
He introduced a two-stage threaded root form pure titanium implant

1
that was placed in patients in 1965. Therefore, Prof. P.I. Bränemark is recognized
as the most important pioneer in modern implant dentistry.

The second pioneer is Prof. Andre Schroeder from the University of Bern
(Switzerland) experimented with prototype dental implants in the early 1970s and
could demon strate first osseointegration in nondecalcified
histologicnsection(bonanthaya et al. 2021). Both pioneers with their teams,
independent ofeach other, performed several preclinical and clinical studies to
establish the current scientific basis for dental implantology. This was the start to
successful osseointegration indentistry.( as in the figure 1)

Fig.(1) osseointegeation dental implants ( Mavrogenis et al. 2009)

2
1.1Structure of dental implant

The structure of the implant, with all the elements and characteristics that
compose it, is referred to as the implant design.The type of prosthetic interface, the
presence or absence of threads, additional macroirregularities, and the shape
outline of the implant are considered some of the most important aspects of
implant design. Dental implants can be categorized into threaded and nonthreaded,
cylindric, or "press-fit" designs. Implant companies have been using a plethora of
additional features to accentuate or replace the effect of threads. These features
include vents, grooves, flutes, indentations, and perforations of various shapes.
Implants can be hollow or solid, with a parallel, tapered/conical, or stepped
shape/outline and a flat, round, or pointed apical end.(Sykara et al 2000)

The macrodesign or shape of an implant has an important bearing on the bone

response; growing bone concentrates preferentially on protruding elements of the
implant surface such as ridges, crests, teeth, ribs, or the edge of threads, which
apparently act as stress risers when load in transferred. (Schenk,Buser 2000), The
shape of the implant determines the surface area available for stress transfer and
governs the initial stability of the implant. Finite element analysis studies of
implants indicate that bone stress distributions and magnitudes vary with implant
shape. (Rieger,Bayberry 1990)(Rieger et al 1989)

3
Figure(2) The components of the micro-locking implant prosthetic
system. (a) Body; (b) ball involved in retention; (c) ball
involved in preventing spring rotation; (d) spring; (e) cap;
(f) retention groove.(kim et al 2007)

4
1.2 Osseointegration: The apparent direct attachment or connection of osseous
tissue to an inert, alloplastic material without intervening connective tissue Direct
bone anchorage to an implant body, which can provide a foundation to support
prosthesis (Branemark, 1983)

Figure(3) Difference between teeth and implants; Good blood flow and nerves
in interface of teeth but not so around titanium that shows condensation of bone
instead ( Albrektsson et al 2014 )

5
2. CURRENT MAXILLOFACIAL RADIOGRAPHIC
TECHNOLOGIES
Various imaging techniques are employed during dental implant therapy including
the conventional two-dimensional examinations namely, intraoral periapical,
panoramic, and lateral cephalometric radiographs, and the more sophisticated
three-dimensional x-ray volumes such as Computed Tomography (CT), Cone-
Beam Computed Tomography (CBCT)). Each radiographic technology has
indications, advantages, and disadvantages.

2.1 Conventional two-dimensional techniques

2.1.1 Intraoral periapical radiography (IPR)
IPR is a widely used imaging technique that exposes a limited number of teeth.
( Gupta et al.; 2014)
In daily practice, these radiographs are used to evaluate the teeth’s architecture,
position, boundaries, caries detection, and the status of the periapical regions.
( Gupta et al.; 2014)
During implant therapy, the IRPs are popular and indicated for potential implant
site assessment and during the post-implant assessment.( Deshpande ,Bhargava
2014) (Tyndall et al.2012(

