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ORIGINAL ARTICLE
Background: During treatment planning for dental implant placement, there is a need for assessment
of alveolar bone. Bone evaluation limited to the use of panoramic and or periapical radiographs may
be insufficient, as it provides only twodimensional information about the implant sites. Computed
tomography(CT) provides threedimensional information. The measurement of alveolar ridge
dimensions can be accomplished using ridgemapping technique. This technique involves penetrating
the buccal and lingual mucosa down to the alveolar bone(following the administration of local
anesthetic) with calipers and measures the buccolingual width of the underlying bone.
Purpose: The aim of the study is to compare the techniques, i.e.ridge mapping, direct surgical
exposure, and CT scan, which are used to measure the alveolar ridge bone width, and determine their
accuracy in the clinical application.
Materials and Methods: The study was conducted on 20patients who reported to the Outpatient
Department(OPD) of Prosthodontics and Crown and Bridge, PGIDS, Rohtak(Haryana) for replacement
of edentulous span with dental implant. Width of alveolar ridge was studied by three techniques, i.e.CT
scan procedure, ridge mapping, and direct surgical exposure at two points(3mm from the crest of
ridge and 6mm from the crest of ridge), and then taking measurements of surgical exposure as the
control group, the measurements obtained from the other two techniques were compared and then
accuracy of these methods was assessed. The mean, standard deviation, standard error of mean, and
degree of freedom were calculated and subjected to statistical analysis using Students unpaired t test.
Results: Results suggested that there is no significant difference in the measurements obtained by
direct surgical exposure technique, ridgemapping technique, and CT technique.
Conclusion: Use of ridgemapping technique along with panoramic and intraoral radiograph is adequate
in cases where the pattern of resorption appears more regular and where mucosa is of more even thickness.
It is suggested to use CT scan technique in situations where the alveolar ridges are resorbed, there is presence
of maxillary anterior ridge concavities, vestibular depth is inadequate, and ridge mapping is not feasible.
KEY WORDS: Computed tomography scan, direct surgical exposure, implants alveolar ridge height
Website:
www.jdionline.org
DOI:
10.4103/0974-6781.118872
INTRODUCTION
Throughout history, humans have attempted to replace
missing or diseased tissues with natural or synthetic
substances. There are two elements in tooth replacement,
the materials for the replacement of tooth and some form
of attachment mechanism. Various materials have been
used for replacement of missing teeth, including carved
ivory and bone, and also natural extracted teeth. As a
mechanism of attachment, clinicians have long sought
an analog for periodontal ligament. An alternative
attachment mechanism was discovered by means of
an accidental finding by Prof. Per Ingvar Branemark
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Chugh, etal.: Comparative evaluation of three different methods for evaluating alveolar ridge dimension prior to implant placement
Inclusion criteria
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Chugh, etal.: Comparative evaluation of three different methods for evaluating alveolar ridge dimension prior to implant placement
Exclusion criteria
1.
2.
3.
4.
5.
6.
7.
8.
Pregnancy
Smoking habits
Debilitating diseases
Immunocompromised patients
Pregnancy
Smoking habits
Debilitating diseases
Immunocompromised patients.
