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Importance of the axial reference plane in computed tomography for dental implant surgery: A cadaveric study

September 23, 2016 / Categories: Digital Dentistry, Implant Dentistry

Vilaplana Vivo, Carlos

Vilaplana Vivo, Jaime

Sánchez Alfonso, Miguel

Vilaplana Gómez, Juan Ángel

Camacho Alonso, Fabio

The aims of the study were to assess the accuracy of dental computed tomography (CT) scans and to compare the discrepancies obtained when either the occlusal plane or the basal plane was used as the axial reference plane.

Introduction

Edentulous patients seeking dental treatment to restore function and esthetics have traditionally received removable complete or partial dentures.

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However, the use of removable dentures may give the patient a sense of insecurity, reduced masticatory function and taste capacity, as well as low self-esteem.1Ostman PO. Immediate/early loading of dental implants. Clinical documentation and presentation of a treatment concept.
→ Periodontol 2000. 2008 Jun;47(1):90–112.
For these reasons, approaches to treatment have turned toward dental implants, which produce marked improvements in patients’ quality of life and high treatment success rates.2Brief J, Edinger D, Hassfeld S, Eggers G. Accuracy of image-guided implantology. → Clin Oral Implants Res. 2005 Aug;16(4):495–501.3Barnea E, Alt I, Kolerman R, Nissan J. Accuracy of a laboratory-based computer implant guiding system.
→ Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 May;109(5):e6–10.

An adequate radiographic technique that will provide a su iciently accurate assessment of the bone dimensions is of great help when planning the surgical intervention. Intra-oral and panoramic radiographs give information in two dimensions, visualizing bone morphology in a buccolingual direction, but lack the third dimension. Both techniques are only useful for a primary preoperative evaluation to obtain preliminary information about the available bone height.4Bou Serhal C, van Steenberghe D, Quirynen M, Jacobs R. Localisation of the mandibular canal using conventional spiral tomography: a human cadaver study.
→ Clin Oral Implants Res. 2001 Jun;12(3):230–6.
Three-dimensional information is obtained using computed tomography (CT).

In edentulous mandibles, the location and course of the mandibular canal remain relatively unchanged in the cranial and caudal borders of the mandible, although some atrophy at the lingual and buccal external borders may occur.5Ulm CW, Solar P, Blahout R, Matejka M, Watzek G, Gruber H. Location of the mandibu- lar canal within the atrophic mandible.
→ Br J Oral Maxillofac Surg. 1993 Dec;31(6):370–5.
Recently, some anatomical structures in the jawbone, which are di icult to detect using conventional radiography, have been explored using CT.6Cotton TP, Geisler TM, Holden DT, Schwartz SA, Schindler WG. Endodontic applications of cone-beam volumetric tomography.
→ J Endod. 2007 Sep;33(9):1121–32.
7Estrela C, Bueno MR, Azevedo BC, Azevedo JR, Pécora JD. A new periapical index based on cone beam computed tomography.
→ J Endod. 2008 Nov;34(11):1325–31.
8Hamada Y, Kondoh T, Noguchi K, Iino M, Isono H, Ishii H, Mishima A, Kobayashi K, Seto K. Application of limited cone beam computed tomography to clinical assessment of alveolar bone grafting: a preliminary report.
→ Cleft Palate Craniofac J. 2005 Mar;42(2):128–37.
9Katakami K, Shimoda S, Kobayashi K, Kawasaki K. Histological investigation of osseous changes of mandibular condyles with backscattered electron images.
→ Dentomaxillofac Radiol. 2008 Sep;37(6):330–9.
Investigations of mandibular accessory foramina and canals have drawn attention to anatomical variations of perimandibular neurovascularization.10Jacobs R, Lambrichts I, Liang X, Martens W, Mraiwa N, Adriaensens P, Gelan J. Neovascularization of the anterior jaw bones revised using high-resolution magnetic resonance imaging.
→ Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 May;103(5):683–93.
11Trikeriotis D, Paravalou E, Diamantopoulos P, Nikolau D. Anterior mandible canal communications: a potential portal of entry for tumour spread.
→ Dentomaxillofac Radiol. 2008 Mar;37(3):125–9.
12Vandewalle G, Liang X, Jacobs R, Lambrichts I. Macroanatomic and radiologic characteri- stics of the superior genial spinal foramen and its bony canal.
→ Int J Oral Maxillofac Implants. 2006 Jul-Aug;21(4):581–6.
13Fuakami K, Shiozaki K, Mishima A, Shimoda S, Hamada Y, Kobayashi K. Detection of buccal perimandibular neurovascularisation associated with accessory foramina using limited cone-beam computed tomography and gross anatomy.
→ Surg Radiol Anat. 2011 Mar;33(2):141–6.