IPR has multiple advantages during implant therapy and is widely available, cost-
effective, provides images with high spatial and contrast resolutions, and allows for
the assessment of potential implant site boundaries in the vertical and mesiodistal
dimensions.( Nagarajan et al. 2014)( Gupta et al. 2015), ( Tyndall , et al, 2012 ) .
Although IPR usually produces only nominal geometrical distortion.
this geometrical precision can be vary depending on the patients' compliance and
operator skills.(Tyndall et al.2012)
Due to the technical challenges, the dimensional accuracy obtained for wide
edentulousness bone segments on the IRP can be inconsistent and less reliable.
(Tyndall et al.2012)
One of the main disadvantages of the technique is the lack of cross-sectional
images of the region of interest. (Tyndall et al.2012)

The lack of this information compromises the optimal assessment of the quality
and quantity of the bone structures of the potential implant site, moreover, the

6
anatomical relation with the vital structure in the vicinity of the surgical site may
not be accurately revealed. ( Gupta et al. 2015)

Figure 4: Intraoral periapical radiograph showing implant

.) Mishra et al 2013)

7
2.1.2 Lateral cephalometric radiography (LCR)
LCR is a conventional, two-dimensional radiographic technique that depicts the
lateral aspect of the maxillofacial region. (Tyndall et al.2012)
This view provides the clinicians with information about the teeth inclination, jaws
relationships, and the soft and hard tissue profile of the patient.( Agrawal et al.
2014)

Although the use of LCR during DIT is not very popular, (Tyndall et al.2012)
it may be indicated in order to plan implant treatments in the edentulous midline
areas; as this radiograph provides a cross-sectional view of these anterior regions.
(Tyndall et al.2012) ( Agrawal et al. 2014)

This view allows a suitable evaluation of the bone quantities in both dimensions
(buccolingual and vertical planes of the anterior alveolar ridges), particularly that
the LCR has a constant magnification ratio. (Tyndall et al.2012)
Disadvantages of this technique during DIT also exist and include the
superimposition of the anatomical structures, teeth and bone, lies in the opposite
side of the jaw. Uncertain assessment of bone quality and geometric distortion can
be encountered if a patient is incorrectly positioned. ( Nagarajan et al. 2014)
( Gupta et al. 2015) ( Agrawal et al. 2014)

Figure 5. Lateral cephalometric radiography.(González-

Garcia A et al. (2012)

8
2.1.3 Orthopantomography or panoramic radiography (PAN)
Panoramic radiographs are a widely used imaging technique that shows a
panoramic view of the maxilla and mandible. ( White, Pharoah , 2013 )This
modality is unique as only anatomical structures that lie inside a three-dimensional
horseshoeshaped zone, namely the focal trough, are depicted clearly on the
radiograph.( White, Pharoah, 2013 ) .

Panoramic radiographs are commonly used in various treatment phases during

DIT. (Tyndall et al.2012)
These radiographs are indicated during the initial evaluation of the potential
implant site and the adjacent structures(Tyndall et al.2012)
,( Lingam , et al , 2013 ) and frequently prescribed directly after the surgical
placement of several implants and during further follow-up. (Tyndall et al.2012),
(Harris , et al, 2011 ).

PAN provides a broad view of the jaws, is relatively less expensive, and is widely
available.( Gupta , et al, 2015 ),(Tyndall et al , 2012 ) , (Lingam, et al, 2013) ,
(Manisundar , et al , 2014 ). Nevertheless, these radiographs can be compromised
due to geometrical distortion and inherent magnification, reproducibility
challenges, uncertainties in bone density assessment, lack of cross-sectional
images, inferior resolution compared with intraoral radiographs, and greater
technique sensitive., ( Nagarajan et al. 2014),( Gupta et al. 2015),( Tyndall, et al,
2012 ) ,(Manisundar, et al , 2014 ).

The head position during the acquisition of these radiographs is critical particularly
during implant planning as any minor deviation can result in magnification (15-
22%) and image distortion. ( Gupta et al. 2015),(Karjodkar, 2009 ) .

