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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 6  |  Issue : 4  |  Page : 113-121

Cone-beam computed tomography versus orthopantomography in sinus lift procedures: Two-dimensional versus three-dimensional imaging


1 Department of Oral Radiology, College of Dentistry, University of Ha'il, Ha'il, Kingdom of Saudi Arabia
2 Department of Restorative Dentistry, College of Dentistry, University of Ha'il, Ha'il, Kingdom of Saudi Arabia
3 Department of Oral Diagnosis and Oral Medicine, College of Dentistry, University of Ha'il, Ha'il, Kingdom of Saudi Arabia
4 Department of Maxillofacial Surgery, College of Dentistry, University of Ha'il, Ha'il, Kingdom of Saudi Arabia
5 Department of Oral Medicine and Radiology, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India

Date of Web Publication13-Dec-2018

Correspondence Address:
Dr. S Manoj Kumar
Department of Oral Radiology, College of Medicine, University of Hail, Ha'il
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ssj.ssj_53_17

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  Abstract 

Context: The present study was undertaken to do a comparative evaluation of the role of cone-beam computed tomography (CBCT) imaging and orthopantomography (OPG) for preoperative implant planning in combination with sinus grafting procedures to assess sinus anatomy and morphology and the existing bone height in three-dimensions (3D).
Aim: The aim of the present study was to assess sinus anatomy and morphology and the existing bone height in all the 3D.
Materials and Methods: Pre- and postoperative assessment of maxillary sinuses was done in 17 patients who underwent implant therapy in combination with sinus augmentation procedures using CBCT and OPG. These patients were subjected to orthopantomographs and CBCT imaging both preoperatively and postoperatively. CBCT imaging helped decide the type of sinus augmentation procedure best suited for the patients as per the individual needs and depending on the residual alveolar bone height, timing of implant placement, sinus morphology, anticipation of complication, and comparative analysis between pre- and postprocedural gain in vertical alveolar bone height and increase in bone density.
Statistical Analysis Used: The results were tabulated and statistically analyzed using paired and unpaired t-tests.
Results: In the majority of cases, there was a concordance between the treatment types based on pre- and postoperative CBCT scans. The assessment of sinus morphology revealed a significantly higher detection rate of aberrations in the form of sinus mucosal hypertrophy and septae on CBCT which were imperceptible on routine radiographs. The most appealing result was that vertical alveolar bone height could be measured precisely, and there was a significant increase in surgical confidence and a significantly better prediction of complications when using CBCT imaging.
Conclusions: A preoperative planning based on CBCT imaging seems to improve sinus diagnostics and helps execute a better treatment plan. Furthermore, it is a good tool for the comparison of vertical alveolar bone height pre- and postoperatively following sinus augmentation procedures using various graft materials.

Keywords: Cone-beam computed tomography, sinus augmentation, sinus lift procedures


How to cite this article:
Kumar S M, Al Hobeira H, Aljanakh MD, Shaikh S, Ponnuse K, Deivanayagi M. Cone-beam computed tomography versus orthopantomography in sinus lift procedures: Two-dimensional versus three-dimensional imaging. Saudi Surg J 2018;6:113-21

How to cite this URL:
Kumar S M, Al Hobeira H, Aljanakh MD, Shaikh S, Ponnuse K, Deivanayagi M. Cone-beam computed tomography versus orthopantomography in sinus lift procedures: Two-dimensional versus three-dimensional imaging. Saudi Surg J [serial online] 2018 [cited 2019 Jan 18];6:113-21. Available from: http://www.saudisurgj.org/text.asp?2018/6/4/113/247418


