cone beam CE

cone beam1_2012 I case study _ anterior mandible Figs. 1, 2_ Pre-op presentation. (Photos/Provided by Dr. Parmar) 26 I _Implant treatment in the anterior mandible has favourable long-term success rates when compared with other areas of the mouth (Gokcen- Rohlig et al. 2009). Placement of dental implants in the interforaminal area is considered a safe and predictable procedure. However, perforation of the lingual cortical plate canresultinaprofoundandpotentiallylifethreaten- ing sublingual bleed (Bucal 2008). The blood supply to this area is provided by the submental, 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 protru- sion of the tongue, resulting in airway obstruction andnecessitatesurgicalintervention.Ithasbeenrec- ommendedbyTepperetal.(2001)thatCTimagingof thisareaiswarrantedtovisualize3-Dboneanatomy prior to surgery, thereby reducing the possibility of surgical instrumentation of this sensitive area. This case report shall show how CBCT, coupled with chairside diagnostic imaging, has helped plan, simplify and execute implant placement in the ante- rior mandible. _Patient history A 44-year-old female who has been undergoing long term periodontal treatment presented with mobile and painful lower incisors. She exhibited very goodoralhygienebutwithaperiapicalareaandmo- bility associated with the UR4 and grade 2 mobility of her lower incisors. The patient described difficulty and embarrassment when eating due to the move- ment of her lower teeth and wanted a fixed solution. _Clinical examination The patient had a lightly restored dentition with a thin gingival biotype. As previously mentioned, her oral hygiene was good and she was a non-smoker (gave up 11 years previously). She exhibited bilateral canine guidance with no evidence of any parafunc- tion. Her BPE scores were 312/231. _Treatment options Duetothepatient’shistoryofperiodontaldisease and associated mobility, she was aware that some CBCT-assisted implant therapy Author_Nilesh R. Parmar, BDS (Lond), Msc (ProsthDent), Msc (ImpDent) Fig. 1 Fig. 2