The objective of this study was to evaluate the location of the mandibular canal and the thickness of the occlusal cortical bone at dental implant sites in the lower second premolar and lower first molar by using dental cone-beam computed tomography (CBCT). Seventy-nine sites (47 second premolar and 32 first molar sites) were identified in the dental CBCT examinations of 47 patients. In this study, 4 parameters were measured: (1) MC—the distance from the mandibular canal to the upper border of the mandible; (2) CD—the distance from the mandibular canal to the buccal border of the mandible; (3) MD—the distance from the mandibular canal to the lingual border of the mandible; (4) TC—the thickness of the cortical bone at the occlusal side. A statistical analysis was employed to compare the size and differences between these 4 parameters at the lower second premolar and lower first molar. Regarding the MC and MD, the experimental results showed no statistical difference between the first molar and second premolar. However, the TC for the second premolar was greater than that of the first molar. Thus, careful consideration is necessary in choosing the size of and operation type for dental implants. 1. Introduction The location of the mandibular canal is a critical factor that can influence dental implant surgery [1–5]. Dental implant surgery demonstrates a 6.5%–37% incidence of temporary or permanent paralysis, or even sensory loss, because of inferior alveolar nerve damage in the mandibular canal resulting from the poor assessment of bone length and the subsequent use of implant bodies of excessive lengths [2, 3, 6–8]. Therefore, to avoid damage, it is crucial to properly assess the mandibular canal location in the mandible before dental implant procedures. In addition to dental implant surgery, the inferior alveolar nerve may also be damaged by osteotomies or fracture repair; thus, a strong understanding of the intrabony anatomy of the mandibular canal is required before conducting dental implant surgery or operative procedures (e.g., sagittal split osteotomies or placement of cortical fixation screws). Furthermore, the cortical bone thickness of the alveolar bone at the implant site is a critical factor affecting the success of dental implant surgery, because the primary stability of the implant body insertion in the alveolar bone increases with the thickness of the cortical bone [9–13]. Superior osseointegration enhances the long-term survival rate of the implant body. Although the location of the mandibular canal in the mandible can be precisely
References
[1]
C. B. Serhal, D. van Steenberghe, M. Quirynen, and R. Jacobs, “Localisation of the mandibular canal using conventional spiral tomography: a human cadaver study,” Clinical Oral Implants Research, vol. 12, no. 3, pp. 230–236, 2001.
[2]
R. Bartling, K. Freeman, and R. A. Kraut, “The incidence of altered sensation of the mental nerve after mandibular implant placement,” Journal of Oral and Maxillofacial Surgery, vol. 57, no. 12, pp. 1408–1410, 1999.
[3]
R. Kubilius, G. Sabalys, G. Juodzbalys, and V. Gedrimas, “Traumatic damage to the inferior alveolar nerve sustained in course of dental implantation. Possibility of prevention,” Stomatologija, vol. 6, no. 4, pp. 106–110, 2004.
[4]
M. H. Levine, A. L. Goddard, and T. B. Dodson, “Inferior alveolar nerve canal position: a clinical and radiographic study,” Journal of Oral and Maxillofacial Surgery, vol. 65, no. 3, pp. 470–474, 2007.
[5]
Y. Kaya, M. Sencimen, S. Sahin, K. M. Okcu, N. Do？an, and M. Bahcecitapar, “Retrospective radiographic evaluation of the anterior loop of the mental nerve: comparison between panoramic radiography and spiral computerized tomography,” The International Journal of Oral and Maxillofacial Implants, vol. 23, no. 5, pp. 919–925, 2008.
[6]
D. Wismeijer, M. A. J. van Waas, J. I. J. F. Vermeeren, and W. Kalk, “Patients' perception of sensory disturbances of the mental nerve before and after implant surgery: a prospective study of 110 patients,” The British Journal of Oral and Maxillofacial Surgery, vol. 35, no. 4, pp. 254–259, 1997.
[7]
D. van Steenberghe, U. Lekholm, C. Bolender et al., “Applicability of osseointegrated oral implants in the rehabilitation of partial edentulism: a prospective multicenter study on 558 fixtures,” The International Journal of Oral and Maxillofacial Implants, vol. 5, no. 3, pp. 272–281, 1990.
[8]
L. G. Ellies and P. B. Hawker, “The prevalence of altered sensation associated with implant surgery,” The International Journal of Oral and Maxillofacial Implants, vol. 8, no. 6, pp. 674–679, 1993.
[9]
J. T. Hsu, L. J. Fuh, M. G. Tu, Y. F. Li, K. T. Chen, and H. L. Huang, “The effects of cortical bone thickness and trabecular bone strength on noninvasive measures of the implant primary stability using synthetic bone models,” Clinical Implant Dentistry and Related Research, vol. 15, no. 2, pp. 235–261, 2013.
[10]
J. T. Hsu, H. L. Huang, C. H. Chang, M. T. Tsai, W. C. Hung, and L. J. Fuh, “Relationship of three-dimensional bone-to-implant contact to primary implant stability and peri-implant bone strain in immediate loading: microcomputed tomographic and in vitro analyses,” The International Journal of Oral and Maxillofacial Implants, vol. 28, no. 2, pp. 367–374, 2012.