  Introduction Top


Apart from clinical evaluation, diagnostic imaging is an integral part of dental implant therapy for preoperative planning and peri- and postoperative evaluations by use of various imaging techniques. Intraoral radiography, although easily available and relatively inexpensive, is not considered satisfactory in giving reliable information regarding the anatomy of the region due to its major constraints of overlapping and superimpositions and geometric and anatomic limitations in the form of the measurements, for the teeth and surrounding bone and other anatomic landmarks, which change with a change in the angulations used during the exposure of the radiographs. Regarding orthopantomography, as with the other extra-oral radiographic projections, lack of image sharpness and resolution and unequal magnification with geometric distortion are the major limitations that lead to an inaccurate interpretation and measurements underlying the significance of three dimensional imaging over the conventional radiological procedures.[1] Although computed tomography (CT) is superior as it gives three-dimensional (3D), multiplanar reformatted images, with no superimposition of anatomic structures and with a high contrast and resolution, it is less acceptable owing to its relatively higher radiation exposure, cost, huge footprint, and difficulty in accessibility. Hence, Cone Beam Computed Tomography (CBCT) was developed with distinct advantages in the form of reasonably low levels of radiation and higher resolution that the conventional CT. CBCT uses a round or rectangular, cone-shaped X-ray beam centered on a 2D X-ray sensor to scan a 360° rotation around the patient's head. During the scan, a series of 360 exposures or projections, one for each degree of rotation, is acquired, which provides the raw data for the final image reconstruction with the help of computer software. Multiplanar reformatting of the primary reconstruction allows for both 3D- and 2D images in any selected plane required. Furthermore, CBCT has shown to be authentic and a good indicator of regenerated bone, pre- and postprocedures, for easy comparisons.[1],[2] Various studies have concluded that CBCT imaging should be recommended for planning sinus augmentation procedures;[3] however, there is a dearth of studies regarding the comparison between CBCT and panoramic radiography for planning sinus augmentation procedures before implant placement in the literature. The present study was undertaken to do a comparative evaluation of the role of CBCT imaging and OPG for preoperative implant planning in combination with sinus grafting procedures to assess sinus anatomy and morphology and the existing bone height in 3D.


  Materials and Methods Top


Sinus augmentation procedures were carried out in 17 patients seeking implant options for oral rehabilitation including 10 for direct and 10 of indirect procedures (n = 20, 10 direct and 10 indirect). The study comprised 43% of females and 57% of males with a mean age of 46.07 years. A total of 17 patients (20 segments) satisfying the above criteria requiring placement of implants in atrophic maxilla/increased pneumatization of the maxillary sinus were selected for the study. The patients were informed about the study including the use of the synthetic graft material, and their approval was sought before their inclusion in the study. Written informed consent was obtained from each of the participating patients. For each patient, a detailed case history was taken including chief complaint, history of presenting illness, and medical and personal history. A thorough clinical examination, including systemic and regional examination, was done. Patients with sinus pathology, previous sinus surgeries, chronic smokers, under 18 years of age, and underlying systemic conditions which contradict any surgical procedures were excluded from the study. The type of sinus lift was decided based on the preoperative residual bone height evaluated radiographically. The residual bone height was recorded using CBCT scan and a computer-based software where the measurements were made from the crest of the ridge till the sinus floor lining. Indirect sinus augmentation was done in patients with a bone height of <9 mm but ≥5 mm. Patients with a bone height of <5 mm were taken up for direct sinus augmentation. The period of edentulousness varied from 6 months to 12 months. Apically tapered, commercially pure titanium implants (Life Care Devices Private Limited Mahim, West Mumbai, India) were used for patients undergoing indirect sinus augmentation. The length of implant was 8, 10, and 11.5 mm with diameters of 3.5, 4.0, and 5 mm respectively. Patients in the category of direct augmentation underwent the lateral approach procedure and augmentation with an alloplastic graft material. Implant placement was done after 6 months as the second-stage procedure. The patients were assessed clinically at immediate postoperatively and at 1 week, 1 month, 3 months, and 6 months postoperatively. Radiographic assessment for bone height was done preoperatively and at 6 months postoperatively using CBCT. In this comparative study, the measurements were tabulated and statistically analyzed to evaluate the difference in increase in bone height between direct and indirect sinus augmentation procedures radiographically. Orthopantomographs (screening tool) were taken to rule out other pathologies and as a part of initial assessment. CBCT scans were assessed for pre- and postoperative bone height, bone width, and bone density. The CBCT scans were obtained from Kodak® 9000C 3D (Carestream FR, © Carestream Health, Inc. 2012, Atlanta, GA) which is a hybrid machine using a 3D imaging software and flat panel detector sensor with exposure parameters of 90 KVp and 10 mA and with a resolution of 90 microns. The cross sections were made 1 mm apart [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d, [Figure 1]e, [Figure 1]f, [Figure 2] and [Figure 3]a, [Figure 3]b. The bone height measured preoperatively using CBCT considered the preoperative bone height as a measurement taken from the crest of the ridge till the sinus floor and postoperatively, from the crest till hyperdensity evident apically. Bone width was taken as the buccopalatal width at three intervals: at the crest, 3 mm from the crest, and 6 mm from the crest. Bone density was assessed visually by assessing the width of the trabecular pattern and was classified based on the Misch's classification.[4] Another additional bone density tool used was the pixel values (the gray scale values) obtained on the CBCT scan, although not reliable, and comparison was done preoperatively and postoperatively. The pixel values contained were a mean of three measurements obtained along the residual bone corresponding with the bone width levels.
Figure 1: (a-f) Routine sequential cone-beam computed tomography scans. (a and b) Axial sections. (c) Cross section. (d) Oblique sagittal section. (e) Three-dimensional reconstruction. (f) Width measurement