Figure 6. Postoperative panoramic radiograph following sinus

augmentation along with the placement of dental implants.
(seung-bum et al) 2010

9
2.2Three-dimensional radiographic techniques
2.2.1 Magnetic resonance imaging (MRI)
MRI is a sophisticated imaging technique that uses a non-ionizing magnetic field
and radio waves to reconstruct cross-sectional images. ( Nagarajan et al. 2014),
( Gray et al ,2003 ). The use of this modality in dental fields including implant
therapies are limited, nonetheless, it can be beneficial to use during the planning
phase. (Tyndall et al.2012)

Disadvantages like higher costs, prolonged acquisitions time, challenges of volume

interpretation, poor characterization of bone minerals, artifacts from ferromagnetic
metals, and contra-indication for certain patients (e.g. cardiac pacemaker, surgical
clips in situ) contributed to its limited use in DIT.(Nagarajan, 2014 ),(Tyndall, et
al, 2012 ),( Gray et al ,2003 ).

Figure(7) Post-implantation assessment. Post implantation

assessment of
zirconia and titanium implants in porcine mandible specimen,
comparing magnetic resonance imaging (MRI) and micro-CT
maging.(eggers et al 2005)

10
2.2.2 Computed tomography (CT)
CT is a three-dimensional imaging technique that was developed by Hounsfield
(1972). (Hounsfield , 1973 ) .This modality improved the diagnostic capability of
clinicians in medicine and dentistry
The CT units generate a fan-shaped X-ray beams that are received by multiple
detector arrays where the remaining beam intensities are measured.(Tyndall et al ,
2012 ),(White , Pharoah , 2013 ). These intensity values are incorporated into
mathematical algorithms in order to reconstruct multiplanar images.(White ,
Pharoah , 2013 ) .

The use of CT scans during DIT is indicated during the planning phase, in
particular, complex cases where the implant site is in close proximity to vital
structures and the quantity of the bone is less than optimal. CT scans are also
indicated when bone augmentation procedures are needed in sinuses and alveolar
ridges, during computerguided surgeries, and in post-operative complications.,
(Tyndall et al.2012),( Harris , et al, 2011 ).

CT scans are considered advantageous during implant therapy; as this modality

provides three-dimensional multi planar views, accurate dimensions, and optimal
resolution of the potential implant site and the surrounding structures.(Tyndall , et
al, 2012 ),(Serram, 2009 ) CT scans also allow for reliable quantitative and
qualitative bone assessment, vital for the success of DIT, before implant surgery., (
Gupta et al. 2015) (Tyndall et al.2012)
The main drawbacks of this technique are the generation of high radiation doses
compared with conventional radiographs, less availability, higher cost
implications, and possible volume artifacts that may arise from metallic objects
and patient movement.(Nagarajan , et al , 2014 ), (Tyndall et al.2012)

11
FIGURE 8. Coronal section of computed tomography
scan demonstrating dental implant protruding approximately 5 to 6 mm into
right maxillary sinus. Opacification of right maxillary and ethmoid
sinus are also seen.( Hunter et al. 2009)

12
2.2.3 Cone beam computed tomography (CBCT
CBCT is a relatively recent three-dimensional imaging modality that uses a cone-
shaped x-ray beam and digital x-ray receivers to reconstruct multiplanar images
using special algorithms. (Tyndall et al.2012)
The commercial use of this techniquein dentistry began in 1999 in Europe and is
now a vastly popular imaging modality in the dental practice. (Tyndall et al.2012)

The use of CBCT scans during DIT is indicated during the planning phase
especially complex cases involving proximity of vital structures and low bone
quantity, in cases where bone augmentation procedures are needed in sinuses and
alveolar ridges, during computer-guided surgeries, and in post-operative
complications., (Tyndall et al.2012),(Harris , et al, 2011 ).

