The success of dental implants depends primarily on the primary implant stability and the bone density so that predictable osseointegration can be achieved. To achieve the desired results, systematic preoperative planning for implant placement is required. The sole aim of the study was to assess the reliability of preoperative bone density of mandibular posterior region for implant placement using computerized tomography-derived bone densities in Hounsfield units (HU). A total of 200 patients with 352 implant sites between 2014 and 2017 were assessed for the posterior mandibular area using cone-beam computed tomography (CBCT). Evaluation was done by two experienced observers independently. The mean bone density of males was 690.5 ± 104.12 HU and in females, it was 580.20 ± 120.2 HU. Overall, 21% of sites were of low bone density, 39.5% were of intermediate density, and 39.4% were of high density. Receiver operating characteristic (ROC) analysis presented that the CBCT intensity values had a high predictive power for predicting both high-density sites and intermediate-density sites. We can say from our results that, for predicting the bone densities in posterior mandible for determining implant sites, so as to achieve best osseointegration, CBCT values can be reliably used. It has been proved that bone density and implant stability are dependent on each other and osseointegration is important for the success of treatment. With advancements in dentistry and introduction of CBCT, treatment planning and prediction of appropriate implant sites could be made easy and more predictable. Thus, we can say that CBCT can be considered an alternative diagnostic tool for the bone density evaluation during treatment planning for implant placement. Bone density, Cone-beam computed tomography, Implants, Osseointegration.
A 21-year-old healthy male reported to the Department of Orthodontics with a complaint of irregular upper front teeth and inability to chew food properly.Examination revealed a skeletal Class I pattern with moderate upper and lower arch crowding and bilateral posterior crossbites on account of a transverse maxillary deficiency [Table/ Fig-1,2]. There was a Class I molar and canine relation on the left and a Class II molar and canine relation on the right.Treatment involved surgically assisted upper arch expansion, to relieve crossbites and increase arch length enabling alignment, followed by fixed orthodontic therapy. A Hyrax expander was cemented in the upper arch and was activated preoperatively by 0.5mm twice a day for a week to enable shelf separation [1].A modified SARME technique with osteotomies extending only till the zygomatic buttresses with separation of the hemimaxillae was executed. This enabled expansion with reduced morbidity and faster healing. Hospital stay was not required since the procedure was carried out in the dental operatory. Intravenous sedation (IV) was given followed by infiltration of local anaesthesia bilaterally in the mucobuccal fold of the maxilla along with infraorbital nerve blocks, posterior superior alveolar nerve blocks, nasopalatine and greater palatine nerve blocks. Additional local anaesthetic was administered during the procedure as and when required when the patient complained of sensation.Bilateral osteotomies were performed from the piriform rims till the zygomatic buttress [Table/ Fig-3]. The cuts were not extended till the pterygomaxillary junctions. Hemi maxillae separation was achieved by driving an osteotome between the upper centrals, parallel to the palate for 1.5 cm . Midline sectioning progressed superiorly from alveolar crest to anterior nasal spine till the chisel was felt parallel to the palate. The expander was then activated by 6 quarter turns (0.25mm each) to ensure clean separation. The screw was then reversed and the surgical site was cleaned and sutured. No expansion was carried out for a week postoperatively to ensure comfort.Postoperative instructions included taking a soft diet for 2 weeks following the procedure. Oral hygiene was to be maintained by using a soft brush and supplemented with chlorhexidine rinses after every meal. Oral antibiotics and analgesics were prescribed for a Keywords: Posterior cross bites, Pterygomaxillary disjunction, Transverse maxillary hypoplasia Transverse maxillary hypoplasia or maxillary constriction in conjunction with unilateral or bilateral posterior cross bites is a common finding in cleft palate patients. These situations are also commonly encountered in adults who have not had recourse to orthodontic treatment in childhood. In adults, after ossification of the mid palatal suture is complete, the accepted means of correcting transverse skeletal discrepancies is by Surgically Assisted Rapid Maxillary Expansion (SARME). The disadvantage of this technique in the Indian scenario is reduced patient acceptance and in...
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