Although there is a wide range of dental CT equipment marketed as providing exact bone data at a 1:1 scale, several studies have shown discrepancies between radiographic CT measurements and clinical measurements taken directly from the bone.14Bou Serhal C, van Steenberghe D, Quirynen M, Jacobs R. Localisation of the mandibular canal using conventional spiral tomography: a human cadaver study.
→ Clin Oral Implants Res. 2001 Jun;12(3):230–6.
15Covino SW, Mitnick RJ, Shprintzen RJ, Cisneros GJ. The accuracy of measurements of three-dimensional computed tomography reconstructions.
→ J Oral Maxillofac Surg. 1996 Aug;54(8):982–90.
16Kamburoğlu K, Kiliç C, Ozen T, Yüksel SP. Measurements of mandibular canal region obtained by cone-beam computed tomography: a cadaveric study.
→ Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Feb;107(2):e34–42.
17Bou Serhal C, Jacobs R, Flygare L, Quirynen M, van Steenberghe D. Perioperative validation of localisation of the mental foramen.
→ Dentomaxillofac Radiol. 2002 Jan;31(1):39–43.
Furthermore, depending on the positioning of the patient when the CT measurements are taken, these discrepancies between radiographic measurement and measurements taken from real bone can increase even further.18Lindh C, Petersson A, Klinge B. Measurements of distances related to the mandibular canal in radiographs.
→ Clin Oral Implants Res. 1995 Jun;6(2):96–103.
19Bolin A, Eliasson S, von Beetzen M, Jansson L. Radiographic evaluation of mandibular posterior implant sites: correlation between panoramic and tomographic determinations. → Clin Oral Implants Res. 1996 Dec;7(4):354–9. In 2008, Cucchiarelli et al. compared the discrepancies between radiographic measurements with CT and measurements taken directly from 15 edentulous maxillae, using two di erent axial reference planes.20Cucchiarelli D, Kitrilakis A, Pastori E. Tomographic distortion in toothless patients. → Acta Odontol Latinoam. 2008;21(1):35–41. The study showed distortions with regard to the real bone measurements, and these discrepancies were di erent for each of the two axial reference planes used.

The aims of the present ex vivo study were to assess the accuracy of dental CT scans and to compare the discrepancies obtained when either the occlusal plane or the basal plane was used as the axial reference plane.

Materials and methods

Mandibles

A total of 39 normal and dry mandibles from adult cadavers aged 35–83 (mean age of 50) were examined following state regulations, the study protocol having been approved by the Murcia (Spain) City Hall Health Service. Thirty of these mandibles were edentulous and the other nine retained teeth. In order to homogenize the study, multiple exodontias were performed on the nine mandibles that retained teeth.

Fig. 1a-d
Marking the occlusal plane: (a) marking mandibles with teeth intact before multiple exodontias were performed; (b) marking edentulous mandibles; (c) placing the wax piece to simulate the occlusal plane; (d) wax piece divided into 18 parts with lead strips corresponding to the 18 tomographic slices taken of each mandible).