[11]
J. T. Hsu, H. L. Huang, M. T. Tsai, A. J. Wu, M. G. Tu, and L. J. Fuh, “Effects of the 3D bone-to-implant contact and bone stiffness on the initial stability of a dental implant: micro-CT and resonance frequency analyses,” The International Journal of Oral and Maxillofacial Surgery, vol. 42, no. 2, pp. 276–280, 2013.
[12]
H. L. Huang, Y. Y. Chang, D. J. Lin, Y. F. Li, K. T. Chen, and J. T. Hsu, “Initial stability and bone strain evaluation of the immediately loaded dental implant: an in vitro model study,” Clinical Oral Implants Research, vol. 22, no. 7, pp. 691–698, 2011.
[13]
C. Liu, M. T. Tsai, H. L. Huang et al., “Relation between insertion torque and bone-implant contact percentage: an artificial bone study,” Clinical Oral Investigations, vol. 16, no. 6, pp. 1679–1684, 2012.
[14]
J. Yang, M. G. P. Cavalcanti, A. Ruprecht, and M. W. Vannier, “2-D and 3-D reconstructions of spiral computed tomography in localization of the inferior alveolar canal for dental implants,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, vol. 87, no. 3, pp. 369–374, 1999.
[15]
B. J. Potter, M. K. Shrout, C. M. Russell, and M. Sharawy, “Implant site assessment using panoramic cross-sectional tomographic imaging,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, vol. 84, no. 4, pp. 436–442, 1997.
[16]
P. A. Monsour and R. Dudhia, “Implant radiography and radiology,” Australian Dental Journal, vol. 53, supplement 1, pp. S11–S25, 2008.
[17]
A. A. Tyndall and S. L. Brooks, “Selection criteria for dental implant site imaging: a position paper of the American academy of oral and maxillofacial radiology,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, vol. 89, no. 5, pp. 630–637, 2000.
[18]
C. B. Serhal, R. Jacobs, L. Flygare, M. Quirynen, and D. van Steenberghe, “Perioperative validation of localisation of the mental foramen,” Dentomaxillofacial Radiology, vol. 31, no. 1, pp. 39–43, 2002.
[19]
H. Tomomi, S. Tsukasa, S. Kenji, and O. Tomohiro, “Radiologic measurements of the mandible: a comparison between CT-reformatted and conventional tomographic images,” Clinical Oral Implants Research, vol. 15, no. 2, pp. 226–232, 2004.
[20]
H. Sato, A. Kawamura, M. Yamaguchi, and K. Kasai, “Relationship between masticatory function and internal structure of the mandible based on computed tomography findings,” The American Journal of Orthodontics and Dentofacial Orthopedics, vol. 128, no. 6, pp. 766–773, 2005.
[21]
A. A. Al-Kalaly, R. W. K. Wong, L. K. Cheung, S. K. Purkayastha, M. Sch？tzle, and A. B. M. Rabie, “Evaluation of bone thickness around the mental foramen for potential fixation of a bone-borne functional appliance: a computer tomography scan study,” Clinical Oral Implants Research, vol. 21, no. 11, pp. 1288–1293, 2010.
[22]
H. W. Chang, H. L. Huang, J. H. Yu, J. T. Hsu, Y. F. Li, and Y. F. Wu, “Effects of orthodontic tooth movement on alveolar bone density,” Clinical Oral Investigations, vol. 16, no. 3, pp. 679–688, 2012.
[23]
J. T. Hsu, H. W. Chang, H. L. Huang, J. H. Yu, Y. F. Li, and M. G. Tu, “Bone density changes around teeth during orthodontic treatment,” Clinical Oral Investigations, vol. 15, no. 4, pp. 511–519, 2011.
[24]
V. Arisan, Z. C. Karabuda, H. Avsever, and T. ？zdemir, “Conventional multi-slice computed tomography (CT) and cone-beam CT (CBCT) for computer-assisted implant placement—part I: relationship of radiographic gray density and implant stability,” Clinical Implant Dentistry and Related Research, 2012.
[25]
D. D. Brüllmann, I. Schmidtmann, S. Hornstein, and R. K. Schulze, “Correlation of cone beam computed tomography (CBCT) findings in the maxillary sinus with dental diagnoses: a retrospective cross-sectional study,” Clinical Oral Investigations, vol. 16, no. 4, pp. 1023–1029, 2012.
[26]
C. Marca, P. M. Dummer, S. Bryant et al., “Three-rooted premolar analyzed by high-resolution and cone beam CT,” Clinical Oral Investigations, vol. 17, no. 6, pp. 1535–1540, 2013.
[27]
M. Shahbazian, C. Vandewoude, J. Wyatt, and R. Jacobs, “Comparative assessment of panoramic radiography and CBCT imaging for radiodiagnostics in the posterior maxilla,” Clinical Oral Investigations, 2013.
