Kaya Doğan Ilgaz, Şatır Samed, Öztaş Beyza, Yıldırım Hasan, Aktı Ahmet
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Karamanoglu Mehmetbey University, 70200 Karaman, Turkey.
Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Karamanoglu Mehmetbey University, 70200 Karaman, Turkey.
Diagnostics (Basel). 2024 Jul 10;14(14):1479. doi: 10.3390/diagnostics14141479.
Implant surgery in individuals with atrophic maxilla presents challenges, particularly concerning nasal cavity complications such as perforations, implant migration, and airway obstruction. While panoramic radiographs offer diagnostic convenience, their two-dimensional nature limits the evaluation of anatomical structures. Cone beam computed tomography (CBCT) provides a three-dimensional assessment, enhancing surgical planning accuracy and potentially reducing complications. With the aim of understanding the measurement differences between panoramic radiographs and CBCT images, this retrospective study examined CBCT images of patients with severely atrophic maxilla taken between September 2021 and December 2023 at the Ahmet Keleşoğlu Faculty of Dentistry. Virtual implants were placed in various tooth regions using OnDemand3D software. The incidence of nasal cavity perforations and vertical bone height differences between panoramic radiographs and CBCT images were evaluated. For this purpose, vertical bone length measurements in panoramic and CBCT images were compared for the virtual implant placement areas. Statistical analyses, including -tests and ANOVA, were performed to determine significant differences among quantitative measurements, and a chi square test with Bonferroni corrected z-tests were used for possible associations between ratios. CBCT data from 59 patients, totaling 1888 virtual implants, revealed significant differences in implant depths among tooth regions (F = 9.880, < 0.001). Canine regions showed higher perforation risks, especially with 12 mm and 14 mm implants. Panoramic radiographs often overestimated vertical bone height in canine and first premolar regions compared to CBCT measurements, which could lead to increased perforation risks. Radiographic evaluations using CBCT prior to implant surgery in atrophic maxilla cases are crucial to prevent nasal cavity complications. Panoramic radiographs may inadequately represent three-dimensional anatomy, underscoring the importance of CBCT for accurate implant placement and surgical planning. Further studies should consider varying implant sizes and brands to generalize findings.
在患有上颌骨萎缩的个体中进行种植手术存在挑战，尤其是在鼻腔并发症方面，如穿孔、种植体移位和气道阻塞。虽然全景X线片提供了诊断便利性，但其二维特性限制了解剖结构的评估。锥形束计算机断层扫描（CBCT）提供三维评估，提高手术规划的准确性并可能减少并发症。为了了解全景X线片和CBCT图像之间的测量差异，这项回顾性研究检查了2021年9月至2023年12月在艾哈迈德·凯莱索卢牙科学院拍摄的严重上颌骨萎缩患者的CBCT图像。使用OnDemand3D软件在各个牙齿区域植入虚拟种植体。评估了全景X线片和CBCT图像之间鼻腔穿孔的发生率以及垂直骨高度差异。为此，比较了全景和CBCT图像中虚拟种植体植入区域的垂直骨长度测量值。进行了包括t检验和方差分析在内的统计分析，以确定定量测量之间的显著差异，并使用经Bonferroni校正z检验的卡方检验来分析比率之间可能的关联。来自59名患者的CBCT数据，共1888个虚拟种植体，显示不同牙齿区域的种植体深度存在显著差异（F = 9.880，P < 0.001）。犬齿区域显示出更高的穿孔风险，特别是对于12毫米和14毫米的种植体。与CBCT测量相比，全景X线片在犬齿和第一前磨牙区域常常高估垂直骨高度，这可能导致穿孔风险增加。在萎缩性上颌骨病例中，种植手术前使用CBCT进行影像学评估对于预防鼻腔并发症至关重要。全景X线片可能无法充分呈现三维解剖结构，凸显了CBCT对于准确种植体植入和手术规划的重要性。进一步的研究应考虑不同的种植体尺寸和品牌，以使研究结果更具普遍性。