Fig. 4
Bar graph comparing discrepancies between radiographic measurements (mm) and measurements taken directly from the mandibles (mm) using both axial reference planes studied.

Marking the occlusal plane

The occlusal plane was marked on the nine mandibles that retained teeth before the exodontias were performed. This was done by marking a line parallel to the teeth from the incisal edge of the central incisor to the vestibular cusps of the second molar (Fig. 1a). Once the occlusal plane had been marked, the teeth were extracted.

For the 30 edentulous mandibles, the occlusal plane was established in the anterior region by measuring a height of 1 cm (the usual height of the mandibular incisal crowns) and in the posterior region by dividing the retromolar trigone into three parts: upper, middle and lower. Thereafter, a meeting point between the upper third and the middle part was chosen; this point usually measured 1 cm in height (Fig. 1b).21Abadi BJ, Okeson JP. Alteration of vertical dimension in the treatment of craniomandibular disorders.
→ J Craniomandibular Pract. 1983 Sep-Nov;1(4):55–9.

Once the occlusal planes of the mandibles had been established, a Moyco wax piece (Thompson Dental Manufacturing, Montgomeryville, Pa., U.S.) was molded to follow the previously established plane. After placing the wax simulation of the occlusal plane (Fig. 1c), this was divided into 18 parts using 2 mm lead strips. These strips were placed 6 mm apart so that they corresponded to the 18 tomographic slices performed for each mandible
(Fig. 1d).

Lastly, Fox planes were attached to the wax on each of the 39 mandibles (to be used as a guide for delimiting the occlusal plane radiographically) and each assembly was placed into a polymethyl methacrylate (PMMA) box for radiograhic study.

Basal plane

In order to establish a good axial reference from the basal plane, all of the mandibles were positioned in PMMA boxes to support the lower edge (basal plane) against the container’s anterior wall (Fig. 2a).

Fig. 2a-c
Basal plane: (a) positioning of mandibles in PMMA boxes to support the lower edge against the container’s anterior wall; (b) use of the occlusal plane as the axial reference plane; (c) use of the basal plane as the axial reference plane.

Dental CT

The CT equipment used was a Toshiba Multi CT scan Aquilion 16 TSX-101A/6A (Toshiba America Medical Systems, Tustin, Calif., U.S.). Thirty-six sagittal tomographic slices were performed for each mandible, 18 taking the occlusal plane as the axial reference plane (Fig. 2b) and 18 using the basal plane
(Fig. 2c). The exposure parameters were set at 57 Kv, 56 s and 1.0–3.2 mA, and a rectangular collimator was used. The radiographic images were processed using SIMPLANT software (Materialise Dental, Madrid, Spain). All of the measurements were scored independently by two oral surgeons. When measuring the sagittal tomographic slices, the observers were blinded as to which axial reference plane, occlusal (Fig. 3a) or basal (Fig. 3b), had been used. Lastly, the observers’ mean scores were calculated.

Fig. 3a-c
Measurements taken from the mandibles: (a) radiographic measurement of a sagittal tomographic slice using the occlusal plane as the axial reference plane; (b) radiographic measurement of a sagittal tomographic slice using the basal plane as the axial reference plane; (c) bone measurement taken using a digital calibrator.
Fig. 4
Bar graph comparing discrepancies between radiographic measurements (mm) and measurements taken directly from the mandibles (mm) using both axial reference planes studied.

Direct mandibular measurements

These measurements were taken using a digital calibrator (AMIG T304B.W-1220, AMIG, Amorebieta-Etxano, Spain). The interedges (apicalcoronal distance in mm) were measured perpendicularly from the base of the mandibular body to the alveolar ridge, along each of the lines corresponding to the tomographic slices (Fig. 3c).