The use of the modality during DIT has been growing exponentially as it is readily
available and easy to use., (Tyndall et al.2012),(Jacobs et al , 2018 ).
lower radiation doses when compared to CT’s, high spatial resolution, dimensional
accuracy, cheaper unit cost (compared to CT) . (Tyndall et al.2012),(Sahai , 2015 ),
(Fokas , et al , 2018 ) .
CBCT is advantageous in potential implant site assessment as it provides
comprehensive anatomical details allowing accurate surgical planning and possible
integration with guided surgical techniques.(Jacobs, et al , 2018 )

The drawbacks of CBCT include poor soft-tissue contrast, higher radiation doses
when compared with conventional techniques, beam hardening artifact when
metallic objects are present, and extra cost implications. (Tyndall et al.2012)

Figure(9) Dental Implants Displaced into the

Mandibular Corpus (Antonio Scarano et al )
2018

13
3. PHASES OF DENTAL IMPLANT THERAPY WHERE
RADIOGRAPHIC MODALITIES ARE INDICATED

The quality and quantity of the anatomical details gathered via dental imaging of
the potential implant site influences the success of DIT. Information on the jaw
bone anatomy, the quantity and the quality of the alveolar ridge, detection of
underlying pathologies, and demarcation of the vital anatomical structure in the
vicinity of the implant site can be acquired., ( Nagarajan et al. 2014)( Gupta et al.
2015)(Lingam et al . 2013 ) ,(Karjodkar .2009 ) .

Various factors influence the selection of a suitable imaging technique during DIT.
These include the amount of anatomical detail required for the treatment, the
amount of information gathered through clinical evaluation of the patient,
variations in the clinical judgments among clinicians, radiation concerns, and
patient-related factors such as esthetic demands and complications risk
assessment., ( Agrawal et al. 2014) ,(Bornstein et al. 2014)

14
3.1 Radiographic examination: Planning phase
Thorough planning is a prerequisite for successful dental implant treatment and
this decreases the risk of potential postoperative complications. During this stage
of treat-ment, the clinician acquires pre-operative vital clinical information on the
potential implant site.

Dental imaging plays a major role during this phase as it provides information
relating to the potential implant site which includes the alveolar ridge dimensions,
the quality of the bone, the spatial relationship of the implant site and other vital
structures, determination of the required number of implants, and assessment of the
prosthetic needs. ( Nagarajan et al. 2014 )( Gupta et al. 2015 )

Various imaging techniques are being used during this phase including
conventional two dimensional to more sophisticated three-dimensional views,
(Tyndall ,Brooks . 2000 )

Other technical aspects also play a role in this decision and include related costs,
accessibility and availability of certain imaging techniques, and radiation exposure
levels.(Gupta et al .2015 )

The Intraoral periapical radiographs (IRP) are very commonly used during this
phase to initially assess the potential implant sites, appreciation of vital structures,
and the discovery of any pathologies in the region of interest. ( Nagarajan et al.
2014)( Gupta et al. 2015 )

Panoramic radiographs are another example of widespread two-dimensional

examinations utilized during this phase. Several published reports indicate the
beneficial use of panoramic radiographs during implant treatments (Vazquez et
al.2008),(Assaf , Gharbyah . 2014 )

The leading prescription of panoramic examinations during implant therapy is

documented in multiple surveys conducted in various geographical parts of the
world.( Sakakura et al , 2003 ) , (Rabi , et al , 2017 )

These examinations are considered simple, widely available, less costly, and
expose the patients to only low radiation doses (compared with CT/CBCT).
(Vazquez et al . 2008) –(Assaf , Gharbyah , 2014 )

15
MRI is advantageous during treatment planning in cases where the identification of
the neurovascular bundles was not precisely identified using other radiographic
techniques.