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Figure 2: Axial section of cone-beam computed tomography showing sinus septae

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Figure 3: (a and b) Axial sections of cone-beam computed tomography showing sinus mucosal thickening

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Statistical analysis used

The results were tabulated and were statistically analyzed. The statistical tests used were paired and unpaired t-tests.


  Cases Done with Preoperative Cone-Beam Computed Tomography Evaluations Top


Case report 1

With a preoperative residual bone height of 0.8 mm in #16 region and 1.5 mm in #17 region, direct sinus augmentation was carried out in a 40-year-old male patient followed by implant placement of 3.75 × 11.5 mm as a single-step procedure. Lateral window was created and synthetic graft material was dispensed through the lateral osteotomy site to maintain the elevated sinus membrane followed by placement of two dental implants through the crestal approach measuring 3.75 mm × 11.5 mm under local anesthesia and strict aseptic protocols. At the end of 6 months, a CBCT scan was advised to evaluate the increase in bone height, which was 11 mm and 10.8 mm in #16 and #17 region, respectively [Figure 4]a, [Figure 4]b, [Figure 4]c and [Figure 5]a, [Figure 5]b, [Figure 5]c, [Figure 5]d, [Figure 5]e.
Figure 4: (a-c) Preoperative orthopantomograph and cross sections of cone-beam computed tomography showing residual alveolar bone height

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Figure 5: (a-e) Postoperative orthopantomograph and cross sections of cone-beam computed tomography showing an increase in residual alveolar bone height

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Case report 2

A 45 year old male patient with a residual bone height of 6.6 mm in 17 region underwent procedure of indirect sinus elevation using sinus osteotomy in relation to 17 region. Synthetic graft material was dispensed through the crestal osteotomy site to maintain the elevated sinus membrane followed by placement of a dental implant measuring 5 mm × 10 mm under local anesthesia and strict aseptic protocols. The implant was allowed to osseointegrate for a period of 6 months, during which the patient was followed periodically and was assessed for peri-implantitis, crestal bone loss, and mobility. At the end of 6 months, a CBCT scan was advised to evaluate the increase in bone height, which was 12 mm [Figure 6]a, [Figure 6]b and [Figure 7]a, [Figure 7]b.
Figure 6: (a and b) Preoperative orthopantomograph and cross section of cone-beam computed tomography showing residual alveolar bone height

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Figure 7: (a and b) Postoperative orthopantomograph and cross section of cone-beam computed tomography showing residual alveolar bone height

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Case report 3

A 75-year-old male reported to the unit seeking options for replacement of his missing upper right first molar with fixed prosthesis. Due to the residual bone height of 5.3 mm, the patient was advised and, subsequently, underwent the procedure of indirect sinus elevation using sinus osteotomy in relation to #16 region followed by placement of a dental implant measuring 5 mm × 10 mm under local anesthesia and strict aseptic protocols. The implant was allowed to osseointegrate for a period of 6 months, during which the patient was followed periodically. At the end of 6 months, a CBCT scan showed an increase in bone height to 11.5 mm [Figure 8]a, [Figure 8]b, [Figure 8]c, [Figure 8]d.
Figure 8: (a-d) Preoperative and postoperative orthopantomographs and cross sections of cone-beam computed tomography showing residual alveolar bone height

