Diagnostic methods
1-Diagnostic imaging:
The appropriate radiographic examination for the proposed treatment should be performed in order to highlight possible pathologies and to evaluate the hard tissues, but also as an aid to the treatment plan.
A complete radiographic assessment makes it possible to evaluate the available bone volume as well as the bone quality of the sites to be implanted.
To make a therapeutic decision, various radiological examinations are necessary.
Panoramic radiography and retroalveolar images can be produced using film or digital techniques. Advances in digital radiography have made it widely available to a large number of practitioners.
Digital mode uses different technologies:
-CCD (charged coupled device) sensors;
-CMOS (complementary metal oxide semiconductor) sensors;
-radioluminescent memory screens (ERLM).
Diagnostic methods
Its advantages over silver radiography are numerous :
-no constraints on developing the silver image (no more need for a “dark room” or chemicals, better management and disposal of waste);
-reduction of doses and exposure time to X-rays;
– possibility of manipulating the digital image (contrasts, formats, etc.);
– storage of images and integration into a computer file;
-exchange of data by remote transmission between practitioners.
Its disadvantages must also be taken into consideration :
– high cost of equipment and maintenance costs;
– sensor more difficult to handle than a conventional film;
– non-sterilizable sensors (hygiene precautions);
-image work in limited specific formats;
– temptation to multiply the shots, thereby leading to an increase in the patient’s exposure.
- Panoramic X-ray:
The panoramic dental image allows you to visualize the jaws and dental arches including the temporomandibular joints and the maxillary sinuses, it highlights
– various dental and bone pathologies;
-available bone height;
-the relationships between the edentulous site and the anatomical obstacles.
A good OPT ( Orthopantomography) – or panoramic dental pantomography – gives the clinician a global view of the oral cavity.
The presence of pathologies and anatomical obstacles in an image of teeth provides invaluable assistance in diagnosis.
- Periapical radiographs :
Periapical radiographs provide details of the area to be evaluated. The structure, periodontal health and endodontic diagnosis of the teeth can be observed.
Bone levels of edentulous ridges and their relationships to adjacent teeth can be accurately measured, as can residual roots and pathological elements not clinically detectable.
These radiographic examinations are indicated for patients who are candidates for implant treatment: they are an aid in patient selection or treatment planning.
- Long cone balance:
The image quality is better and more precise than that of panoramic radiography. The long cone assessment is indicated in the partially edentulous to clarify the diagnosis:
-periodontal;
-endodontic;
-prosthetic.
- Profile teleradiographies:
Lateral teleradiographs provide excellent information on facial profile (using soft tissue filters), arch relationships, and some indication of bone thickness at the midline.
- Profile teleradiographies:
Lateral teleradiographs provide excellent information on facial profile (using soft tissue filters), arch relationships, and some indication of bone thickness at the midline.
- Digital tomographic scanners : The Jaw Scanner (or Computed Tomography, CT):
The scanner also called CT scan (computerized tomography scanner)
CT scans provide a lot of important information to the clinician.
Accurate measurements can be made, which is particularly useful for the posterior mandibular areas.
The scans provide information on the density of the cortical and cancellous components of the bone crest.
Being able to plan treatment interactively using a digital graphic simulation facilitates surgical protocols. The computer simulation of a treatment can now be transferred to the surgical field using guides made from this data. The implants are thus positioned precisely. The use of radiopaque markers allows the clinician to relate the diagnosed position of the tooth to the available bone.
Advances in interactive planning combined with three-dimensional visualization further refine the treatment plan, especially because they allow the position of the tooth to be related to that of the implant-abutment complex and the bone volume present, the increase of which can thus be predicted. The software is sophisticated enough to differentiate between a bone graft and host bone and between many markers of different radiopacities.
Software that evaluates the consequences of treatment, but also the proposed treatment on the contours of the soft tissues of the face, is available and is being improved.
Diagnostic methods
- Magnetic resonance imaging :
Magnetic resonance imaging (MRI) is useful for imaging soft tissues, but is not often used during implant treatment planning because assessment of hard tissues is difficult with this technique.
