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PRESENTED BY:
DR. MONALI PRAJAPATI
PG PART III
UNDER GUIDANCE OF:
DR. JIGNA SHAH
PROFESSOR AND HOD
ORAL MEDICINE AND RADIO...
In the present era when it comes to oral rehabilitation, a wide array of options are available
to restore the missing teet...
Figure -2Figure -1
Figure -3 Figure -4
1.5mm
3mm
Bone Density Description Tactile Analog Typical Anatomical
Location
D1 Dense Cortical Oak or maple wood Anterior mandible
...
ORAL AND
MAXILLOFACIAL
RADIOLOGISTS
IMPLANTOLOGIST
S
MAXIMISE DIAGNOSTIC EFFICIENCY
MINIMISE RADIATION RISK
 To decide if implant treatment is appropriate for the patient,
 To detect any possible pathological conditions,
 To as...
 PHASE 1: PRE-PROSTHETIC IMPLANT IMAGING
 PHASE 2: SURGICAL AND INTERVENTIONAL
IMPLANT IMAGING
 PHASE 3: POST-PROSTHETI...
 PLANAR TWO DIMENSIONAL IMAGING
 QUASI THREE DIMENSIONAL IMAGING
 THREE DIMENSIONAL IMAGING
DETERMINE
IMPLANT
ORIENTATION
DETERMINE
IMPLANT POSITION
IDENTIFY
DISEASE
DETERMINE BONE
QUANTITY
DETERMINE
BONE
QUALITY
MAXILLARY SINUS
LINING
VERTICAL HEIGHT
ORIENTATION
MESIODISTAL WIDTH
FOR SINGLE IMPLANT SITE
Residual bone cyst Dense bone islands
Sites with acute infection
including exudate or pus flow are
considered high-risk, and can
cause post-surgical
complicatio...
FLOOR OF NASAL CAVITY NASOPALATINE CANAL INCISIVE CANAL
MAXILLARY SINUS
INCICIVE FORAMEN
MENTAL FORAMEN
MANDIBULAR CANAL
A reduced vertical bone
height at an adjacent
root surface (>6mm)
affect the height of the
Interdental papilla
following i...
COMPUTER-ASSISTED MEASUREMENTS, RULERS, CALIPERS, AND SUPRABONY
THREAD EVALUATION
DISTORTION
LACKS THIRD
DIMENSION
FI NE TRABECULAR
PLATES AND MULTIPLE
SMALL TRABECULAR
SPACES
GENERALLY SHOWING LARGE
MARROW SPACES AND SPARSE
TRABECULATIO...
CRESTAL BONE LOSS EVALUATION CAN BE BENEFITTED USING
DIGITAL PERIAPICAL RADIOGRAPHY
ASSESS ALVEOLAR CREST
The mandibular occlusal radiograph shows the
widest width of bone (i.e., the symphysis) versus the
width at the crest, whi...
SPATIAL RELATION OF OCCLUSION
AND ESTHETICS
CROSS-SECTION OF CANINE AND
LATERAL INCISOR REGION
VERTICAL DIMENSION
RELATION...
THESE TECHNIQUE PRODUCES A NUMBER OF CLOSELY SPACED
TOMOGRAPHIC IMAGES
VERTICAL HEIGHT MESIODISTAL WIDTH
ORIENTATION PERIODONTAL CONDITION
PATHOLOGY VITAL ANATOMIC
STRUCTURES
WHEN PANORAMIC AND THE PERIAPICAL IMAGES
ARE THE ONLY DIAGNOSTIC TOOL TO ASSESS
AVAILABLE BONE HEIGHT
ZONE OF SAFETY
DEMERITS
 Distortions inherent in the panoramic systems
 Fixed vertical magnification of upto 10%
 Uncertain horizontal...
RADIOGRAPHIC MARKER
(a)Cropped panoramic radiograph
demonstrating excellent bone height in
the lower right molar region. (b)
Reformatted cross...
CROSS SECTIONAL DIAGRAM
OF THE MANDIBLE
SHOWING THAT
STRUCTURES THAT ARE
MORE LINGUAL ARE
PROJECTED HIGHER ON THE
FILM THA...
DOES NOT DEMONSTRATE BONE
QUALITY
NO SPATIAL RELATIONSHIP BETWEEN
STRUCTURES CAN BE ESTABLISHED
Dentascan imaging provides programmed
reformation, organization and display of the imaging
study.