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Case report 4

A 19-year-old young woman was referred to the department seeking options for rehabilitation of missing right upper first molar with fixed prosthesis as she was uncomfortable with the removable partial denture in relation to #16. The residual bone height was 4 mm in #16 region. The patient was taken up for direct sinus elevation via lateral window approach for sinus augmentation in relation to #16 region. Under aseptic conditions and local anesthesia, lateral wall of the maxilla was exposed after mucoperiosteal flap elevation. A window was created of 1 cm diameter corresponding to apical aspect of #16. Sinus membrane was identified and elevated using sinus elevators and reamers without perforating the lining. Once the sinus membrane was elevated, graft material was dispensed to achieve an augmentation of 1 cm assessed clinically and confirmed using postoperative OPG. At the end of 6 months, a CBCT scan showed an increased bone height of 12.7 mm [Figure 9]a, [Figure 9]b, [Figure 9]c, [Figure 9]d.
Figure 9: (a-d) Preoperative and postoperative orthopantomographs and cross sections of cone-beam computed tomography showing residual alveolar bone height

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  Results Top


The study comprised 43% of females and 57% of males with a mean age of 46.07 years. The study included nine males and eight females. The gender distribution in the indirect sinus augmentation procedures was four males and six females, while direct sinus augmentation was done in six males and three females. Two patients (one male and one female) underwent both direct and indirect sinus augmentation on their right and left maxillary quadrants, and one female underwent direct technique on both sides. The region of sinus augmentation varied from premolar to molar region, with the majority of it being in the first molar region. In indirect sinus augmentation procedure, as measured by CBCT, the average preoperative height of bone was 6.8 mm while postoperative height of bone was 11.86 mm. A paired sample t-test was carried out to know the difference in pre- and posttreatment measurements of bone height with indirect sinus augmentation procedure. The posttreatment bone height (11.86 ± 1.11 mm) was significantly higher than pretreatment bone height (6.80 ± 0.70 mm) (t = 12.90, P < 0.005) [Table 1] and [Graph 1]. In direct sinus augmentation procedure, the average preoperative height of bone was 2.44 mm while postoperative height of bone was 11.27 mm. When a paired sample t-test was carried out to know the difference in pre- and posttreatment measurements of bone height with direct sinus augmentation, it showed that the posttreatment bone height (11.27 ± 0.71 mm) was significantly higher than pretreatment bone height (2.44 ± 0.81 mm) (t = 32.17, P < 0.005) [Table 2] and [Graph 2]. In indirect sinus augmentation procedure, as measured by OPG, the average preoperative height of bone was 7.2 mm while postoperative height of bone was 10.2 mm. A paired sample t-test was carried out to know the difference in pre- and posttreatment measurements of bone height with indirect sinus augmentation procedure. The posttreatment bone height (10.20 ± 0.92 mm) was significantly higher than pretreatment bone height (7.20 ± 1.23 mm) (t = 10.06, P < 0.005) [Table 3] and [Graph 3]. In direct sinus augmentation procedure, the average preoperative height of bone, as measured by OPG, was 1.3 mm while postoperative height of bone was 8.85 mm. When a paired sample t-test was carried out to know the difference in pre- and posttreatment measurements of bone height with direct sinus augmentation, it showed that the posttreatment bone height (8.85 ± 1.0 mm) was significantly higher than pretreatment bone height (1.30 ± 0.92 mm) (t = 19.33, P < 0.005) [Table 4] and [Graph 4]. When a comparison was done in the assessment of mean preoperative height of bone in the indirect sinus augmentation procedure as measured by CBCT and OPG, the average preoperative height of bone was 6.80 ± 0.70 mm in case of CBCT while 7.20 ± 1.23 mm in case of OPG. When a paired sample t-test was carried out to know the difference in pretreatment measurements of bone height with indirect sinus augmentation in case of CBCT and OPG, it showed P = 0.173, which was not statistically significant [Table 5] and [Graph 5]. When a comparison was done in the assessment of mean postoperative height of bone in the indirect sinus augmentation procedure as measured by CBCT and OPG, the average postoperative height of bone was 11.86 ± 1.11 mm in case of CBCT while 10.20 ± 0.92 mm in case of OPG. When a paired sample t-test was carried out to know the difference in posttreatment measurements of bone height with indirect sinus augmentation in case of CBCT and OPG, it showed P < 0.005, which was statistically significant [Table 6] and [Graph 6]. When a comparison was done in the assessment of mean preoperative height of bone in the direct sinus augmentation procedure as measured by CBCT and OPG, the average preoperative height of bone was 2.44 ± 0.81 mm in case of CBCT while 1.30 ± 0.92 mm in case of OPG. When a paired sample t-test was carried out to know the difference in pretreatment measurements of bone height with indirect sinus augmentation in case of CBCT and OPG, it showed P < 0.005, which was statistically significant [Table 7] and [Graph 7]. When a comparison was done in the assessment of mean postoperative height of bone in the direct sinus augmentation procedure as measured by CBCT and OPG, the average postoperative height of bone was 11.27 ± 0.71 mm in case of CBCT while 8.85 ± 1.0 mm in case of OPG. When a paired sample t-test was carried out to know the difference in posttreatment measurements of bone height with indirect sinus augmentation in case of CBCT and OPG, it showed P < 0.005, which was statistically significant [Table 8] and [Graph 8].
Table 1: Comparison of mean pre- and postoperative bone height (mm) with indirect sinus augmentation as measured by cone-beam computed tomography

