Dental Tribune United Kingdom Edition

CBCT assisted implant therapy - a case study page 14DTà Nilesh Parmar describes how CBCT can help in treatment planning and execu- tion in the lower mandible I mplant treatment in the anterior mandible has fa- vourable long-term suc- cess rates when compared with other areas of the mouth (Gokcen-Rohlig et al. 2009). Placement of dental implants in the interforaminal area is considered as a safe and pre- dictable procedure. Howev- er, perforation of the lingual cortical plate can result in a profound and potentially life threatening sub-lingual bleed (Bucal 2008). The blood supply to this area is provided by the submen- tal, sublingual and mylohyoid arteries which if perforated, may set-off a massive internal haemorrhage in the floor of the mouth. Although rare, this can ultimately cause protrusion of the tongue resulting in air- way obstruction and neces- sitate surgical intervention. It has been recommended by Tepper et al (2001) that CT im- aging of this area is warranted to visualize 3D bone anatomy prior to surgery, thereby re- ducing the possibility of sur- gical instrumentation of this sensitive area. In this case report I shall show how CBCT coupled with chairside diagnostic imaging has helped plan, simplify and execute implant placement in the anterior mandible. Patient History A 44-year-old female who has been undergoing long term periodontal treatment pre- sented with mobile and pain- ful lower incisors. She exhib- ited very good oral hygiene but with a periapical area and mobility associated with the UR4 and grade 2 mobility of her lower incisors. The pa- tient described difficulty and embarrassment when eat- ing due to the movement of her lower teeth and wanted a fixed solution. Clinical examination The patient had a lightly restored dentition with a thin gingival biotype. As previ- ously mentioned, her oral hy- giene was good and she was a non-smoker (gave up 11 years previously). She exhibited bi- lateral canine guidance with no evidence of any parafunc- tion. Her BPE scores were 312/231. Treatment options: Due to the patients’ history of periodontal disease and as- sociated mobility, she was aware that some form of re- placement was necessary. The patient did not want a remov- able restoration and preferred a fixed solution. In this area of the mouth either fixed bridgework or an implant re- tained prosthesis were pos- sible. After discussing the op- tions, and highlighting the increased risk of peri-implanti- tis of implants in patients with previous periodontal disease, (Esposito 2006) the patient opted for a fixed implant re- tained solution. The treatment was to be planned in such a way that if she lost her poste- rior molars in the future, a full arch fixed prosthesis could be made after subsequent implant placement. Treatment Plan: 1Continuation of periodon- tal treatment and oral hygiene advice 2CBCT Sirona Galileos scan to assess bone height, bone profile and associated anatomy 3Extraction of all four low- er incisors and the UR4 4Placement of two Strau- mann SLA active implants 5Restoration with a Screw retained 4 unit PFM bridge. CBCT It was decided to take a full volume CBCT to further assess the upper teeth and the UR4 for future implant Pre-op presentation ‘The patient described difficulty and embarrassment when eating due to the movement of her lower teeth and want- ed a fixed solution’ Implant Tribune