Cancellous bone density Hounsfield unit
D1 > 1250HU
D2 850-1250HU
D3 350-850HU
D4 150-350HU
D5 <150HU
DEMERITS
HIGH RADIATION DOSE
TECHNIQUE SENSITIVE
EXPENSIVE
EXPOSURE TIME – 36seconds
SINGLE EXPOSURE REQUIRED
LESS RADIATION EXPOSURE
EXPOSES BOTH ARCHES SIMULTANEOUSLY
LESS SCATTER
If the facial wall is thin (≤ 1 mm), this bone will resorb
within 4 to 8 weeks leading to a horizontal, crater-
shaped bon...
EVALUATES THE
SURGICAL SITES
DURING AND
IMMEDIATELY
AFTER SURGERY
OPTIMAL
POSITIONIN
G AND
ORIENTATIO
N OF
DENTAL
IMPLANTS...
ORIENTATION OF
IMPLANT
SEATING OF PROSTHESIS
INVERSION OF GRAY
SCALE TO EVALUATE
OSSEOUS QUALITY AND
LOCATION OF VITAL
STRUTURES
EDGE ENHANCEMENT,” WHICH IS THE ABILITY TO DETECT SPACE
BETWEEN THE IMPLANT AND THE SURROUNDING BONE
ALLOW VIEWING OF ANY ...
BONE LOSS AROUND A ROOT-
FORM DENTAL IMPLANT (THIN
RADIOLUCENT BAND
SURROUNDING THE IMPLANT),
INDICATING FAILURE OF
OSSEOU...
A panoramic radiograph used for
postoperative assessment of multiple
successfully restored rootform implants.
The cross-sectional reformatted CBCT images reveal nonrestorable ectopic
placement of the existing implants with lingual c...
DETERMINE
CRESTAL BONE
LEVELS
ASSESS THE BONE
ADJACENT TO THE
DENTAL IMPLANT
CLOSE
APPOSITION OF
THE BONE TO THE
SURFACE OF
EACH IMPLANT.
MINOR AMOUNT OF SAUCERIZATION IS PRESENT AT THE
ALVEOLAR CRES...
BITEWING RADIOGRAPH
FACTORS TWO DIMENSIONAL
IMAGING
THREE DIMENSIONAL
IMAGING
MESIODISTAL WIDTH ASSESSED ASSESSED
BUCCOLINGUAL WIDTH NOT ASSES...
PERIAPICAL RADIOGRAPHY
ADVANTAGES DISADVANTAGES INDICATIONS
• Low radiation dose
• Minimal magnification
with proper techn...
OCCLUSAL RADIOGRAPHY
ADVANTAGES DISADVANTAGES INDICATIONS
• Low radiation dose
• High resolution
• Inexpensive
• spatial r...
PANORAMIC RADIOGRAPHY
ADVANTAGES DISADVANTAGES INDICATIONS
• Single image of maxilla
and mandible
obtained
• Convenience, ...
DENTASCAN/ CBCT
ADVANTAGES DISADVANTAGES INDICATIONS
• Negligible
magnification
• High contrast
• Axial, coronal sagittal
...
 Carl E. Misch, Conmtemporary implant dentistry, 3rd edition
 Textbook Of Dental And Maxillofacial Radiology By Freny Ka...
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT
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RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT

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This presentation deals with radiographic imaging of three important phases of implant placement; PHASE 1: PRE-PROSTHETIC IMPLANT IMAGING
PHASE 2: SURGICAL AND INTERVENTIONAL IMPLANT IMAGING
PHASE 3: POST-PROSTHETIC IMPLANT IMAGING



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RADIOGRAPHIC IMAGING FOR DENTAL IMPLANT ASSESSMENT

  1. 1. PRESENTED BY: DR. MONALI PRAJAPATI PG PART III UNDER GUIDANCE OF: DR. JIGNA SHAH PROFESSOR AND HOD ORAL MEDICINE AND RADIOLOGY DEPARTMENT GDCH, AHMEDABAD
  2. 2. In the present era when it comes to oral rehabilitation, a wide array of options are available to restore the missing teeth using the fixed or removable prosthesis. The advent of implants in the field of dentistry has given the dental professionals a viable option to provide the patients with nearly a third set of dentition.