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Table 2: Comparison of mean pre- and postoperative bone height (mm) with direct sinus augmentation as measured by cone-beam computed tomography

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Table 3: Comparison of mean pre- and postoperative bone height (mm) with indirect sinus augmentation as measured by orthopantomography

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Table 4: Comparison of mean pre- and postoperative bone height (mm) with direct sinus augmentation as measured by orthopantomography

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Table 5: Comparison of mean preoperative bone height (mm) with indirect sinus augmentation as measured by orthopantomography and cone-beam computed tomography

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Table 6: Comparison of mean postoperative bone height (mm) with indirect sinus augmentation as measured by orthopantomography and cone-beam computed tomography

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Table 7: Comparison of mean preoperative bone height (mm) with direct sinus augmentation as measured by orthopantomography and cone-beam computed tomography

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Table 8: Comparison of mean postoperative bone height (mm) with direct sinus augmentation as measured by orthopantomography and cone-beam computed tomography

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  Discussion Top


Radiology and imaging plays an important part in any minor or major surgical procedure which is planned. The presurgical radiographic assessment allows the surgeon to plan implant insertion in the subantral maxillary regions. An accurate presurgical planning, based on adequately selected radiology and imaging techniques, ensures optimal surgical results. By bringing new and detailed information through cross-sectional imaging and 3D assessment of the region in the presurgical phase of treatment, the present study revealed that CBCT may change treatment planning for the various sinus lift procedures carried out in cases with atrophic maxillae and in the presence of numerous other anatomic constraints.[5] Fewer studies, till date, have evaluated the efficacy of cross-sectional imaging in the form of CBCT as against the conventional radiographic techniques which proved the need for the present study. Radiographic evaluation is necessary for information regarding the quantity and quality of the bone available and to localize anatomic structures in the proximity of the region where the procedure is supposed to be carried out. Presurgical implant imaging should provide information about the implant site with regard to the osseous morphology such as knife edge ridges, cortical irregularities and thickness, developmental variations, enlarged marrow spaces, density of the trabecular bone, and postextraction irregularities in addition to the amount of bone available for implant placement along with the orientation of the alveolar bone. Cross-sectional imaging is required to obtain such information regarding the osseous morphology in terms of the relative proportion and densities of the cortical and medullary bones for implant site assessment. Cross-sectional imaging provides information regarding the osseous morphology in terms of the relative proportion and density of the cortical and medullary bones for implant site assessment. The relevance of such imaging, rather, becomes obvious at all stages of treatment planning including the decision-making to carry-out such surgical procedures, assessing information pertaining to sinus anatomy, the time of implant placement, technique best suited for intervention as well as the type and volume of the graft material to be used. Furthermore, since the position of the maxillary sinus floor is difficult to be assessed on 2D imaging and CBCT has numerous advantages over the conventional radiography as well as CT, CBCT was used in the present study for carrying out the intended sinus augmentation procedures while bone density was assessed visually by assessing the width of the trabecular pattern and was classified based on the Misch's classification.[4] This was in accordance with the study conducted by Temmerman et al. in 2011, which showed that panoramic imaging underscored the mesiodistal distance of the available bone in upper premolar region and concluded the need for going for cross-sectional imaging like CBCT for presurgical treatment planning.[3] In the present study, measurements (based on CBCT imaging) preoperatively and postoperatively for indirect sinus augmentation procedures were 6.8 mm and 11.76 mm, respectively, while for direct augmentation procedures, the values were 2.44 mm and 11.7 mm, respectively. The mean of difference in bone height in direct and indirect sinus augmentation procedures was 8.83 mm and 4.96 mm, with the difference obtained being statistically significant with P < 0.005. Arias-Irimia et al. measured the volume of sinus lifts postoperatively using CBCT imaging and showed a correlation between the volume of the sinus lift required and the size of the bone graft to be used (height and length).