Evaluation of the risk of inferior alveolar nerve injury during an implant procedure: A comparative study between OPG and CBCT

  • Hassan A. Barzanji Department of Oral and Maxillofacial Surgery, College of Dentistry, Hawler Medical University.
  • Alan A. Tahir Department of Oral and Maxillofacial Surgery (M.Sc. student), College of Dentistry, Hawler Medical University.
Keywords: Dental implant, cone beam computed tomography, orthopantomogram

Abstract

Background and objectives: Dental implants are considered as one of the major options for replacement of missing teeth and this surgical procedure may be accompanied by trauma to the adjacent vital structure when there is inadequate information of the implant site. The use of OPG as a preliminary diagnostic instead of CBCT may expose the patient to a high risk of trauma to an inferior alveolar canal. To evaluate the possibility of the risk of endangering inferior alveolar nerve during implant placement using OPG or CBCT as a preoperative assessment tool.

Patients and methods: This study is a prospective cross-sectional study carried out in outpatient clinic of the college of dentistry and Denta Plus private center in Erbil city during the period from 1st of January to 31st of August, 2018. A sample of 49 patients was selected according to special criteria: Group I consists of 33 patients who had implant in molar and premolar regions, in this group pre-implant assessment done by Orthopantomogram (OPG). Group II; consists of 16 patients who had implant in molar and premolar regions, in this group pre-implant assessment done by Cone beam computed tomography (CBCT). The measurement of the distance between a dental implant and inferior alveolar canal were analyzed by CBCT which classified into four levels of parameters (distances) a-Safety zone ≥2 mm, b-Risky zone 1-2 mm, c-Error and high risk >0-1 mm, d-Traumatized ≤0 mm.

Results: the distance between implant and inferior alveolar canal (IAC) for group I (OPG) patients were as following: - in the safety zone for 30.3%, in the risky zone for 15.2%, in error & high risk for 21.2% and traumatized for 33.3%, while this distance for group II (CBCT) patients was in the safety zone for 75%, in the risky zone for 6.3%, in error & high risk for 12.5% and traumatized for 6.3%.

Conclusion: Cone beam computed tomography is the best choice compared to OPG in the pre-implant evaluation and planning for placement as it showed a lower risk of injury to an inferior alveolar canal.

References

Saavedra-Abril JA, Balhen-Martin C, Zaragoza-Velasco K, Kimura-Hayama, ET, Saavedra S, Stoopen ME. Dental multisection CT for the placement of oral implants: technique and applications. Radiographics 2010; 30(7): 1975-1991.

Tyndall DA, Price JB, Tetradis S, Ganz SD, Hildebolt C, Scarfe WC. Position statement of the American Academy of Oral and Maxillofacial Radiology on selection criteria for the use of radiology in dental implantology with emphasis on cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113(6): 817-826.

Gupta J, Ali SP. Cone beam computed tomography in oral implants. National Journal Maxillofacial Surgery 2013; 4: 2-6.

Kanazirska PG, Jordanov GY, Angelova IA, Bakardjiev AG. Comparison of diagnostic capabilities of Orthopantomography and Cone beam computed tomography in determining the topographic relationship between impacted mandibular third molars and mandibular channel. JIMAB 2017; 23(2):1546-1549.

Scarfe WC, Farman AG, Sukovic P. Clinical applications of cone-beam computed tomography in dental practice. Journal Canadian Dental Association 2006; 72: 75-80.

Madhav VNV. Cone beam computed tomography in implantology. Indian Journal of Dental Sciences 2011; 3: 10-15.

Kumar V, Satheesh K. Applications of cone beam computed tomography (Cbct) in implant treatment planning. JSM Dentistry 2013; 1: 1008.

Bornstein MM, Scarfe WC, Vaughn VM, Jacobs R. Cone beam computed tomography in implant dentistry: A systematic review focusing on guidelines, indications, and radiation dose risks. The International Journal of Oral and Maxillofacial Implants 2014; (29 Suppl): 55-77.

Libersa P, Savignat M, Tonnel A. Neurosensory disturbances of the inferior alveolar nerve: A retrospective study of complaints in a 10-Year period. Journal of Oral and Maxillofacial Surgery 2007; 65: 1486-1489.

Hegedus F. Diecidue RJ. Trigeminal nerve injuries after mandibular implant placement– practical knowledge for clinicians. The International Journal of Oral & Maxillofacial Implants 2006; 21: 111–116.

Tay AB, Zuniga JR. Clinical characteristics of trigeminal nerve injury referrals to a university centre. International Journal of Oral and Maxillofacial Surgery 2007; 36: 922-927.

Renton T, Yilmaz Z. Profiling of patients presenting with post-traumatic neuropathy of the trigeminal nerve. Journal of Orofacial Pain 2011; 25: 333-344.

Prasad DK, Shetty M, Mehra DR. Anatomical considerations in implant selection and positioning. Int J Oral Implantol Clin Res 2013; 4 (1): 24-29.

Sahota J, Bhatia A, Gupta M, Singh, V, Soni J, Soni R. Reliability of Orthopantomography and Conebeam Computed Tomography in Presurgical Implant Planning: A Clinical Study. J Contemp Dent Pract 2017; 18(8):1-5.

de Mello LA, Garcia RR, Leles JL, Leles CR, Silva MA. Impact of cone-beam computed tomography on implant planning and on prediction of implant size. Braz Oral Res 2014; 28:46-53.

Angelopoulos C, Thomas SL, Hechler S, Parissis N, Hlavacek M. Comparison between digital panoramic radiography and cone-beam computed tomography for the identification of the mandibular canal as part of presurgical dental implant assessment. J Oral Maxillofac Surg 2008; 66(10):2130-2135.

Tay AB, Zuniga JR. Clinical characteristics of trigeminal nerve injury referrals to a university centre. Int J Oral Maxillofac Surg 2007; 36:922-927.

Hillerup S. Iatrogenic injury to the inferior alveolar nerve: Etiology, signs and symptoms, and observations on recovery. Int J Oral Maxillofac Surg 2008; 37:704-709.

Shahidi S, Zamiri B, Abolvardi M, Akhlaghian M, Paknahad M. Comparison of Dental Panoramic Radiography and CBCT for Measuring Vertical Bone Height in Different Horizontal Locations of Posterior Mandibular Alveolar Process. Journal of dentistry (Shiraz, Iran) 2018; 19 (2): 83-91.

Mirbeigi S, Kazemipoor M, Khojastepour L. Evaluation of the Course of the Inferior Alveolar Canal: The First CBCT Study in an Iranian Population. Polish journal of radiology 2016; 81, 338-341.

Kamrun N, Tetsumura A, Nomura Y, Yamaguchi S, Baba O, Nakamura S, et al. Visualization of the superior and inferior borders of the mandibular canal: A comparative study using digital panoramic radiographs and cross-sectional computed tomography images. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:550-557.

Vazquez L, Saulacic N, Belser UP, Bernard J. Efficacy of panoramic radiographs in the preoperative planning of posterior mandibular implants: a prospective clinical study of 1527 consecutively treated patients. Clin Oral Implants Res 2008; 19(1): 81-85.

Published
2019-06-06
How to Cite
Barzanji, H., & Tahir, A. (2019). Evaluation of the risk of inferior alveolar nerve injury during an implant procedure: A comparative study between OPG and CBCT. Erbil Dental Journal (EDJ), 2(1), 141-148. https://doi.org/10.15218/edj.2019.03
Section
Original Articles