Pikos Online Journal - Case Challenge

The Importance of CBCT for Single Tooth Implant Planning

This case represents a 27 year old caucasian female who presented to the office with congenitally missing maxillary left lateral incisor (Figure 1).

Clinical evaluation including 2 dimensional radiography (periapical radiograph) reveals what appears to be division A bone present in this edentulous site (Figures 2, 3).

The periapical radiograph appeared to be within normal limits. However the cone beam CT showed differently (Figure 4).

There was evidence of a radiolucency indicative of some odontogenic pathology as shown in all four windows including the axial, coronal and sagittal sections. Compare Figures 5 and 6 where the CBCT sagittal section clearly shows what appears to be an odontogenic lesion that was ultimately tied into the cuspid tooth (Figure 5).

Using Simplant software a virtual implant abutment crown complex was made and compared to where the pathology would have been present in red (Figures 7, 8). Without question, had a cone beam CT not been obtained in this case, then conventional implant placement would have been done without knowing that the implant would actually be adjacent to this pathology. Instead, I was able to have a clear 3D understanding that in fact a lesion was present in that specific site. A root canal was performed ultimately for that devitalized tooth. I was able to utilize a palatal full thickness flap approach as I remove the pathology and grafted the defect with MinerOss and PRGF (Figures 9, 10).

In Figure 11 you will see a 3 year follow-up of the implant abutment crown complex completed with intact alveolar bone especially on the palatal aspect where the lesion was originally found. In summary, this is an excellent example of using cone beam CT even for single tooth cases that appear to be very "straight forward" and the potential problems that exist by using only 2D radiography.

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