[6] There are several studies that have evaluated bone formation after sinus lift procedures and demonstrated the aptness of CBCT imaging for the postoperative evaluation of sinus lift. According to Baciut et al., CBCT increases the accuracy of both assessment of sinus morphology and harvesting of bone grafts in line with the estimated volume available.[7] CBCT provides 3D imaging in the maxillofacial region at relatively low radiation doses as compared to the conventional CT. Furthermore, because of these inherent advantages over conventional CT and 2D radiography, CBCT was recommended in the present study for the evaluation of residual alveolar bone height as an easy and effective way of measuring the pre- and postoperative bone heights.[8] Soardi et al. in 2014 did a quantitative comparison of CBCT and microradiography in the evaluation of bone density after maxillary sinus augmentation procedures by conducting a two-stage protocol in 19 consenting patients, all having the crestal bone < 2 mm. A succession of CBCT images of the maxilla was taken before surgery, after the sinus augmentation procedure, and immediately after implant insertion. Furthermore, bone core biopsy was taken at the site of implant placement 6 months after the surgical procedure. The authors concluded that CBCT imaging had a clear predictability in the treatment planning.[9] Panoramic radiography displays an inherent deformation, which impedes its interpretation and exact quantitative measurements. Rodriguez-Recio et al. have, also, shown the benefits of using CT and specialized software that can provide important information about the quality and quantity of bone in the palatal donor areas.[10] In the present study, paired sample t-test was used to know the difference in original and grafted sinus floor measurements for bone density (gray scale values) in case of both direct and indirect sinus augmentation procedures and found extremely promising results which were found to be statistically significant (P < 0.001). The outcome of the present study suggested that CBCT can be used for analysis of bone quantity and quality and in predicting the success of grafts in direct and indirect sinus augmentation procedures. The decision to perform the type of sinus augmentation procedure was made based on the residual alveolar bone/crestal bone height remaining and to avoid undue tissue insult and injury. In any sinus lift procedure for a successful implant placement, there is always a need felt to reduce surgical risks, invasiveness, cost, and time while simultaneously performing the best-suited surgical procedure to exploit most of the existing bone and morphology for the purpose of implant placement. An accurate estimation of the necessary bone graft volume is very important to optimize the surgical technique and to reduce the risk of impending complications. In this, a key point in cross-sectional imaging is in the aptness achieved in the evaluation of a deficient crest and comparison of the original and postaugmentation dimensions.[3] Buyukkurt et al. showed that 3D CT techniques can be used to calculate the volume required for sinus floor augmentation procedures.[11] The present study evaluated the clinical validity of CBCT in comparison to panoramic radiography regarding preoperative implant planning in combination with sinus grafting procedures and assessed the accuracy of CBCT for preoperative estimation of the required sinus lift height and in the estimation of the volume of grafting material required for sinus grafting procedures. The results proved that using specialized software, CBCT allows the estimation of the height for bone grafts significantly better than panoramic radiography. Therefore, within the limitations of the present study, CBCT seems to be a superior examination technique because of the provision for 3D planning. Several studies have shown the advantages of using CT in providing important volumetric information about the quality and quantity of bone in the said procedures.[12],[13] Nevertheless, in the present study, also, few patients were encountered wherein the treatment choice was adapted after having CBCT imaging. In a clinical context, this treatment switch prevents complications or unexpected events during surgery. Indeed, instead of a bone shortage revealed during surgery, requiring a sudden change in treatment strategy, this bone shortage can be detected before surgery, giving the intervention an optimal set-off. Furthermore, there are several studies that emphasize the usefulness of CBCT in the evaluation of bone formation after sinus lift procedures, demonstrating the efficacy of CBCT for postoperative evaluation of sinus lift procedures.[14]