Statistical analysis

The data were analyzed using SPSS statistical software (Version 12.0; SPSS, Chicago, Ill., U.S.). Descriptive statistics were obtained for each variable. The associations between the different qualitative variables were studied using Pearson’s chi-squared test. Student’s t-test for two independent samples was applied to quantitative variables, in each case determining whether variances were homogeneous. Statistical significance was set at p ≤ 0.05.

Results

In comparing measurements taken from the 18 tomographic slices of each mandible with measurements taken directly from the bone when the occlusal plane was used as the axial reference plane, discrepancies were found in all of the tomographic slices assessed. These discrepan-cies were positive in nine (50%) of the slices, while in the remaining nine (50%), the measurements taken from the CT scans were lower than the measurements taken from the bone. In six of the 18 slices analyzed (33.33%), the discrepancies observed showed statistically significant di erences (p ≤ 0.05; Table 1).

When the basal plane was used as the axial reference plane, discrepancies were also found between measurements taken from tomographic slices and clinical measurements of the mandibles in all 18 slices analyzed. These discrepancies were negative in all cases. In 17 of the slices (94.44%), the discrepancies showed statistically significant di erences (p ≤ 0.05; Table 2).

In this sense, with regard to positioning the patient when the CT scans were taken, use of the occlusal plane as axial reference produced the most accurate measurements (Fig. 4).

When the distribution of discrepancies in millimeters found in each of the 18 tomographic slices was compared in relation to the axial reference plane, a higher percentage (99.44%) of discrepancies greater than 0.5 mm were produced when the basal plane was used than when the occlusal plane was used (44.44%), with the difference being statistically significant (p = 0.001; Table 3).

Fig. 4

Fig. 4

table-1

Table 1
Discrepancies between radiographic measurements (mm) and measurements taken directly from the bone (mm) using the occlusal plane as the axial reference plane (Student’s t-test).
† SD = standard deviation.

table-2

Table 2
Discrepancies between radiographic measurements (mm) and measurements taken directly from the bone (mm) using the basal plane as the axial reference plane (Student’s t-test).
† SD = standard deviation.

table-3

Table 3
Distribution of discrepancies in millimeters observed in each of the 18 sagittal tomographic slices in relation to the axial reference plane used (Pearson’s chi-squared test).

