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Comparison of Accuracy of Digital Radiography and Panoramic Radiography in Dental Implants Procedure - a Literature Review M Review Article Comparison of accuracy of digital radiography and panoramic radiography in dental implants procedure - A literature review M. Keerthna, Ashish R. Jain* ABSTRACT Appropriate treatment planning for replacement of lost teeth is required, and imaging plays an important role to ensure a beneficiary outcome that satisfies the patient desires and needs. Dental implants are gaining immense popularity and wide acceptance because they not only replace lost teeth but also provide permanent restorations that do not interfere with mastication or speech or compromise the self-esteem of a patient. Radiological examination is very necessary for evaluating the anatomy of the structures such as maxillary sinus, the mental foramen, and the inferior alveolar nerve canal in relation to the teeth that are to be replaced by implants. Cone beam computed tomography (CBCT) has been widely used in dental implanting. However, the local hospitals usually do not have access to CBCT due to the cost and medical investment. The doctors in local hospitals have to make reasonable dental planting using orthopantomography (OPG) to reduce risks. Therefore, it is clinically meaningful to determine the magnification rate of OPG to obtain correct diagnosis. KEY WORDS: Cephalometry, Cone beam computed tomography, Dental implants, Digital radiography, Orthopantomography INTRODUCTION implant placement, the anatomical structures in and around them are considered the crucial factor for Currently, the placements of oral implants are selecting the implants to be placed and preventing performed as a routine treatment in rehabilitation complications.[4] As there were no specific selection of edentulous jaw. As the demands for placement criteria for such imaging techniques to be employed, of implants have increased following it, the need of this leads to overconsumption of these advanced accurate imaging techniques has also tremendously imaging techniques.[5] increasing.[1] As history roles back to the 1980s, only plain film radiography was used commonly to perform Hence, an obvious need to reduce such situations was the pre-implant assessment of the potential sites controlled by evaluating the reliability and accuracy where implants can be placed in an edentulous jaw.[2] of these cross-sectional techniques for the two main To overcome many such limitations, the advanced reasons, first being the effect of treatment outcome imaging techniques came into play to improve the and second, the dosages of radiation involved in the treatment planning. procedure. The reliability and accuracy of these cross- sectional techniques have to be specially checked and The objectives in digital imaging techniques are analyzed for the anatomic structures of upper and mainly used for pre-implant assessment, evaluating lower jaws.[5,6] In case of mandible, the visibility of the normal anatomical structures, detecting any mandibular canal and the distance of alveolar crest pathologies in surrounding areas, and estimating the formed the two main areas of interest.[7] The potential quality and quantity of bone where the implants are risk of damage in mandibular region rehabilitation is [3] supposed to be placed. Depending on the site of the injury to inferior alveolar nerve is very prominent in nature. Furthermore, other anatomic structures Access this article online such as the maxillary sinus location or nasal fossae are taken into only little consideration because they Website: jprsolutions.info ISSN: 0975-7619 result in only very less significant results.[2] A variety Department of Prosthodontics and Implant Dentistry, Saveetha Dental College, Saveetha University, Chennai, Tamil Nadu, India *Corresponding author: Dr. Ashish R. Jain, Department of Prosthodontics, Saveetha Dental College, Saveetha University, 162, Poonamallee High Road, Chennai - 600 077, Tamil Nadu, India. Phone: +9884233423. E-mail: [email protected] Received on: 18-02-2017; Revised on: 24-04-2018; Accepted on: 16-05-201 748 Drug Invention Today | Vol 10 • Issue 5 • 2018 M. Keerthna and Ashish R. Jain of imaging modalities are available which includes diagnose anomalies such as caries, check shapes, and panoramic radiography, computed radiography, pathologies near the tooth roots, also to check possible radiovisiography, and cone beam computed bone loss, stages of tooth development, or even just to tomography (CT) for assessing the site where monitor good oral health.[8] implants are planned to be placed.[5] These modern digital imaging techniques displayed are subjected In the case of extraoral techniques, as the name to various procedures like magnification for accurate indicates, they are radiographs which are taken with derivation of measurements from the reformatted data. the film outside the mouth. In general, these are Along with these are factors like reduced radiation considered the “big picture” X-rays. In these, we can exposure to patient compared with medical CT and a observe teeth, bone, eventual tumors, and anatomic main modality for maxillofacial diagnosis.[7] The aim structures. However, often, the analysis of these of this literature review was to compare and analyze radiographs focuses more on the facial bones. These the accuracy of digital radiography and panoramic types of radiographs are frequently used in areas of radiography in dental implant procedures through dentistry like orthodontics, to monitor growth and various parameters of concern. development. In maxillofacial and oral surgery, these are very commonly used for the assessment of METHODS impacted teeth or possible impacted pathologies within bone, also to examine relationships between teeth and The keywords used for search are as follows: jaws and examining the temporomandibular joint or “Cone beam CT (CBCT)” or “cone beam computed other bones of the face. Within these techniques, we tomography (CBCT)” and “implant*” AND/OR can find panorex or panoramic X-ray, cephalometric (“panoramic radiography” OR “orthopantomography” projections, CBCT, tomograms, and sialographies.[4,8] OR “cephalometry”). The panoramic X-ray is known by different names: LITERATURE REVIEW Orthopantomogram or dental panoramic radiograph or “panorex.” Basically, it consists of a dental Dental radiography is an area of study that has changed X-ray scanning of the upper and lower jaws, in a lot throughout the years. Initially called X-rays, two-dimensions (2D) which show a view of a half- dentists use this tool in their offices every day to circle from ear to ear. It depends on the tomography give better and more accurate diagnosis. In the dental principles since the images of specific radiographic office, these images are used to diagnose cavities, planes are taken to make up the larger panoramic cancerous or benign masses, hidden dental structures, image. The equipment used in this technique consists and bone loss hidden under the gums. Furthermore, of a horizontal rotating arm which holds an X-ray this technique is used to check the status of a procedure source on one side and in the other side a moving film and even as a follow-up of some treatments.[3] mechanism (carrying a film). The patient is located between the X-ray source and the film. The arm The images taken with these technologies are rotates around an instant center (patients head) which usually able to show calcified structures such as shifts on a dedicated trajectory. The X-ray source is teeth and bones, and sometimes, one can visualize collimated toward the film, to give the least distortion the surrounding soft tissues. The picture shown on possible, after crossing the patient’s skull.[4,6] In the an X-ray is formed by the radiation emitted by a case of lateral or cephalometric, these are extraoral machine. This radiation will enter the oral structures radiographs taken from the side of the head, showing at different levels, depending on varying anatomical a 2D picture of the side of the head of the patient. densities. For example, teeth appear lighter because This technique is often used to gauge the size and less radiation penetrates them to reach the film. In the spatial relationships of the teeth, jaws, and cranium. case of cavities or bone loss, they look usually darker This seven analysis informs treatment planning, because X-rays penetrate these less dense structures, quantifies changes during treatment, and provides so more radiation can reach the film.[1,3] In the case of data for clinical research in the areas of orthodontics dental radiography, the dosage of radiation received and maxillofacial and oral surgery.[3] In general, all by a patient is typically around 0.005–0.03 mSv. these 2D techniques are nowadays available as digital radiography. This is considered really low, equivalent to a few days of background environmental radiation exposure. This This change has become the standard of care since with exposure can be reduced using different protective these type of techniques we can reduce the radiation, lead barriers.[6] In dentistry, there are two types of improve the quality of the image, and make different radiographs intraoral and extraoral. Intraoral X-rays analysis using different types of dental software.[8] The are the most common since they give a high level of general disadvantage that these techniques encounter detail, also they help the dentist in a very fast way to is that all are mainly dependent on patient positioning. Drug Invention Today | Vol 10 • Issue 5 • 2018 749 M. Keerthna and Ashish R. Jain Furthermore, due to the certain limitations such as
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