  Conclusion Top


Based on the findings of the present study, it can be concluded that CBCT has an important role in cases of sinus lift procedures to improve the diagnostic efficiency as well as the accuracy of sinus lift procedures. Furthermore, it is extremely helpful in the presurgical planning of the sinus lift procedures and for an efficient comparison of the gain in vertical alveolar bone height postgraft placements. When only panoramic radiographs are used, bone quantity and quality are risked to be overestimated. The present study demonstrates that CBCT increases the accuracy of both the sinus morphology assessment and the estimation of gain in vertical alveolar bone height, in addition to bone density, which remains unassessed by conventional radiological techniques.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Chan HL, Misch K, Wang HL. Dental imaging in implant treatment planning. Implant Dent 2010;19:288-98.  Back to cited text no. 1
    
2.
White SC, Pharoah MJ. Oral Radiology. Principles and Interpretation. 5th ed. St. Louis: Mosby; 2004.  Back to cited text no. 2
    
3.
Temmerman A, Hertelé S, Teughels W, Dekeyser C, Jacobs R, Quirynen M. Are panoramic images reliable in planning sinus augmentation procedures? Clin Oral Implants Res 2011;22:189-94.  Back to cited text no. 3
    
4.
Misch CE. Contemporary Implant Dentistry. 3rd ed. St. Louis, Missouri: Mosby, Elsevier; 2008.  Back to cited text no. 4
    
5.
Tatum H Jr. Maxillary and sinus implant reconstructions. Dent Clin North Am 1986;30:207-29.  Back to cited text no. 5
    
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Arias-Irimia O, Barona-Dorado C, Martínez-Rodríguez N, Ortega-Aranegui R, Martínez-González JM. Pre-operative evaluation of the volume of bone graft in sinus lifts by means of compuDent. Med Oral Patol Oral Cir Bucal 2010;15:e512-6.  Back to cited text no. 6
    
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Baciut M, Hedesiu M, Bran S, Jacobs R, Nackaerts O, Baciut G, et al. Pre- and postoperative assessment of sinus grafting procedures using cone-beam computed tomography compared with panoramic radiographs. Clin Oral Implants Res 2013;24:512-6.  Back to cited text no. 7
    
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Pjetursson BE, Tan WC, Zwahlen M, Lang NP. A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation. J Clin Periodontol 2008;35:216-40.  Back to cited text no. 8
    
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Soardi CM, Zaffe D, Motroni A, Wang HL. Quantitative comparison of cone beam computed tomography and microradiography in the evaluation of bone density after maxillary sinus augmentation: A preliminary study. Clin Implant Dent Relat Res 2014;16:557-64.  Back to cited text no. 9
    
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Rodriguez-Recio O, Rodriguez-Recio C, Gallego L, Junquera L. Computed tomography and computer-aided design for locating available palatal bone for grafting: Two case reports. Int J Oral Maxillofac Implants 2010;25:197-200.  Back to cited text no. 10
    
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Buyukkurt MC, Tozoglu S, Yavuz MS, Aras MH. Simulation of sinus floor augmentation with symphysis bone graft using three-dimensional computerized tomography. Int J Oral Maxillofac Surg 2010;39:788-92.  Back to cited text no. 11
    
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Liang X, Jacobs R, Hassan B, Li L, Pauwels R, Corpas L, et al. Acomparative evaluation of cone beam computed tomography (CBCT) and multi-slice CT (MSCT) part I. On subjective image quality. Eur J Radiol 2010;75:265-9.  Back to cited text no. 12
    
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Liang X, Lambrichts I, Sun Y, Denis K, Hassan B, Li L, et al. Acomparative evaluation of cone beam computed tomography (CBCT) and multi-slice CT (MSCT). Part II: On 3D model accuracy. Eur J Radiol 2010;75:270-4.  Back to cited text no. 13
    
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Kher U, Ioannou AL, Kumar T, Siormpas K, Mitsias ME, Mazor Z, et al. Aclinical and radiographic case series of implants placed with the simplified minimally invasive antral membrane elevation technique in the posterior maxilla. J Craniomaxillofac Surg 2014;42:1942-7.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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