Discussion

Ever since the first dental implants were introduced by Brånemark et al. in 1969, dental practitioners and researchers have sought methods that might improve the accuracy of surgical implant placement.22Brånemark PI, Adell R, Breine U, Hansson BO, Lindström J, Ohlsson A. Intra-osseous anchorage of dental prostheses. I. Experimental studies.
→ Scand J Plast Reconstr Surg. 1969;3(2):81–100.
CT has been widely used for preoperative assessment of dental implant treatments.23Monsour PA, Dudhia R. Implant radiography and radiology.
→ Aust Dent J. 2008 Jun;53 Suppl 1:S11–25.
It provides good images of the thickness of vestibular cortical bone and interalveolar distances, as well as of important anatomical features in jaws.24Klinge B, Petersson A, Maly P. Location of the mandibular canal: comparison of macroscopic findings, conventional radiography, and computed tomography.
→ Int J Oral Maxillofac Implants. 1989 Winter;4(4):327–32.
When used for imaging the mandible, the main advantage of CT scans over periapical or panoramic radiographs is that they provide a relatively accurate assessment of the alveolar crestal bone height and width and its spatial relationship with the mandibular canal.25Frederiksen NL. Diagnostic imaging in dental implantology.
→ Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995 Nov;80(5):540–54.
However, although there is a wide range of dental CT equipment marketed as providing accurate bone data at a 1:1 scale, several studies have shown discrepancies between the radiographic measurements taken using CT and clinical measurements taken directly from the bone.26Covino SW, Mitnick RJ, Shprintzen RJ, Cisneros GJ. The accuracy of measurements of three-dimensional computed tomography reconstructions.
→ J Oral Maxillofac Surg. 1996 Aug;54(8):982–90.
27Hanazawa T, Sano T, Seki K, Okano T. Radiologic measurements of the mandible: a comparison between CT-reformatted and conventional tomographic images.
→ Clin Oral Implants Res. 2004 Apr;15(2):226–32.
In 1996, Covino et al.used ten rectangular acrylic blocks (prepared with titanium–molybdenum alloy) as markers spaced from 1 to 10 mm, respectively.28Covino SW, Mitnick RJ, Shprintzen RJ, Cisneros GJ. The accuracy of measurements of three-dimensional computed tomography reconstructions.
→ J Oral Maxillofac Surg. 1996 Aug;54(8):982–90.
A plastic sphere was prepared with ten sets of titanium markers spaced at variable intervals of 1–10 mm. Each object was scanned three times at slice thicknesses of 3.0 mm and slice thicknesses of 1.5 mm with 0.5 mm overlap, positioned in the CT scanner in two di erent positions in relation to the scanning beam (perpendicular and parallel). The authors concluded that when CT was carried out with slices every 3.0 mm, if the procedure was not performed correctly, significant errors would occur, but if the slices were less than 1.5 mm, even if the CT procedure were performed erroneously to some extent, the results would not show much variation and would be more precise. In 2004, Hanazawa et al. compared data obtained by means of a modified CT system and a conventional CT device with real measurements taken directly from cadaver mandibles, finding discrepancies in 90% of the measurements taken with the modified CT system compared with the direct measurements and in 87.5% of those taken with the conventional CT device, the discrepancies being approximately 1 mm.29Hanazawa T, Sano T, Seki K, Okano T. Radiologic measurements of the mandible: a comparison between CT-reformatted and conventional tomographic images.
→ Clin Oral Implants Res. 2004 Apr;15(2):226–32.

These radiographic discrepancies can lead to iatrogenic lesions during implant treatment, which are of particular concern in posterior mandibular regions, where they can produce lesions of the mandibular canal. In this regard, Klinge et al., who studied sensitivity and accuracy in locating the mandibular canal using cadaverous mandibles, observed that when the accuracy in determining mandibular canal position was evaluated, comparing the extent of error with the true value, the error was up to 1 mm in 94% of the CT measurements, but 39% with tomography, 17% with panoramic radiography and 53% using intra-oral radiography.30Klinge B, Petersson A, Maly P. Location of the mandibular canal: comparison of macroscopic findings, conventional radiography, and computed tomography.
→ Int J Oral Maxillofac Implants. 1989 Winter;4(4):327–32.
Similar discrepancies between mandibular canal positions determined radiographically using CT and measurements taken directly from the bone have been observed by other authors.31Kamburoğlu K, Kiliç C, Ozen T, Yüksel SP. Measurements of mandibular canal region obtained by cone-beam computed tomography: a cadaveric study.
→ Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Feb;107(2):e34–42.
32Bou Serhal C, Jacobs R, Flygare L, Quirynen M, van Steenberghe D. Perioperative validation of localisation of the mental foramen.
→ Dentomaxillofac Radiol. 2002 Jan;31(1):39–43.
33Greenstein G, Tarnow D. The mental foramen and nerve: clinical and anatomical factors to dental implant placement: a literature review. → J Periodontol. 2006 Dec;77(12):1933–43.