[28]
M. á. Fuster-Torres, M. Pe？arrocha-Diago, D. Pe？arrocha-Oltra, and M. Pe？arrocha-Diago, “Relationships between bone density values from cone beam computed tomography, maximum insertion torque, and resonance frequency analysis at implant placement: a pilot study,” The International Journal of Oral and Maxillofacial Implants, vol. 26, no. 5, pp. 1051–1056, 2011.
[29]
R. Jacobs, N. Mraiwa, D. VanSteenberghe, F. Gijbels, and M. Quirynen, “Appearance, location, course, and morphology of the mandibular incisive canal: an assessment on spiral CT scan,” Dentomaxillofacial Radiology, vol. 31, no. 5, pp. 322–327, 2002.
[30]
N. Makris, H. Stamatakis, K. Syriopoulos, K. Tsiklakis, and P. F. van der Stelt, “Evaluation of the visibility and the course of the mandibular incisive canal and the lingual foramen using cone-beam computed tomography,” Clinical Oral Implants Research, vol. 21, no. 7, pp. 766–771, 2010.
[31]
H. Alamri, M. Sadrameli, M. Alshalhoob, and M. Alshehri, “Applications of CBCT in dental practice: a review of the literature,” General Dentistry, vol. 60, no. 5, pp. 390–400, 2012.
[32]
J. W. Ballrick, J. M. Palomo, E. Ruch, B. D. Amberman, and M. G. Hans, “Image distortion and spatial resolution of a commercially available cone-beam computed tomography machine,” The American Journal of Orthodontics and Dentofacial Orthopedics, vol. 134, no. 4, pp. 573–582, 2008.
[33]
A. Suomalainen, T. Vehmas, M. Kortesniemi, S. Robinson, and J. Peltola, “Accuracy of linear measurements using dental cone beam and conventional multislice computed tomography,” Dentomaxillofacial Radiology, vol. 37, no. 1, pp. 10–17, 2008.
[34]
S. Baumgaertel, J. M. Palomo, L. Palomo, and M. G. Hans, “Reliability and accuracy of cone-beam computed tomography dental measurements,” The American Journal of Orthodontics and Dentofacial Orthopedics, vol. 136, no. 1, pp. 19–25, 2009.
[35]
A. Gahleitner, G. Watzek, and H. Imhof, “Dental CT: imaging technique, anatomy, and pathologic conditions of the jaws,” European Radiology, vol. 13, no. 2, pp. 366–376, 2003.
[36]
K. A. Horner, R. G. Behrents, K. B. Kim, and P. H. Buschang, “Cortical bone and ridge thickness of hyperdivergent and hypodivergent adults,” The American Journal of Orthodontics and Dentofacial Orthopedics, vol. 142, no. 2, pp. 170–178, 2012.
[37]
F. Ozdemir, M. Tozlu, and D. Germec-Cakan, “Cortical bone thickness of the alveolar process measured with cone-beam computed tomography in patients with different facial types,” The American Journal of Orthodontics and Dentofacial Orthopedics, vol. 143, no. 2, pp. 190–196, 2013.
[38]
L. J. Fuh, H. L. Huang, C. S. Chen et al., “Variations in bone density at dental implant sites in different regions of the jawbone,” Journal of Oral Rehabilitation, vol. 37, no. 5, pp. 346–351, 2010.
[39]
S. Lee, B. Gantes, M. Riggs, and M. Crigger, “Bone density assessments of dental implant sites: 3. Bone quality evaluation during osteotomy and implant placement,” The International Journal of Oral and Maxillofacial Implants, vol. 22, no. 2, pp. 208–212, 2007.
[40]
I. Turkyilmaz and E. A. McGlumphy, “Is there a lower threshold value of bone density for early loading protocols of dental implants?” Journal of Oral Rehabilitation, vol. 35, no. 10, pp. 775–781, 2008.
[41]
R. González-García and F. Monje, “The reliability of cone-beam computed tomography to assess bone density at dental implant recipient sites: a histomorphometric analysis by micro-CT,” Clinical Oral Implants Research, vol. 24, no. 8, pp. 871–879, 2013.
[42]
P. Aranyarachkul, J. Caruso, B. Gantes et al., “Bone density assessments of dental implant sites: 2. Quantitative cone-beam computerized tomography,” The International Journal of Oral and Maxillofacial Implants, vol. 20, no. 3, pp. 416–424, 2005.
[43]
I. Miyamoto, Y. Tsuboi, E. Wada, H. Suwa, and T. Iizuka, “Influence of cortical bone thickness and implant length on implant stability at the time of surgery—clinical, prospective, biomechanical, and imaging study,” Bone, vol. 37, no. 6, pp. 776–780, 2005.
[44]
M. G. Tu, J. T. Hsu, L. J. Fuh, D. J. Lin, and H. L. Huang, “Effects of cortical bone thickness and implant length on bone strain and interfacial micromotion in an immediately loaded implant,” The International Journal of Oral and Maxillofacial Implants, vol. 25, no. 4, pp. 706–714, 2010.
