Panoramic Images versus Three‐Dimensional Planning Software for Oral Implant Planning in Atrophied Posterior Maxillary: A Clinical Radiological Study

Abstract

The objectives of this radiographic study were to determine to what degree the available residual bone area for implant placement was underestimated on panoramic radiographs (by comparison with multislice computed tomography CT/cone beam CT images combined with planning software) and to what degree the rate of severely resorbed posterior maxillae requiring sinus lift was overestimated on panoramic radiographs (by comparison with planning software in combination with strategic implant placement). During a 2-year period, every patient who presented for the placement of implants in the posterior maxilla was examined by three practitioners to discuss the treatment plan. When two to three practitioners indicated a sinus lift with creation of a lateral window, a CT scan was performed and examined using dedicated three-dimensional software by a clinician familiar with the Computer Assisted Design/ Computer Assisted Manufacturing (CAD/CAM) implant placement protocol. For each tooth to be replaced, the presence of anatomical features such as anterior or posterior wall, palatal curvature, and septa were examined in view of the placement of an 8-mm or longer implant. One hundred one patients were studied in this case series for the treatment of 135 edentulous spans accounting for 301 missing teeth. After examination of the CT data on the three-dimensional software, 202 teeth (67.1%) could be replaced using a CAD/CAM procedure; 60.7% of the edentulous spans could be completely repaired by a crown or bridge supported by implants. In addition, 67.3% of edentulism with no teeth posterior to the span could be completely repaired using a fixed prosthesis supported by implants. This radiological study demonstrates that the use of a panoramic exam for oral implant planning in severely resorbed maxillae overestimates the need for a sinus augmentation procedure when compared with the use of both three-dimensional planning software and strategic implant placement on small remaining bone volume.