Similarly, numerous authors have observed small variations between the precision of three-dimensional preoperative imaging and the final surgical positions of the dental implants, with variations ranging between 0.7 mm and 1.0 mm,34Brief J, Edinger D, Hassfeld S, Eggers G. Accuracy of image-guided implantology. → Clin Oral Implants Res. 2005 Aug;16(4):495–501. 35Valente F, Schiroli G, Sbrenna A. Accuracy of computer-aided oral implant surgery: a clinical and radiographic study.
→ Int J Oral Maxillofac Implants. 2009 Mar-Apr;24(2):234–42.
due to the discrepancies between CT measurements and the real dimensions. In this way, the results of the present study, in which discrepancies varied between 0.03 mm and 1.47 mm, coincide with the discrepancies observed by these authors.Acquiring a good CT scan is of primary importance for visualizing the di erent bony structures, and the quality and accuracy of the scan are influenced by various factors. The skill of the operator has a major influence. Adequate positioning of the patient will minimize error, and the choice of the appropriate equipment settings is important for achieving good contrast. Discrepancies between radiographic and real measurements can increase according to patient positioning for CT scanning.36Lindh C, Petersson A, Klinge B. Measurements of distances related to the mandibular canal in radiographs.
→ Clin Oral Implants Res. 1995 Jun;6(2):96–103.
37Bolin A, Eliasson S, von Beetzen M, Jansson L. Radiographic evaluation of mandibular posterior implant sites: correlation between panoramic and tomographic determinations. → Clin Oral Implants Res. 1996 Dec;7(4):354–9. However, although many authors have observed discrepancies between radiographic measurements using CT and real bone measurements, these authors used a single axial reference plane, which in many cases was not specified.38Seoares MM, Harari ND, Cardoso ES, Manso MC, Conz MB, Vidigal GM Jr. An in vitro model to evaluate the accuracy of guided surgery systems.
→ Int J Oral Maxillofac Implants. 2012 Jul-Aug;27(4):824–31.
39Patcas R, Müller L, Ullrich O, Peltomäki T. Accuracy of cone-beam computed tomography at di erent resolutions assessed on the bony covering of the mandibular anterior teeth.
→ Am J Orthod Dentofacial Orthop. 2012 Jan;141(1):41–50.
40Takahashi A, Watanabe H, Kamivama Y, Honda E, Sumi Y, Kurabavashi T. Localizing the mandibular canal on dental CT reformatted images: usefulness of panoramic views.
→ Surg Radiol Anat. 2013 Nov;35(9):803–9.
41Ozan O, Turkyilmaz I, Ersoy AE, McGlumphy EA, Rosenstiel SF. Clinical accuracy of 3 di erent types of computed tomographyderived stereolithographic surgical guides in implant placement.
→ J Oral Maxillofac Surg. 2009 Feb;67(2):394–401.
Currently, there are very few articles that examine the discrepancies obtained with various axial reference planes. Cucchiarelli et al.’s comparison of the discrepancies between radiographic measurements with CT and measurements taken directly from 15 edentulous maxillae showed distortions with regard to the real bone measurements.42Cucchiarelli D, Kitrilakis A, Pastori E. Tomographic distortion in toothless patients. → Acta Odontol Latinoam. 2008;21(1):35–41. It was found that the use of the horizontal plane showed 19.20% magnification, as opposed to the use of the occlusal plane, which showed 16.5% magnification. In this regard, Abrahams made a general study of mandibles using CT and concluded that the best axial reference plane is the occlusal plane.43Abrahams JJ. Dental CT imaging: a look at the jaw.
→ Radiology. 2001 May;219(2):334–45.
Although the present study found discrepancies when both the occlusal plane and the basal plane were taken as the axial reference plane, the discrepancies were greater when the basal plane was used.

Conclusion

The present study found that there are slight discrepancies between radiographic measurements taken using CT and real bone measurement. These must be taken into consideration in order to perform satisfactory implant treatments. With regard to patient positioning for the CT procedure, use of the occlusal plane as axial reference will produce the most accurate measurements.

Competing interests

We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that may have influenced its outcome.

Acknowledgments

We wish to acknowledge the contribution of the radiology unit of Virgen de la Arrixaca Hospital, Murcia, Spain.

Fabio Camacho Alonso

Interview

with Dr. Fabio Camacho Alonso

Why did you conduct the research reported on in this paper?

To assess the accuracy of dental CT and to compare the discrepancies obtained when either the occlusal plane or the basal plane is used as the axial reference plane.

