Abstract
BackgroundThe posterior regions of the jaws usually represent a significant risk for implant surgery. A non-valid assessment of the available bone height may lead to either perforation of the maxillary sinus floor or encroachment of the inferior alveolar nerve and consequently to implant failure. This study aimed to evaluate the reliability of surgeon’s decision in appraising the appropriate implant length, in respect to vital anatomical structures, using panoramic radiographs.MethodsOnly implants that are inserted in relation to the maxillary sinus (MS) or the mandibular canal (MC) were enrolled (first premolars [1P], second premolars [2P], first molars [1M], and second molars [2M]). All preoperative panoramic radiographs were evaluated under standard conditions. The postoperative estimation (under/over) was determined depending on the available bone height (ABH) measured from the apical end of the implant to the floor of the MS and the roof of the MC using cone beam computed tomography (CBCT). Any complication or side effect that associated with overestimated implants insertion was recorded.ResultsThe study sample included 73 patients (predominantly females) who had consecutively received 148 implants, of which 68 were inserted in the posterior maxilla and 80 in the posterior mandible. Underestimation was recorded in 93.2% of the measurements. The remaining bone height after implants insertion was < 2 mm in the majority of underestimated cases (73.9%); they were significantly (P < 0.01) more than sites with remaining bone ≥ 2 mm (26.1%). In the posterior mandible, overestimation was significantly higher than posterior maxilla. Five cases with transient paresthesia were reported in the mandibular overestimated implants.ConclusionsThis study specified that surgeon’s choice of implants length, based on panoramic radiographs, was reliable regarding the incapability to insert implants with further length in the majority of underestimated cases, the low percent of overestimated measurements, and the minor associated complications.
Highlights
The posterior regions of the jaws usually represent a significant risk for implant surgery
Any patient with implants that required to be installed at the anterior regions, implants that did not have any relation with the maxillary sinus (MS) and mandibular canal (MC), or radiographs presented with unclear findings were excluded from enrollment
Regarding posterior regions of the jaws, there is a tendency toward underestimation in panoramic radiographs, which is better than overestimation
Summary
The posterior regions of the jaws usually represent a significant risk for implant surgery. Surgical complications and accidents do occur [1] and may cause damage of vital anatomical structures [2] They may result in infection, inflammation, and the loss of implants [3, 4]. Radiographic misinterpretation can result in serious complications These complications can involve damage to adjacent teeth and/or encroachment of vital structures, including the maxillary sinus and/or inferior alveolar nerve (IAN). Dental implants were found to be the most common etiological risk factor (56.3%) of nerve injury [7]. To avoid these complications, meticulous preoperative assessment is critical before insertion. Most implant surgeries can proceed uneventfully and fulfill functional and esthetic demands when proper diagnosis and treatment planning are implemented [8]
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