cone beam international magazine of cone beam dentistry

32 I I case report _ CBCT in implant dentistry _Implanttreatmentintheanteriormandiblehas favourable long-term success rates when compared with other areas of the mouth (Gokcen-Rohlig et al. 2009). Placement of dental implants in the inter- foraminal area is considered a safe and predictable procedure.However,perforationofthelingualcorti- calplatecanresultinaprofoundandpotentiallylife- threateningsublingualbleed(Bucal2008).Theblood supplytothisareaisprovidedbythesubmental,sub- lingual and mylohyoid arteries, which if perforated may set off a massive internal haemorrhage in the floor of the mouth. Althoughrare,thiscanultimatelycauseprotrusion of the tongue, resulting in airway obstruction and necessitating surgical intervention. It has been sug- gested by Tepper et al. (2001) that CT imaging of this area is warranted for visualising 3-D bone anatomy prior to surgery, thereby reducing the possibility of surgical instrumentation of this sensitive area. Inthiscasereport,IshallshowhowCBCTcoupled with chairside diagnostic imaging can help in plan- ning, simplifying and executing implant placement in the anterior mandible. _Patient history A 44-year-old female patient who was under- going long-term periodontal treatment presented withmobileandpainfullowerincisors.Sheexhibited very good oral hygiene but with a periapical area and mobility associated with tooth #14 and Grade II mobility of her lower incisors. The patient described difficultyandembarrassmentwheneating,owingto themovementofherlowerteethandwantedafixed solution. _Clinical examination The patient had a lightly restored dentition with a thin gingival biotype. As previously mentioned, her cone beam1_2014 Figs. 1 & 2_Pre-op presentation. Fig. 3_Maximum intensity projection using Sirona GALILEOS. Fig. 4_A CBCT scan with a CEREC Bluecam overlay showing the ideal final result. Fig. 5_Stage 1 of implant placement, with healing abutments in place. CBCT-assisted implant therapy:Acase study Author_ Dr Nilesh Parmar, UK Fig. 5 Fig. 6 Fig. 4 Fig. 1 Fig. 2 Fig. 3 CBE0114_32-34_Parmar 31.01.14 15:52 Seite 1