  3. 3. Figure -2Figure -1 Figure -3 Figure -4
  4. 4. 1.5mm 3mm
  5. 5. Bone Density Description Tactile Analog Typical Anatomical Location D1 Dense Cortical Oak or maple wood Anterior mandible D2 Porous cortical and coarse trabecular White pine or spruce wood Anterior mandible Posterior mandible Anterior maxilla D3 Porous cortical (thin) and fine trabecular Balsa wood Anterior maxilla Posterior maxilla Posterior mandible D4 Fine trabecular Styrofoam Posterior maxilla
  6. 6. ORAL AND MAXILLOFACIAL RADIOLOGISTS IMPLANTOLOGIST S
  7. 7. MAXIMISE DIAGNOSTIC EFFICIENCY MINIMISE RADIATION RISK
  8. 8.  To decide if implant treatment is appropriate for the patient,  To detect any possible pathological conditions,  To ascertain height, buccolingual width, and angulation of alveolar process,  To identify the location of vital anatomical structures such as the inferior alveolar nerve and maxillary sinus,  To ascertain bone quantity,  To decide the length and width of the implant to be placed
  9. 9.  PHASE 1: PRE-PROSTHETIC IMPLANT IMAGING  PHASE 2: SURGICAL AND INTERVENTIONAL IMPLANT IMAGING  PHASE 3: POST-PROSTHETIC IMPLANT IMAGING
  10. 10.  PLANAR TWO DIMENSIONAL IMAGING  QUASI THREE DIMENSIONAL IMAGING  THREE DIMENSIONAL IMAGING
  11. 11. DETERMINE IMPLANT ORIENTATION DETERMINE IMPLANT POSITION IDENTIFY DISEASE DETERMINE BONE QUANTITY DETERMINE BONE QUALITY
  12. 12. MAXILLARY SINUS LINING VERTICAL HEIGHT ORIENTATION MESIODISTAL WIDTH FOR SINGLE IMPLANT SITE
  13. 13. Residual bone cyst Dense bone islands
  14. 14. Sites with acute infection including exudate or pus flow are considered high-risk, and can cause post-surgical complications if implants are inserted in these infected sites.
  15. 15. FLOOR OF NASAL CAVITY NASOPALATINE CANAL INCISIVE CANAL MAXILLARY SINUS
  16. 16. INCICIVE FORAMEN MENTAL FORAMEN MANDIBULAR CANAL
  17. 17. A reduced vertical bone height at an adjacent root surface (>6mm) affect the height of the Interdental papilla following implant therapy.
  18. 18. COMPUTER-ASSISTED MEASUREMENTS, RULERS, CALIPERS, AND SUPRABONY THREAD EVALUATION
  19. 19. DISTORTION
  20. 20. LACKS THIRD DIMENSION
  21. 21. FI NE TRABECULAR PLATES AND MULTIPLE SMALL TRABECULAR SPACES GENERALLY SHOWING LARGE MARROW SPACES AND SPARSE TRABECULATION COARSER TRABECULAR PLATES AND LARGER MARROW SPACES
  22. 22. CRESTAL BONE LOSS EVALUATION CAN BE BENEFITTED USING DIGITAL PERIAPICAL RADIOGRAPHY
  23. 23. ASSESS ALVEOLAR CREST
  24. 24. The mandibular occlusal radiograph shows the widest width of bone (i.e., the symphysis) versus the width at the crest, which is where diagnostic information is needed most .
  25. 25. SPATIAL RELATION OF OCCLUSION AND ESTHETICS CROSS-SECTION OF CANINE AND LATERAL INCISOR REGION VERTICAL DIMENSION RELATION OF LINGUAL PLATE WITH PATIENTS SKELETAL ANATOMY CAN BE DETERMINED (IMPLANTS ARE USUALLY PLACE ADJACENT TO LINGUAL PLATE IN ANTERIOR REGION)
  26. 26. THESE TECHNIQUE PRODUCES A NUMBER OF CLOSELY SPACED TOMOGRAPHIC IMAGES
  27. 27. VERTICAL HEIGHT MESIODISTAL WIDTH ORIENTATION PERIODONTAL CONDITION PATHOLOGY VITAL ANATOMIC STRUCTURES
  28. 28. WHEN PANORAMIC AND THE PERIAPICAL IMAGES ARE THE ONLY DIAGNOSTIC TOOL TO ASSESS AVAILABLE BONE HEIGHT ZONE OF SAFETY
  29. 29. DEMERITS  Distortions inherent in the panoramic systems  Fixed vertical magnification of upto 10%  Uncertain horizontal magnification upto 20%
  30. 30. RADIOGRAPHIC MARKER
  31. 31. (a)Cropped panoramic radiograph demonstrating excellent bone height in the lower right molar region. (b) Reformatted cross-sectional CT images showing reasonable bone height but the ridge is narrow bucco-lingually.
  32. 32. CROSS SECTIONAL DIAGRAM OF THE MANDIBLE SHOWING THAT STRUCTURES THAT ARE MORE LINGUAL ARE PROJECTED HIGHER ON THE FILM THAN STRUCTURES THAT ARE MORE BUCCAL
  33. 33. DOES NOT DEMONSTRATE BONE QUALITY NO SPATIAL RELATIONSHIP BETWEEN STRUCTURES CAN BE ESTABLISHED
  34. 34. Dentascan imaging provides programmed reformation, organization and display of the imaging study.