Study design
Study design
Methods
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Chugh, etal.: Comparative evaluation of three different methods for evaluating alveolar ridge dimension prior to implant placement
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Chugh, etal.: Comparative evaluation of three different methods for evaluating alveolar ridge dimension prior to implant placement
Figure 8: Slice no. having all five reference points selected and
measurements made
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Chugh, etal.: Comparative evaluation of three different methods for evaluating alveolar ridge dimension prior to implant placement
RESULTS
According to the results obtained from the above study,
Table1 shows that mean alveolar ridge dimensions
obtained from three methods i.e.direct surgical
exposure, CT scan procedure and ridge mapping was
3.9800mm, 4.1250mm and 3.9600mm respectively for
point 1 and 6.4050mm, 6.5700mm and 6.4250mm
respectively for point 2. The graph depiction of table
is shown in Graph1. This data shows that the mean
difference between CT Procedure measurements and
direct surgical exposure at point 1 is 0.1450mm and at
Table 1: Mean, standard deviation and degree of freedom of measurements made in all the three
groups
Groups
Direct surgical exposure group-1
CT scan procedure group-2
Ridge mapping procedure
group-3
Point of
measurements
Mean (mm)
Standard
deviation
Degree of
freedom
Point 1
20
3.9800
2.1289
38
Point 2
20
6.4050
2.3885
Point
Point
Point
Point
20
20
20
20
4.1250
6.5700
3.9600
6.4250
2.1545
2.4401
2.0899
2.4498
1
2
1
2
38
38
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Chugh, etal.: Comparative evaluation of three different methods for evaluating alveolar ridge dimension prior to implant placement
0.18
0.16
POINT 2
0.165
0.145
0.14
0.12
MEAN DIFFERENCE (mm)
0.1
0.08
0.06
0.04
0.02
0.02
0
GROUP 2 GROUP 1
GROUP 3 GROUP 1
0.02
0.02
GROUPS
3.96
3.5
6.42
6.4
3
5
2.5
1.5
0.5
GROUP 1
GROUP 3
GROUP 1
GROUP 3
GROUPS
GROUPS
Group
Mean Standard
(mm) deviation
Group 1
Group 3
20
20
3.9800
3.9600
2.1289
2.0899
Df
0.2141
38
0.0300
P value
Group
Mean
(mm)
Standard
deviation
Df
P
value
0.9762
Group 1
Group 3
20
20
6.4050
6.4250
2.3885
2.4498
0.2173
0.0263
38
0.9791
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Chugh, etal.: Comparative evaluation of three different methods for evaluating alveolar ridge dimension prior to implant placement
Group
Mean
(mm)
Standard
deviation
df
P
value
Group
Mean
(mm)
Standard
deviation
Group 1
Group 2
20
20
3.9800
4.1250
2.1289
2.1545
0.2141
0.2458
38
0.8316
Group 1
Group 2
20
20
6.4050
6.5700
2.3885
2.4401
0.2173
0.1900
df P value
38
0.8291
6.57
7
4.5
6.4
4.12
3.98
6
3.5
2.5
1.5
1
1
0.5
0
0
GROUP 1
GROUP 2
GROUPS
GROUP 1
GROUP 2
GROUPS
DISCUSSION
In all phases of clinical dentistry, careful planning
and diagnosis result in a more predictable
outcome.[3] Fabrication of an implantsupported single
tooth restoration, both esthetically and functionally,
depends on the ridge morphology and the orientation
of implant. The placement of dental implants requires
meticulous planning and careful surgical procedures.
The contour of the residual bone must be evaluated prior
to implant placement in order to assure proper implant
positioning. It can be visualized using study models
along with diagnostic waxup.[23] A further important
part of the planning process is to determine the nature
of surgical procedure required to place the implant.[17]
Preoperative radiographic assessment has assumed
an increasingly important role in treatment planning
for implantsupported prostheses. [13] A panoramic
radiograph gives an overall view; however, it is
incomplete due to the distortions and inconsistent
magnification that it generates.[8,24] Periapical radiographs
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Chugh, etal.: Comparative evaluation of three different methods for evaluating alveolar ridge dimension prior to implant placement
CONCLUSION
The aim of this study was to assess alveolar ridge width
obtained from direct surgical exposure, ridge mapping,
and CT, and compare and, hence, evaluate the accuracy
of these methods in determining the alveolar ridge width
during the treatment planning procedure for implant
placement.
Thus, this study measured the alveolar ridge width
dimensions for presurgical planning of implant
placement and compared the ridge mapping technique
and the CT scan technique with the direct surgical
exposure technique and further analyzed based on three
parameters selected.
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Chugh, etal.: Comparative evaluation of three different methods for evaluating alveolar ridge dimension prior to implant placement
REFERENCES
1.
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