Table 1: Template for a comprehensive structured report in treatment planning
A complete and comprehensive report in treatment planning should include the following:
General condition of the jaw
o Partially or completely edentulous
o Surgical changes (root canal procedures, extraction sockets)
o Inflammatory disease (periodontal or endodontic peri-apical lesions, cysts, maxillary sinus, condensing osteitis)
o Developmental anomalies (e.g. mandibular torus, sinus septa) o Tumor and tumor-like conditions of the jaw
Bone quantity
o Ridge morphology (angulation/undercuts)
o Relationship to critical structures (nerves, vessels, roots, nasal floor and sinus cavities)
o Ridge dimensions
Bone quality
Fig. 1:
(a: ) Cross-sectional dental CBCT image of the mandibular 1st molar tooth with prior partial root canal treatment and crown placement. There is a well-defined but not corticated radiolucency at the tooth apex compatible with a periapical abscess from recurrent endodontal disease (arrow). Note the surrounding zone of condensing osteitis (arrowheads).
(b: ) Cross-sectional dental CBCT image of the mandible in the same patient showing a good bone regeneration after tooth extraction and debridement without any signs of residual infection and with the maintenance of adequate dimensions of the alveolar ridge. The distances between the alveolar crest and the mandibular canal (long double arrow) (15 mm) and the width of the alveolar ridge at its apex (short double arrow) (8 mm) have been measured.
Fig. 2:
Graphic illustration of the CAWOOD & HOWELL classification in the maxilla (Aa) and mandible (Bb).
Class 1- dentate bone.
Class 2 - immediately post extraction.
Class 3- well-rounded ridge form, adequate in height and width.
Class 4 - knife-edge ridge form, adequate in height but inadequate in width.
Class 5 - flat ridge form, inadequate in height and width.
Class 6 - depressed ridge form, with variable basal bone loss evident.
Fig. 3:
CBCT cross section showing early atrophy of the alveolar process with the development of a labial undercut in the anterior maxilla (a) or a lingual undercut in the mandible (b) (arrowheads). In the anterior maxilla (a) there is a preservation of height (long double arrow) but there is an inadequate width in the middle third (short double arrow). In the mandible (b), width is preserved (horizontal double arrow) but height (vertical double arrow) is reduced with increased risk of alveolar cortical plate perforation during insertion of oral implants.
Fig. 4:
Graphic illustration of the LEKHOLM & ZARB classification Type 1: Entirely homogeneous compact bone
Type 2: Thick layer of compact bone surrounds core of dense trabecular bone Type 3: Thin layer of compact bone surrounds core of dense trabecular bone
Type 4: Thin layer of compact bone surrounds core of sparse, low-density trabecular bone.
Fig. 5:
Preliminary
Graphic illustration of the components of an implant that replaces a fixed tooth. The different parts of an implant used for this purpose are labeled (crown, abutment, abutment/implant interface, cover screw, implant platform, implant body, implant apex).
Fig. 6:
Panoramic radiograph shows a maxillary graftless treatment option using 5 zygomatic implants extending from the maxilla to the zygoma inferolateral to the orbits.
Fig. 7:
CBCT panoramic reformat (a) shows 4 conventional implants with healing abutments and apparent good positioning. CBCT cross section (b) however shows – in spite of the streak and black band artefact- a faciolingual malpositioning with complete labial plate dehiscence (arrowheads) of the implant replacing the right maxillary canine compromising the stability of the implant.
Fig. 8:
CBCT cross section immediate (a) and 6 months (b) following socket grafting procedure showing good consolidation and turnover of the graft. The outline of the extraction socket is less visible (arrowheads). The majority of the graft particles have been replaced by host bone (arrows).
Fig. 9:
Panoramic radiograph (a) showing a fully edentulous maxilla with severe disuse atrophy (Cawood class 6). Panoramic radiograph (b) of the same patient after bony reconstruction with autologous calvarian bone grafts and simultaneous placement of six provisional implants. Small fixation screws are also visible. Panoramic reformatted (c) and axial (d) CBCT images 6 months after surgery shows the healing of the block graft which has joined with the host bone resulting in adequate positioning and osseointegration of the implant- supported full-arch reconstruction.
Fig. 10:
Axial CBCT (a) shows a bilateral sinus augmentation procedure with synthetic grafts material appearing as a conglomerate with high attenuation in the maxillary sinuses.
There is opacification of the right maxillary sinus with sclerotic bone thickening of the wall indicative of a long-standing infection (arrowheads). CBCT cross sections (b, c)
also shows a low -density area visible within the graft (arrow) indicative of soft tissue within the graft and consistent with an infected graft. The persistent linear radiolucency between the graft and the sinus floor (arrowheads) suggest a nonhealing graft. In contrast to the right sinus, the left sinus (c) shows a normal aeration and the graft appears homogenous and continuous with adjacent bone (arrowheads).
Fig. 11:
CBCT panoramic reformat shows a diffuse spread of the bone graft particles (arrows) into the maxillary antrum due to perforation of the sinus/ Schneiderian membrane.
Fig. 12:
CBCT cross section shows the 1st molar implant denuding the superior cortex of the IAC (arrow). The significance depends on the clinical symptoms.
Fig. 13:
Sagittal (a) and axial (b) reformat of CT data shows a migrated implant in the nasal cavity engaging the left inferior nasal turbinate.
Fig. 14:
Preliminary
Graphic illustration of the vertical peri-implantitis morphologic defects in analogy with the periodontal disease classification. A vertical defect can be 1-, 2- or 3-walled depending on the number of bony walls left unaffected. In case of a 1-walled vertical defect, only the opposite bony wall of the adjacent tooth or implant remains intact (a).
In a 2-walled vertical defect, either the vestibular or the oral wall also remains unaffected (b). In a 3-walled vertical defect (c), only the wall adjacent to the implant is compromised.
Fig. 15:
CBCT panoramic (a) reformat shows an advanced circumferential peri-implantitis bone defect (arrowheads) of the implant replacing the left central incisor. Note an underlying fracture of the implant platform (arrow) and increased abutment-implant interface.
CBCT cross section (b) shows and advanced vertical bone loss, exceeding more than 50
% of the implant length (vertical double arrow), measured down from the abutment implant interface (horizontal double arrow).