Sains Malaysiana 50(4)(2021): 1047-1056

http://doi.org/10.17576/jsm-2021-5004-15

 

Risk Associated with Immediate Implant at Mandibular Canine and Premolars: A Cone Beam Computed Tomography (CBCT) Study

(Risiko Berkaitan dengan Implan Segera pada Gigi Taring dan Geraham: Kajian Tomografi Berkomputer Pancaran Kon)

 

KIRTHIGA RAMESWARAN, AMINAH MOHD SHARIFF & DANIEL LIM*

 

Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, 50603 Kuala Lumpur, Federal Territory, Malaysia

 

Diserahkan: 17 Mac 2020/Diterima: 6 September 2020

 

ABSTRACT

With the evolution of implant dentistry, immediate implantation remains a challenge especially in achieving a good primary stability with avoidance of complications such as nerve injuries and lingual perforations. This study was aimed to determine the risks of nerve injury and lingual perforation following virtual implant placement at mandibular canines, mandibular first premolars and mandibular second premolars using cone beam computed tomography (CBCT) scans. From the total of 771 CBCT scans screened, 100 CBCT scans were included. Measurements were made based on the cross-section of the study teeth, that were mandibular canine, first premolar and second premolar, to obtain the distance between root apex and nerve canal as well as risk of nerve injury. A virtual implant was then placed at each site to assess the risk of lingual perforation. Generally, the distance between root apex and nerve was less than 6 mm and the highest risk of nerve injury was observed at second premolar (79.6%) followed by first premolar (45.3%) and canine (23.4%). Risk of lingual perforation following immediate implant placement was between 0.7-1.5%. The risk of nerve injury was considerably high due to insufficient root apex to nerve canal distance while the risk of lingual perforation was low.

 

Keywords: Complications; cone beam computed tomography; dental implant; mandible

 

ABSTRAK

Dengan perkembangan dalam implan pergigian, pengimplanan serta-merta masih merupakan satu cabaran terutamanya dalam mencapai kestabilan primer yang baik di samping mengelakkan komplikasi seperti kecederaan saraf dan perforasi lingual. Penyelidikan ini adalah bertujuan untuk menentukan risiko kecederaan saraf dan perforasi lingual berikutan perletakan implan maya pada gigi taring, gigi geraham kecil pertama dan kedua rahang bawah dengan menggunakan imbasan tomografi berkomputer pancaran kon (CBCT). Daripada 771 imbasan CBCT yang disaring, 100 imbasan CBCT telah dimasukkan dalam penyelidikan ini. Bagi memperoleh jarak antara apeks akar gigi dan kanal saraf, ukuran telah dilakukan pada keratan rentas imbasan CBCT gigi taring, geraham kecil pertama dan kedua rahang bawah. Satu implan maya kemudiannya diletakkan pada kedudukan setiap gigi tersebut untuk menilai risiko perforasi lingual. Secara umumnya, jarak di antara apeks akar dan kanal saraf adalah kurang daripada 6 mm dan risiko kecederaan saraf adalah paling tinggi pada kedudukan geraham kecil kedua (79.6%) diikuti geraham kecil pertama (45.3%) dan geraham kecil kedua (23.4%). Risiko perforasi lingual berikutan implan serta-merta adalah antara 0.7-1.5%. Risiko kecederaan saraf adalah agak tinggi memandangkan kekurangan jarak antara apeks akar gigi dan kanal akar, manakala risiko perforasi lingual adalah rendah.

 

Kata kunci: Implan pergigian; komplikasi; rahang bawah; tomografi berkomputer pancaran kon

 

RUJUKAN

Canellas, J.V.D.S., Medeiros, P.J.D., Figueredo, C.M.D.S., Fischer, R.G. & Ritto, F.G. 2019. Which is the best choice after tooth extraction, immediate implant placement or delayed placement with alveolar ridge preservation? A systematic review and meta-analysis. Journal of Cranio-Maxillofacial Surgery 47(11): 1793-1802.

Chan, H.L., Benavides, E., Yeh, C.Y., Fu, J.H., Rudek, I.E. & Wang, H.L. 2011a. Risk assessment of lingual plate perforation in posterior mandibular region: A virtual implant placement study using cone-beam computed tomography. Journal of Periodontology 82(1): 129-135.

Chan, H.L., Brooks, S.L., Fu, J.H., Yeh, C.Y., Rudek, I. & Wang, H.L. 2011b. Cross-sectional analysis of the mandibular lingual concavity using cone beam computed tomography. Clinical Oral Implants Research 22(2): 201-206.

Chen, S.T. & Buser, D. 2009. Clinical and esthetic outcomes of implants placed in post extraction sites. The International Journal of Oral & Maxillofacial Implants 24(Suppl): 186-217.

Chen, Z., Chen, D., Tang, L. & Wang, F. 2015. Relationship between the position of the mental foramen and the anterior loop of the inferior alveolar nerve as determined by cone beam computed tomography combined with mimics. Journal of Computer Assisted Tomography 39(1): 86-93.

Chrcanovic, B.R., de Carvalho Machado, V. & Gjelvold, B. 2016. Immediate implant placement in the posterior mandible: A cone beam computed tomography study. Quintessence International 47(6): 505-514.

Dora, A.C., Karjodkar, F., Sansare, K., Bansal, L., Ali, I., Motghare, D., Mishra, I., Kapoor, R. & Tambawala, S. 2016. Decortication of inferior alveolar canal in elderly population: A cone beam computed tomography study. International Journal of Health Sciences and Research 6(9): 239-244.

Froum, S., Casanova, L., Byrne, S. & Cho, S.C. 2011. Risk assessment before extraction for immediate implant placement in the posterior mandible. Journal of Periodontology 82(3): 395-402.

Greenstein, G. & Tarnow, D. 2006. The mental foramen and nerve: Clinical and anatomical factors related to dental implant placement: A literature review. Journal of Periodontology 77(12): 1933-1943.

Greenstein, G., Cavallaro, J., Romanos, G. & Tarnow, D. 2008. Clinical recommendations for avoiding and managing surgical complications associated with implant dentistry: A review. Journal of Periodontology 79(8): 1317-1329.

Huang, R.Y., Cochran, D.L., Cheng, W.C., Lin, M.H., Fan, W.H., Sung, C.E., Mau, L.P., Huang, P.H. & Shieh, Y.S. 2015. Risk of lingual plate perforation for virtual immediate implant placement in the posterior mandible. A computer simulation study. Journal of the American Dental Association 146(10): 735-742.

Iasella, J.M., Greenwell, H., Miller, R.L., Hill, M., Drisko, C., Bohra, A.A. & Scheetz, J.P. 2003. Ridge preservation with freeze-dried bone allograft and a collagen membrane compared to extraction alone for implant site development: A clinical and histologic study in humans. Journal of Periodontology 74(7): 990-999.

Juan del, V.L., Grageda, E. & Gómez Crespo, S. 2016. Anterior loop of the inferior alveolar nerve: Averages and prevalence based on CT scans. Journal of Prosthetic Dentistry 115(2): 156-160.

Juodzbalys, G., Wang, H.L. & Sabalys, G. 2010. Anatomy of mandibular structures. Part II: Mandibular incisive canal, mental foramen and associated neurovascular bundles in relation with dental implantology. Journal of Oral & Maxillofacial Research 1(1): e3.

Kusum, C.K., Mody, P.V., Indrajeet, Nooji, D., Rao, S.K. & Wankhade, B.G. 2015. Interforaminal haemorrhage during anterior mandibular implant placement: An overview. Dental Research Journal 12(4): 291-300.

Lazzara, R.J. 1989. Immediate implant placement into extraction sites: Surgical and restorative advantages. International Journal of Periodontics & Restorative Dentistry 9(5): 333-343.

Lin, M.H., Mau, L.P., Cochran, D.L., Shieh, Y.S., Huang, P.H. & Huang, R.Y. 2014. Risk assessment of inferior alveolar nerve injury for immediate implant placement in the posterior mandible: A virtual implant placement study. Journal of Dentistry 42(3): 263-270.

Mardinger, O., Manor, Y., Mijiritsky, E. & Hirshberg, A. 2007. Lingual perimandibular vessels associated with life-threatening bleeding: An anatomic study. The International Journal of Oral & Maxillofacial Implants 22(1): 127-131.

Ortega-Martinez, J., Perez-Pascual, T., Mareque-Bueno, S., Hernandez- Alfaro, F. & Ferres-Padro, E. 2012. Immediate implants following tooth extraction. A systematic review. Medicina Oral Patologia Oral y Cirugia Bucal 17(2): e251-e261.

Pires, C.A., Bissada, N.F., Becker, J.J., Kanawati, A. & Landers, M.A. 2012. Mandibular incisive canal: Cone beam computed tomography. Clinical Implant Dentistry and Related Research 14(1): 67-73.

Poulias, E., Greenwell, H., Hill, M., Morton, D., Vidal, R., Shumway, B. & Peterson, T.L. 2013. Ridge preservation comparing socket allograft alone to socket allograft plus facial overlay xenograft: A clinical and histologic study in humans. Journal of Periodontology 84(11): 1567-1575.

Renton, T. 2010. Prevention of iatrogenic inferior alveolar nerve injuries in relation to dental procedures. Dental Update 37(6): 350-363.

Schwartz-Arad, D. & Chaushu, G. 1997. The ways and wherefores of immediate placement of implant into fresh extraction sites: A literature review. Journal of Periodontology 68(10): 915-923.

Uchida, Y., Noguchi, N., Goto, M., Yamashita, Y., Hanihara, T., Takamori, H., Sato, I., Kawi, T. & Yosue, T. 2009. Measurement of anterior loop length for the mandibular canal and diameter of the mandibular incisive canal to avoid nerve damage when installing endosseous implants in the interforaminal region: A second attempt introducing cone beam computed tomography. Journal of Oral and Maxillofacial Surgery 67(4): 744-750.

Wang, T.Y., Kuo, P.J., Fu, E., Kuo, H.Y., Chang, N.N.S., Fu, M.W., Shen, E.C. & Chiu, H.C. 2019. Risks of angled implant placement on posterior mandible buccal/lingual plate perforation: A virtual immediate implant placement study using CBCT. Journal of Dental Sciences 14(3): 234-240.

 

*Pengarang untuk surat-menyurat; email: daniel_khlim@um.edu.my

 

 

 

 

sebelumnya