During the last decade, CBCT has become increasingly employed during several
dental procedures in particular during implant planning, especially in that it
exposes the patients to lower radiation doses when compared to the traditional CT.(
Jacobs et al , 2018) ,( Deeb et al , 2017 ), ( Chau , Fung , 2009 )

The use of CBCT during implant planning is advantageous as this imaging

technique delivers distortion and superimposition free multi-planar images that
allow for precise assessment and measurements of the potential implant sites.
( Agrawal et al. 2014) , ( Fokas et al ,2018 )

If computer-guided implant surgery is indicated, threedimensional examinations

such as CBCT and/or CT are mandatory. ( Flugge et al ,2017 )The surgical and
prosthetic phases of implant treatment can be virtually simulated by integrating
CBCT and/or CT volumes in the implant planning software.( Colombo , et al ,
2017 ) Interactive virtual implant surgery can be simulated and adjusted the
quantity of the available bone, circumvent vital structures, and predict prosthetic
and esthetic needs.( Colombo , et al 2017 ),( Grunder , et al , 2005 ) .

16
Fig.10 . The implant planning process is
performed using panoramic radiography
(PAN) (A) and cone-beam computed
tomography (CBCT). (B) Images of a
32-year-old woman. After careful eval-
uation of the 3D data, an appropriate
is treatment plan is developed, as seen in
the cross-sectional images. The bone
width is not evident on the PAN image,
whereas a possible fenestration can be
predicted thanks to the availability of
CBCT.( Maria-Eugenia Guerrero et al
2014)

17
3.2 Radiographic examinations: Surgical phase (Intra-operative)
Imaging during this phase of treatment i.e. during and directly after surgery, is
indicated to confirm the accurate placement of the implant within the planned
surgical site and to ensure an ideal position for the prosthetic restoration to follow.
( Nagarajan et al. 2014),( Gupta et al. 2015)

Conventional two-dimensional images are commonly used during this phase such
as Periapical and panoramic radiographs, though periapical radiographs are usually
considered adequate for this stage., ( Gupta et al. 2015), ( Harris , et al , 2011 ) .

The justification to use CBCT in this phase according to the American Academy of
Oral and Maxillofacial Radiology (AAOMR) is confined to cases where there is an
alteration in the patient’s sensory perception and implant mobility. (Tyndall , et
al.2012)

Figure 11. Surgical phase. Panoramic radiographs (A) of the ameloblastoma at

the right side of the mandible, (B) of the ameloblastoma after mandibulotomy
and
nerve repositioning, and (C) of the reconstructed mandible with the distractor.
(D) Recurrence of the ameloblastoma. (E) Panoramic radiograph of the
mandible after
implant placement. (F) Lateral view of the mandible. There was no available
space due to the overgrown mucosa. Poor oral hygiene was observed at the
healing.( Lee et al. Medicine (2019)
abutments.

18
3.3 Radiographic examinations: Restorative phase

In this stage, the functional restoration is fabricated and integrated with the
implant. Periapical radiographs are commonly utilized in this phase and aid in the
assessment of the osteointegration of the fixture with the surrounding bone.
This radiograph also contributes as a baseline radiograph, particularly for future
bone attachment level comparisons, and the evaluation of the mechanical
integration of the different implant components. ( Wadhwani et al ,2012 ) .

It has also been reported that digital periapical radiographs revealed a greater
potential in which misfit of the implant-abutment surface could be detected when
compared to the analogue counterparts. ( Oliveira , et al 2016 ) .

Figure 12. Restorative phase. (A) Casted abutments and

bar attachments. (B) Metal framework try-in. (C)
Occlusal view of the implant superstructures. (D)
Frontal
view of the definitive prosthesis. (E) Occlusal view of
the implant -assisted removable partial denture (F)
Panoramic radiograph at the 3-year follow-up visit.
( Lee et al. Medicine (2019)

19
3.4 Radiographic examinations: Maintenance phase (Post-
prosthetic)
This phase commences directly after the completion of the prosthetic phase and
lasts throughout life as long as the implant is present in the patient’s mouth.
( Nagarajan et al. 2014),( Gupta et al. 2015) .