  35. 35. Cancellous bone density Hounsfield unit D1 > 1250HU D2 850-1250HU D3 350-850HU D4 150-350HU D5 <150HU
  36. 36. DEMERITS HIGH RADIATION DOSE TECHNIQUE SENSITIVE EXPENSIVE
  37. 37. EXPOSURE TIME – 36seconds SINGLE EXPOSURE REQUIRED LESS RADIATION EXPOSURE EXPOSES BOTH ARCHES SIMULTANEOUSLY LESS SCATTER
  38. 38. If the facial wall is thin (≤ 1 mm), this bone will resorb within 4 to 8 weeks leading to a horizontal, crater- shaped bone defect and a loss of bone height on the facial aspect.
  39. 39. EVALUATES THE SURGICAL SITES DURING AND IMMEDIATELY AFTER SURGERY OPTIMAL POSITIONIN G AND ORIENTATIO N OF DENTAL IMPLANTS TO ASCERTAIN THE HEALING TO ENSURE APPROPRIATE ABUTMENT POSITIONING AND PROSTHESIS FABRICATION
  40. 40. ORIENTATION OF IMPLANT SEATING OF PROSTHESIS
  41. 41. INVERSION OF GRAY SCALE TO EVALUATE OSSEOUS QUALITY AND LOCATION OF VITAL STRUTURES
  42. 42. EDGE ENHANCEMENT,” WHICH IS THE ABILITY TO DETECT SPACE BETWEEN THE IMPLANT AND THE SURROUNDING BONE ALLOW VIEWING OF ANY SUBTLE CHANGES IN BONE DENSITY AROUND THE IMPLANT INTERFACE.
  43. 43. BONE LOSS AROUND A ROOT- FORM DENTAL IMPLANT (THIN RADIOLUCENT BAND SURROUNDING THE IMPLANT), INDICATING FAILURE OF OSSEOUS INTEGRATION. PERIAPICAL VIEW OF A FRACTURED ENDOSSEOUS IMPLANT.
  44. 44. A panoramic radiograph used for postoperative assessment of multiple successfully restored rootform implants.
  45. 45. The cross-sectional reformatted CBCT images reveal nonrestorable ectopic placement of the existing implants with lingual cortical perforation and extension into the lingual tissues.
  46. 46. DETERMINE CRESTAL BONE LEVELS ASSESS THE BONE ADJACENT TO THE DENTAL IMPLANT
  47. 47. CLOSE APPOSITION OF THE BONE TO THE SURFACE OF EACH IMPLANT. MINOR AMOUNT OF SAUCERIZATION IS PRESENT AT THE ALVEOLAR CREST ADJACENT TO THE DISTAL FIXTURE
  48. 48. BITEWING RADIOGRAPH
  49. 49. FACTORS TWO DIMENSIONAL IMAGING THREE DIMENSIONAL IMAGING MESIODISTAL WIDTH ASSESSED ASSESSED BUCCOLINGUAL WIDTH NOT ASSESSED ASSESSED VERTICAL HEIGHT ASSESSED ASSESSED SPATIAL RELATION WITH ANATOMIC STRUCTURE NOT ASSESED ASSESSED RADIATION LESS MORE MAGNIFICATION MORE LESS AVAILABITY AND CONVENIENCE EASY, CONVENIENT DIFFICULT BONE DENSITY CAN NOT BE EVALUATED CAN BE EVALUATED
  50. 50. PERIAPICAL RADIOGRAPHY ADVANTAGES DISADVANTAGES INDICATIONS • Low radiation dose • Minimal magnification with proper technique • High resolution • Inexpensive • Distortion and magnification • Minimal site evaluation • Difficulty in film placement • Lack of cross-sectional imaging • Bucco-lingual width can not be measured • Spatial relation can not be established • Bone density can not be evaluated • Single implant site (anterior, middle, posterior maxilla/mandible) • Alignment and orientation during surgery (interventional phase) • Post- prosthetic stage evaluation
  51. 51. OCCLUSAL RADIOGRAPHY ADVANTAGES DISADVANTAGES INDICATIONS • Low radiation dose • High resolution • Inexpensive • spatial relation can not be established • Bone density can not be evaluated Of little value CEPHALOMETERIC IMAGING • Height / width in anterior region • Low magnification • Skeletal relationship • Crown/ implant ratio in anterior region • Relation of lingual cortical plate to skeletal structure can be established • Availability • Image information limited to midline • Reduced resolution • Single implant site evaluation • