title: The impact of CBCT imaging when placing dental implants in the anterior edentulous mandible: a before-after study.
abstract: OBJECTIVE
  To evaluate the impact of CBCT imaging when placing dental implants in the anterior edentulous mandible, using a "before-after" study design.
  
  
  METHODS
  Eight dental practitioners, who regularly place dental implants in independent dental practice in the North West of England, were presented with realistic simulations of four edentulous cases. The practitioners were asked to assess case difficulty, select implants and then drill osteotomies in preparation for dental implants in the lower canine regions to support a complete overdenture. In the "before" part of the study, a panoramic and a trans-symphyseal view were available. In the "after" part of the study, a CBCT image was added. Perception of case difficulty, implant selection and the incidence of perforations or "near miss perforations" of the lingual cortical plate were recorded. Two cases were regarded as "regular" and two as "challenging".
  
  
  RESULTS
  In challenging cases, the availability of CBCT led practitioners to select narrower implants and to assess cases as more difficult. In the challenging cases only, there were fewer perforations of the lingual cortical plate after the availability of CBCT, but this difference was not statistically significant. There were no perforations in the regular cases either before or after the availability of CBCT.
  
  
  CONCLUSIONS
  Perception of case difficulty and implant selection are of importance only if they change the outcome for the patient. This study provided weak evidence that CBCT is helpful in avoiding perforations in challenging cases. The availability of CBCT had no impact in regular cases.
authors.affiliation: 1 Dental Practice, Denton, Manchester, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Shelley
authors.forename: A
authors.initials: A
authors.lastname: Ferrero
authors.forename: P
authors.initials: P
authors.lastname: Brunton
authors.forename: M
authors.initials: M
authors.lastname: Goodwin
authors.forename: K
authors.initials: K
authors.lastname: Horner
mesh_terms: D054893:Cone-Beam Computed Tomography / Q000379:methods*; D065187:Controlled Before-After Studies; D003481:Cuspid; D003657:Decision Making; D003724:Dental Arch / Q000601:surgery; D003758:Dental Implantation, Endosseous / Q000379:methods; D015921:Dental Implants; D019094:Dental Prosthesis, Implant-Supported; D003826:Denture, Complete, Lower; D003828:Denture, Overlay; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007431:Intraoperative Complications / Q000517:prevention & control; D007575:Jaw, Edentulous / Q000000981:diagnostic imaging / Q000601:surgery*; D008334:Mandible / Q000000981:diagnostic imaging / Q000601:surgery*; D008338:Mandibular Injuries / Q000517:prevention & control; D008953:Models, Anatomic; D010027:Osteotomy / Q000379:methods; D010347:Patient Care Planning; D019252:Radiography, Dental, Digital / Q000379:methods; D011862:Radiography, Panoramic / Q000379:methods
chemical_list: D015921:Dental Implants
keywords: dental cone beam computed tomography; dental implants; patient simulation; radiography