For what reasons could others cite your paper?

It is an innovative paper about the accuracy of dental CT.

How could your study’s findings have an impact on dentistry?

The present study found that there are slight discrepancies between radiographic measurements taken using CT and real bone measurements, which must be taken into consideration in order to perform satisfactory implant treatments. With regard to patient positioning for the CT procedure, use of the occlusal plane as axial reference will produce the most accurate measurements.

What is the relevance of your study’s findings to the daily practice of a dentist?

The discrepancies between radiographic measurements and real bone measurements must be taken into consideration in order to perform satisfactory implant treatments. With regard to patient positioning for the CT procedure, use of the occlusal plane as axial reference will produce the most accurate measurements.

What are your recommendations for further investigation of the topic of your article?

The discrepancies between radiographic measurements and real bone measurements must be taken into consideration for all dental implant treatments.

References   [ + ]

1. Ostman PO. Immediate/early loading of dental implants. Clinical documentation and presentation of a treatment concept.
→ Periodontol 2000. 2008 Jun;47(1):90–112.
2, 34. Brief J, Edinger D, Hassfeld S, Eggers G. Accuracy of image-guided implantology. → Clin Oral Implants Res. 2005 Aug;16(4):495–501.
3. Barnea E, Alt I, Kolerman R, Nissan J. Accuracy of a laboratory-based computer implant guiding system.
→ Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 May;109(5):e6–10.
4, 14. Bou Serhal C, van Steenberghe D, Quirynen M, Jacobs R. Localisation of the mandibular canal using conventional spiral tomography: a human cadaver study.
→ Clin Oral Implants Res. 2001 Jun;12(3):230–6.
5. Ulm CW, Solar P, Blahout R, Matejka M, Watzek G, Gruber H. Location of the mandibu- lar canal within the atrophic mandible.
→ Br J Oral Maxillofac Surg. 1993 Dec;31(6):370–5.
6. Cotton TP, Geisler TM, Holden DT, Schwartz SA, Schindler WG. Endodontic applications of cone-beam volumetric tomography.
→ J Endod. 2007 Sep;33(9):1121–32.
7. Estrela C, Bueno MR, Azevedo BC, Azevedo JR, Pécora JD. A new periapical index based on cone beam computed tomography.
→ J Endod. 2008 Nov;34(11):1325–31.
8. Hamada Y, Kondoh T, Noguchi K, Iino M, Isono H, Ishii H, Mishima A, Kobayashi K, Seto K. Application of limited cone beam computed tomography to clinical assessment of alveolar bone grafting: a preliminary report.
→ Cleft Palate Craniofac J. 2005 Mar;42(2):128–37.
9. Katakami K, Shimoda S, Kobayashi K, Kawasaki K. Histological investigation of osseous changes of mandibular condyles with backscattered electron images.
→ Dentomaxillofac Radiol. 2008 Sep;37(6):330–9.
10. Jacobs R, Lambrichts I, Liang X, Martens W, Mraiwa N, Adriaensens P, Gelan J. Neovascularization of the anterior jaw bones revised using high-resolution magnetic resonance imaging.
→ Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 May;103(5):683–93.
11. Trikeriotis D, Paravalou E, Diamantopoulos P, Nikolau D. Anterior mandible canal communications: a potential portal of entry for tumour spread.
→ Dentomaxillofac Radiol. 2008 Mar;37(3):125–9.
12. Vandewalle G, Liang X, Jacobs R, Lambrichts I. Macroanatomic and radiologic characteri- stics of the superior genial spinal foramen and its bony canal.
