Journal of Oral Implantology February 2014 - (Page 77)
RESEARCH
Nerve Damage Assessment Following Implant Placement
in Human Cadaver Jaws: An Ex Vivo Comparative Study
Sema Murat, DDS1*
Kıvanc Kamburoglu, DDS, MSc, PhD2
¸
˘
Cenk Kılıc, MD3
¸
Tuncer Ozen, DDS, PhD4
Ayhan Gurbuz, DDS, PhD1
The present study compared the use of cone beam computerized tomography (CBCT) images and intra-oral
radiographs in the placement of final implant drills in terms of nerve damage to cadaver mandibles. Twelve
cadaver hemimandibles obtained from 6 cadavers were used. Right hemimandibles were imaged using periapical radiography and left hemimandibles using CBCT, and the images obtained were used in treatment
planning for the placement of implant drills (22 for each modality, for a total of 44 final drills). Specimens were
dissected, and the distances between the apex of the final implant drill and the inferior alveolar neurovascular
bundle and incisive nerve were measured using a digital calliper. Nerves were assessed as damaged or not
damaged, and the Chi-square test was used to compare nerve damage between modalities (P , 0.05). Nerve
damage occurred with 7 final drills placed based on peri-apical radiography (31.8%) and 1 final drill placed using
CBCT images (4.5%). The difference in nerve damage between imaging modalities was statistically significant (P
¼ 0.023), with CBCT outperforming intraoral film in the placement of final implant drills ex vivo. In order to
prevent nerve damage, CBCT is recommended as the principal imaging modality for pre-implant assessment.
Key Words: inferior alveolar nerve, incisive nerve, dental implant, CBCT, radiography, nerve damage
INTRODUCTION
P
resurgical implant planning is of paramount importance for the successful
outcome of dental implant treatment. In
order to ensure implants are appropriately placed, planning should include
the identification of critical anatomical landmarks
and a bone-quality assessment in addition to
prosthetic considerations. An inappropriate depth
or insertion path is a common occurrence during
the insertion of implant fixtures and can result in
1
Ankara University, Faculty of Dentistry, Department of Prosthodontics, Ankara, Turkey.
2
Ankara University, Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Ankara, Turkey.
3
¨
Gu lhane Military Medical Academy, Faculty of Medicine,
Department of Anatomy, Ankara, Turkey.
4
¨
Gulhane Military Medical Academy, Dental Science Centre,
Department of Dentomaxillofacial Radiology, Ankara, Turkey.
* Corresponding author, e-mail: semamurat47@hotmail.com.tr
DOI: 10.1563/AAID-JOI-D-11-00191
sensory disturbances1À3 due to direct damage or
stretching of the inferior alveolar nerve if a fixture
placed anterior to the mental foramen engages the
inferior alveolar nerve in the incisive branch of the
mandibular canal or the incisive canal.3,4 This can
result in a loss of lip and chin sensation and lead to
lip biting, impaired speech and diminished salivary
retention that will have significant impact on a
patient's daily life.1 In order to prevent this type of
damage, adequate information is needed regarding
jaw bone quality and quantity in the implant
region.5,6 In addition, anatomical knowledge regarding the location of mandibular canal, the
course of inferior alveolar nerve and incisive nerve
is essential.1
Radiography combined with clinical examination
is the only method available for the presurgical
evaluation of implant sites in routine dental
practice; however, while easily accessible, periapical and panoramic radiographs can provide only
Journal of Oral Implantology
77
Table of Contents for the Digital Edition of Journal of Oral Implantology February 2014
Evolution of Bone Grafting for Improved Predictability
Electrochemical Behavior of Titanium in Artificial Saliva: Influence of pH
Efficacy of Antibacterial Sealing Gel and O-Ring to Prevent Microleakage at the Implant
Wired/Classic and Wireless/Periotest ‘‘M’’ Instruments: An In Vitro Assessment of
Altered Position of the Medial Lingual Nutritional Foramina at Different Stages of Alveolar
Genotoxicity of Endosseous Implants Using Two Cellular Lineages In Vitro
Implants With Internal Hexagon and Conical Implant-Abutment Connections: An In Vitro
Stress Distribution Around Maxillary Anterior Implants as a Factor of Labial Bone Thickness
Peri-Implant Biomechanical Responses to Standard, Short-Wide, and Mini Implants
Removal Torque Analysis of Implants in Rabbit Tibia After Topical Application of
Nonprocessed Adipose Tissue Graft in the Treatment of Peri-Implant Osseous Defects in
Assessment of the Effect of Two Occlusal Concepts for Implant-Supported Fixed
Nerve Damage Assessment Following Implant Placement in Human Cadaver Jaws:
Dental Implants: Early Versus Standard Two-Stage Loading (Animal Study)
Intravenous Sedation for Implant Surgery: Midazolam, Butorphanol, and
Nanocrystalline Hydroxyapatite-Based Material Already Contributes to Implant Stability
Two Neglected Biologic Risk Factors in Bone Grafting and Implantology: High Low-Density
Journal of Oral Implantology February 2014
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