MURAT ULU, Furkan CICIK, FAHRETTİN KALABALIK, Keremcan KURU, HÜSEYİN AKÇAY, Şükrü ENHOŞ

Posterior Mandibulada Dental İmplant Cerrahisi Sırasında Lingual Kemik Perforasyon Riskinin Değerlendirilmesi: 3 Boyutlu İmplant Planlama Programı Kullanılarak Yapılan Retrospektif Çalışma

Amaç: Bu çalışmanın amacı dişsiz mandibular molar ve premolar bölgelere bilgisayar ortamında planlama programı kullanılarak konik ışınlı bilgisayarlı tomografi (KIBT) görüntüleri üzerinde yerleştirilen implantların sebep olduğu lingual perforasyon prevalansının değerlendirilmesi ve kretin morfolojik yapısı ile lingual plakanın perforasyon riski arasındaki ilişkinin belirlenmesidir.Gereç ve Yöntemler: İzmir Katip Çelebi Üniversitesi Diş Hekimliği Fakültesi arşivindeki KIBT görüntüsü alınmış hastalardan 543’ünün tomografi görüntüleri tarandı ve dahil edilme kriterlerine uyan 107 hastanın görüntüleri üzerinde, Simplant® implant planlama programı kullanılarak 179 adet sanal implant yerleştirildi. Kretler kesitlerine göre P tipi, C tipi ve U tipi olmak üzere 3 gruba ayrıldı. Panoramik radyografide inferior alveolar kanala 2 mm uzaklıkta olacak şekilde uzunlukları hesaplanan dental implantların lingual kemikle olan ilişkisi değerlendirildi.Bulgular: Lingualde oluşan perforasyonların büyük çoğunluğu U tipi kretlerde (%87.5) görülürken, perforasyon riskinin 8 mm uzunluktan sonra arttığı görülmüştür. C tipi kretlerde dört (% 8.3) implantda perforasyona rastlanırken, P tipi kretlerde 14mm uzunlukta sadece iki (% 4.2) hastada lingual perforasyon görülmüştür.Sonuçlar: Bu çalışmanın sonuçları implant uygulamalarında, osteotomi yapılacak alanın anatomik oluşumlara olan komşuluğunu değerlendirmede KIBT’nin değerini bir kez daha ortaya koymaktadır. Alt çenede, implant cerrahisi öncesi kret tepesinden mandibular kanala olan mesafenin ölçülmesi rutin yapılan bir hazırlıktır. Bunun yanında sagittal düzlemde mandibulanın anatomik yapısının değerlendirilmesi bu yapılamıyorsa ameliyat sırasında kret morfolojisinin palpasyonla muayenesi ameliyat sırasında ve sonrasında gelişebilecek komplikasyonların önlenmesi açısından önem arz etmektedir.Anahtar Kelimeler: Alt çene, Diş implantı, Konik ışınlı bilgisayarlı tomografi, Sublingual kanama.

Anahtar Kelimeler:

Alt çene, Diş implantı, Konik ışınlı bilgisayarlı tomografi, Sublingual kanama

Risk Assessment Of Lingual Plate Perforation In Posterior Mandibular Region During Implant Placement: Retrospective Study Using 3D Virtual Implant Placement Program

Background: The aim of this study was to determine the risk of lingual perforation related with structure of the crest and evaluate the prevalence of lingual perforation in virtually inserted dental implants to premolar and molar area with the using of computer aided planning program on cone beam computerized tomography (CBCT) images.Material and Method: CBCT images of 543 patients from the archives of Izmir Katip Çelebi University, Faculty of Dentistry were scanned and 179 implants were virtually inserted on CBCT images of 107 patients who met inclusion criteria using a virtual implant placement program (Simplant®). Crests were classified according to sections as P, C and U types. Proximity of lingual plate to implants, inserted 2 mm apart from inferior alveolar canal, was evaluated.Results: The majority of lingual perforations were seen in U-type crests (% 87.5) and risk of perforation tends to increase after 8 mm of length. Four (% 8.3) perforations were encountered in C-type crests and lingual perforation was seen in only two (%4.2) patients in 14 mm length in P-type crests.Conclusion: The results of this study once again demonstrated the importance of CBCT in assessing the proximity of anatomical structures to the area of osteotomy in implant applications. The measurement of the distance from the alveolar crest to the mandibular canal is a routine pre-implant surgery preparation. Mandibular anatomic structure should be assessed on sagittal plane, if it’s not possible, examination with palpation of crest structure is important in prevention of the pre-operative and post-operative complications. Keywords: Mandible, Dental implant, Cone Beam Computerized Tomography, Sublingual bleeding

Keywords:

Mandible, Dental implant, Cone Beam Computerized Tomography, Sublingual bleeding,

PDF

___

(1) Scheller H, Urgell JP, Kultje C, Klineberg I, Goldberg PV, Stevenson-Moore P, et al. A 5-year multicenter study on implant-supported single crown restorations. Int J Oral Maxillofac Implants 1998;13: 212-8. (2) Chan HL, Benavides E, Yeh CY, Fu JH, Rudek IE, Wang HL. Risk Assessment of Lingual Plate Perforation in Posterior Mandibular Region: A Virtual Implant Placement Study Using Cone-Beam Computed Tomography. J Periodontol 2011;82:129-35. (3) Adell R, Lekholm U, Rockler B, Branemark PI. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg 1981;10:387-416. (4) Becker CM, Kaiser DA. Surgical guide for dental implant placement. J Prosthet Dent 2000;83:248-51. (5) Watanabe H, Mohammad Abdul M, Kurabayashi T, Aoki H. Mandible size and morphology determined with CT on a premise of dental implant operation. Surg Radiol Anat 2010;32:343-9. (6) White SC. Cone-beam imaging in dentistry. Health Phys 2008;95:628-37. (7) Ganz SD. Computer-aided design/computer-aided manufacturing applications using CT and cone beam CT scanning technology. Dent Clin North Am 2008;52:777-808. (8) Schneider D, Marquardt P, Zwahlen M, Jung RE. A systematic review on the accuracy and the clinical outcome of computer-guided template-based implant dentistry. Clin Oral Implants Res 2009;20(Suppl. 4): 73-86. (9) van Assche N, van Steenberghe D, Guerrero ME, et al. Accuracy of implant placement based on pre-surgical planning of three-dimensional cone-beam images: A pilot study. J Clin Periodontol 2007;34:816-21 (10) Froum S, Casanova L, Byrne S, Cho SC. Risk assessment before extraction for immediate implant placement in the posterior mandible: a computerized tomographic scan study. J Periodontol. 2011;82(3): 395-402. (11) Chan HL, Brooks SL, Fu JH, Yeh CY, Rudek I, Wang HL. Crosssectional analysis of the mandibular lingual concavity using cone beam computed tomography. Clin Oral Implants Res 2011;22(2):201-6. (12) Greenstein G, Cavallaro J, Tarnow D. Practical application of anatomy for the dental implant surgeon. J Periodontol 2008;79:1833-46. (13) Parnia F, Fard EM, Mahboub F, Hafezeqoran A, Gavgani FE. Tomographic volume evaluation of submandibular fossa in patients requiring dental implants. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109:32-6. (14) Huang RY, Cochran DL, Cheng WC, Lin MH, Fan WH, Sung CE, et al. Risk of lingual plate perforation for virtual immediate implant placement in the posterior mandible. JADA 2015;146(10):735-42. (15) Nickenig HJ, Wichmann M, Eitner S, Zöller JE, Kreppel M. Lingual concavities in the mandible: a morphological study using crosssectional analysis determined by CBCT. J Craniomaxillofac Surg 2015;43:254-9. (16) Dubois L, de Lange J, Baas E, Van Ingen J. Excessive bleeding inthe floor of the mouth after endosseus implant placement: a report oftwo cases. Int J Oral Maxillofac Surg 2010;39:412-5. (17) Givol N, Chaushu G, Halamish-Shani T, Taicher S. Emergencytracheostomy following life-threatening hemorrhage in the floor ofthe mouth during immediate implant placement in the mandibularcanine region. J Periodontol 2000;71:1893-5. (18) Isaacson TJ. Sublingual hematoma formation during immediate placement of mandibular endosseous implants. J Am Dent Assoc 2004;135:168-72. (19) Ferneini, E, Gady, J, Liebrich, SE. Floor ofthe mouth hematoma after poste rior mandibular implants placement: a case report. Journal of Oral and Maxillofacial Surgery 2009;67:1552-54 (20) Del Castillo-Pardo de Vera, JL, Lopez-Arcas Call-eja, JM, Burgueno-Garcia, M. Hematoma of the ﬂoor of the mouth and airway obstruction during mandibular dental implant placement: a case report. J Oral Maxillofac Surg 2008;12:223–6. (21) Hofschneider U, Tepper G, Gahleitner A, Ulm C. Assessment of the blood supply to the mental region for reduction of bleeding complications during implant surgery in the interforaminal region. Int J Oral Maxillofac Implants 1999;14:379–83. (22) Kalpidis CD, Setayesh RM. Hemorrhaging associated with endosseous implant placement in the anterior mandible: a review of the literature. J Periodontol 2004;75: 631–45.