→ Int J Oral Maxillofac Implants. 2006 Jul-Aug;21(4):581–6.
13. Fuakami K, Shiozaki K, Mishima A, Shimoda S, Hamada Y, Kobayashi K. Detection of buccal perimandibular neurovascularisation associated with accessory foramina using limited cone-beam computed tomography and gross anatomy.
→ Surg Radiol Anat. 2011 Mar;33(2):141–6.
15, 26, 28. Covino SW, Mitnick RJ, Shprintzen RJ, Cisneros GJ. The accuracy of measurements of three-dimensional computed tomography reconstructions.
→ J Oral Maxillofac Surg. 1996 Aug;54(8):982–90.
16, 31. Kamburoğlu K, Kiliç C, Ozen T, Yüksel SP. Measurements of mandibular canal region obtained by cone-beam computed tomography: a cadaveric study.
→ Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Feb;107(2):e34–42.
17, 32. Bou Serhal C, Jacobs R, Flygare L, Quirynen M, van Steenberghe D. Perioperative validation of localisation of the mental foramen.
→ Dentomaxillofac Radiol. 2002 Jan;31(1):39–43.
18, 36. Lindh C, Petersson A, Klinge B. Measurements of distances related to the mandibular canal in radiographs.
→ Clin Oral Implants Res. 1995 Jun;6(2):96–103.
19, 37. Bolin A, Eliasson S, von Beetzen M, Jansson L. Radiographic evaluation of mandibular posterior implant sites: correlation between panoramic and tomographic determinations. → Clin Oral Implants Res. 1996 Dec;7(4):354–9.
20, 42. Cucchiarelli D, Kitrilakis A, Pastori E. Tomographic distortion in toothless patients. → Acta Odontol Latinoam. 2008;21(1):35–41.
21. Abadi BJ, Okeson JP. Alteration of vertical dimension in the treatment of craniomandibular disorders.
→ J Craniomandibular Pract. 1983 Sep-Nov;1(4):55–9.
22. Brånemark PI, Adell R, Breine U, Hansson BO, Lindström J, Ohlsson A. Intra-osseous anchorage of dental prostheses. I. Experimental studies.
→ Scand J Plast Reconstr Surg. 1969;3(2):81–100.
23. Monsour PA, Dudhia R. Implant radiography and radiology.
→ Aust Dent J. 2008 Jun;53 Suppl 1:S11–25.
24, 30. Klinge B, Petersson A, Maly P. Location of the mandibular canal: comparison of macroscopic findings, conventional radiography, and computed tomography.
→ Int J Oral Maxillofac Implants. 1989 Winter;4(4):327–32.
25. Frederiksen NL. Diagnostic imaging in dental implantology.
→ Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995 Nov;80(5):540–54.
27, 29. Hanazawa T, Sano T, Seki K, Okano T. Radiologic measurements of the mandible: a comparison between CT-reformatted and conventional tomographic images.
→ Clin Oral Implants Res. 2004 Apr;15(2):226–32.
33. Greenstein G, Tarnow D. The mental foramen and nerve: clinical and anatomical factors to dental implant placement: a literature review. → J Periodontol. 2006 Dec;77(12):1933–43.
35. Valente F, Schiroli G, Sbrenna A. Accuracy of computer-aided oral implant surgery: a clinical and radiographic study.
→ Int J Oral Maxillofac Implants. 2009 Mar-Apr;24(2):234–42.
38. Seoares MM, Harari ND, Cardoso ES, Manso MC, Conz MB, Vidigal GM Jr. An in vitro model to evaluate the accuracy of guided surgery systems.
→ Int J Oral Maxillofac Implants. 2012 Jul-Aug;27(4):824–31.
39. Patcas R, Müller L, Ullrich O, Peltomäki T. Accuracy of cone-beam computed tomography at di erent resolutions assessed on the bony covering of the mandibular anterior teeth.
→ Am J Orthod Dentofacial Orthop. 2012 Jan;141(1):41–50.
40. Takahashi A, Watanabe H, Kamivama Y, Honda E, Sumi Y, Kurabavashi T. Localizing the mandibular canal on dental CT reformatted images: usefulness of panoramic views.
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