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ePaper created 2016-03-24, 17:16:09 | version 1.38.0
a flap for better post-operative healing.13 Traditionally, we do not require CBCT im- ages for a single implant placement.14 However, this case signifies the impor- tance of 3-D imaging in certain situations like deep SF (Fig. 11). When the bone width is narrow, perios- teal elevation is recommended to be able to safely observe the osteotomic drills as they reach to the final depth. This proce- dure is only advised when a panoramic image is the only diagnostic tool we have as it adversely causes further bone loss during the healing phase.13 In the present case, no periosteal elevation was per- formed (Fig. 6) and the patient did not have post-operative pain and swelling. CBCT is a modern technology, which al- lows the three-dimensional evaluation (sagittal, axial and coronal) of maxillofa- cial structures. Among its many advan- tages are the absence of superimposition of structures in obtained slices, acquisi- tion of a 3-D reconstruction (spatial vision for illustrative purpose), as well as the use of lower radiation doses in comparison to medical CT.15–17 SF location, size, shape and its possible variations can be fully as- sessed by CBCT.2,3,18-22 Due to the limita- tions of periapical and panoramic tech- niques, the radiographic assessment of SF is not always available. Jacobs et al. re- ported that SF was detected in 94% of their assessed panoramic radiographs, but only 49% of those were clearly visi- ble.23-25 Therefore, it can be reasonably concluded that the lack of observation of SF in conventional radiograph does not prove its actual absence. In our reported case, we were able to evaluate the mandible of the patients in 3-D and here SFs were actually deeply prominent and hypoplastic. Also, it was impossible to perform the surgery with- out 3-D imaging. A preoperative imaging study is important prior to any surgical procedure in the posterior mandibular re- gion.2,8 CBCT can be very helpful for the detection of SF variations that could be otherwise missed using conventional ra- diographic examination techniques.2,5,7,10 In the present case, the diagnosis of the anatomic limitation was possible to be vi- sualised due to CBCT examination. Fur- thermore, the accurate measurements of SF and the vision of 3-D spatial recon- structions, which are exclusive tools of Fig. 8: Panoramic radiograph, one-year post-op. Fig. 9: Bone width lingual wall 1.9 mm and buccal 2.5 mm. Fig. 8 Fig. 9 the revolutionary bovine bone graft composite Hypro-Oss ® Bioimplon GmbH Friedrich-List-Str. 27 35398 Gießen +49 (0)641 6868 1123 www.bioimplon.de each granule is a composite of 30% Atelo-Collagen Type I, 70% hydroxyapatite atelopeptidized, free of antigenic telopeptides haemostatic and bacteriostatic properties bioactive growth factors natural crystalline structure of hydroxyapatite component no need for steroids as anti-haematoma medication excellent handling due to sticky Atelo-Collagen components highest quality of new bone formation conductive and inductive properties AD 1.90 2.50 +49 (0)64168681123