Radiographs are indicated in this phase to ensure and monitor peri-implant

osteointegration, evaluate the bone levels, and assess the overall status of the
implant, restoration, and surrounding periodontium.( Nagarajan ,et al ,2014 ),
(Tyndall et al.2012)

Conventional two-dimensional imaging techniques like intraoral periapical

radiograph (IPR) or panoramic radiographs especially in instances where the
patient received multiple implants, are recommended by AAOMR to suffice this
phase of treatment. (Tyndall et al.2012)
IRP is considered more advantageous to evaluate the peri-implant region
compared to CBCT; as the metallic nature of the implant body causes radiographic
artifacts (i.e. beam hardening) in the resultant CBCT volumes, which hinders the
precise evaluation of the region of interest. (Tyndall et al.2012)

Although in most cases conventional imaging is sufficient for the assessment, in

the presence of complications related to the procedure like alteration in the
sensation and persistent maxillary sinus infections, the European Association for
Osseointegration (E.A.O) justifies using CBCT for further investigation.( Harris D,
et al , 2011 ).
Additionally, a clinician should consider the limitation of two-dimensional
radiographs as they do not reveal the status of bony structures that lie in the buccal
and lingual/palatal aspect of the implants.( Wadhwani , et al , 2012 ), (Cassetta , et
al , 2018 ).

20
CONCLUSION

Various imaging techniques are being used during different phases of dental
implant therapy. The selection of a certain radiographic examination should be
done after a thorough clinical evaluation of the patient including dental and
medical history. Radiographic modalities used during implant therapy vary in the
indications, advantages, and disadvantages offered, considering these factors aids
in the appropriate selection of the examination that suffices the phase of the
treatment.

The three-dimensional views are advantageous during DIT, but still yields a
considerable amount of radiation compared to conventional counterparts, )Davies
et al ,2018) which is a concern since this modality is fast becoming a routine and
popular procedure in various parts of the world.(Noffke et al,2011) Continuous
updates on the most recent radiographic techniques, dimensional accuracy of
radiographic modalities, and radiation doses would assist the radiation authorities
to establish imaging protocols that ensure clinical efficacy and expose the patient
to the least radiation doses.

21
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survival and success rates of dental implants reported in longitudinal studies with a
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2. Tyndall DA, Brooks SL. Selection criteria for dental implant site imaging: a
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 ‫خالصة‬

‫يعد إدخال األشعة السينية الرقمية التي حلت محل األفالم التقليدية تطورًا شعاعيًا مه ًما يستخدم بشكل‬
‫شائع في الممارسات اليوميه لطب األسنان ‪ .‬يُعد العالج بزراعة األسنان امراً مهما ً بعد التدخل‬
‫العالجي لألسنان ويعتبر التصوير الشعاعي لألسنان مكونًا أساسيًا يساهم في نجاح العالج‪ .‬الصور‬
‫الشعاعية لألسنان المأخوذة في الممارسات‪  ‬اليومية لطب االسنان هي بشكل عام صور ثنائية األبعاد و‬
‫‪ /‬أو صور ثالثية األبعاد‪ .‬من الناحية المثالية ‪ ،‬يجب تحديد اختيار تقنية التصوير الشعاعي بعد فحص‬
‫سريري شامل ودراسة شاملة للمزايا والمؤشرات والعيوب‪.‬‬
‫تم دمج الطرائق الرقمية ثالثية األبعاد التي ظهرت خالل العقد الماضي فيمع افتراض أنه سيتم تحسين‬
‫نتائج العالج‪ .‬يتم إعادة تقييم هذه الطرائق وتحسينها باستمرار ولكن هناك ندرة في المعلومات‬
‫المنشورة بشأن تقييم المتغيرات مثل الجرعات ودقة األبعاد ‪ ،‬مما يشير إلى ضرورة إجراء مزيد من‬
‫البحث في هذه األمور‪ .‬هذا أمر بالغ األهمية من أجل الحصول على المعلومات القائمة على األدلة التي‬
‫قد تؤثر على ممارسات التصوير الشعاعي في المستقبل‪.‬‬

‫‪26‬‬
‫التقييم الشعاعي لزراعة االسنان‬

‫حسين علي غايب‬

‫حسين علي محسن‬

‫‪27‬‬