2- Mapping of the ridge:
Ridge mapping is a direct means of measuring the thickness of the ridge through the soft tissue. This recording is performed under local anesthesia with a graduated caliper with pointed jaws. Measurements are taken at various points along the ridge at the future implant sites. The first measurement is taken approximately 3 mm from the top of the soft tissue ridge, which often corresponds to the top of the bony crest. Several additional measurements are taken every 3 mm and are used to provide axial information about the ridge at these particular points.
The technique using this caliper only reports the thickness of the ridge, and clinical judgment is then used to match these measurements with the position of the tooth. Alternatively, a pointed probe with a rubber stop can be used to map the ridge. The measurements are then transferred to a sectioned model of the ridge, and the profile of the bone is traced indicating the position of the bone within the ridge.
3-Study models and diagnostic project:
Plaster models, cast in alginate impressions, are placed in a semi-adaptable articulator in the maximum intercuspation position with a facebow.
Facebow recordings are used to transfer the relationships between the maxilla and the temporomandibular joints.
Maxillary-mandibular relationships are achieved with registration plasters or wax for patients with stable occlusion. Wax rims mounted on an acrylic resin base are used for edentulous patients whose vertical dimension of occlusion needs to be modified.
These study models placed in an articulator provide information on the static and kinematic relationships of the arches. They allow a diagnostic project to be carried out by placing acrylic resin teeth in the wax according to their ideal positions. Functional reliability and acceptance of the aesthetics, confirmed by the transfer of the project to the patient’s arches, can thus be obtained. Other validations are allowed by provisional restorations that reproduce the diagnostic project in the patient’s mouth.
4-Radiological guide : The radiological guide is made with a thermoformed plate or acrylic resin. The locations of the implant sites are marked and perforations are made using a bur.
Precisely selected sites based on the prosthetic restoration are then filled with a radiopaque material , such as gutta-percha or zinc oxyphosphate cement. Metal landmarks are not recommended during CT scanning because metal causes artifacts that make reading the image difficult.
5-study model and mounting on articulator:
The study models mounted on an articulator allow the analysis of:
-occlusion;
-inter-arcade ratio;
-available prosthetic space;
– interferences and prematurities;
-occlusal pathologies.
The choice generally falls on a semi-adaptable articulator which, thanks to its adjustment possibilities, executes the different movements when the clinical situation presents a:
-extensive edentulism
-loss of the anterior occlusal guide
-absence of posterior occlusal contacts
– dysfunction of the masticatory system
-base shift
– suspicion of vertical or transverse bone defects
– altered occlusal situation
This valuable working tool is less essential when the patient does not have any occlusal disease or is faced with a small amount of edentulism.
Study casts exhibit
- Crestal morphology: Crestal regularity and morphology are clarified.
Irregularities indicate recent extraction sites, but also bone deficits in the different spatial planes. Radiologically confirmed bone insufficiency argues in favor of bone correction before implant
- intermaxillary relationships: in the vertical plane, three situations are possible:
-insufficient inter-arch space which does not allow the adaptation of prosthetic pillars. It is most often appropriate to re-establish by gingivoplasty and/or osteoplasty an inter-arch distance compatible with the creation of an implant-supported prosthesis.
– sufficient inter-arch space in accordance with prosthetic requirements
-an exaggerated inter-arch space which directs the treatment either towards an implant-supported removable prosthesis or towards vertical bone correction before implants.
- Occlusal relationships and position of teeth on the arch
Diagnostic methods
6-Photography:
Some pre-implant intraoral and exooral photographs are recommended for:
-record the patient’s aesthetic characteristics;
-make comparisons during the different therapeutic phases
Diagnostic methods
Bibliography:
-Ashok Sethi, Thomas Kaus Clinical implantology diagnosis, surgery and restorative techniques for aesthetic and functional harmony . Quintessence international
Diagnostic methods
Wisdom teeth may need to be extracted if they are too small.
Sealing the grooves protects children’s molars from cavities.
Bad breath can be linked to dental or gum problems.
Bad breath can be linked to dental or gum problems.
Dental veneers improve the appearance of stained or damaged teeth.
Regular scaling prevents the build-up of plaque.
Sensitive teeth can be treated with specific toothpastes.
Early consultation helps detect dental problems in time.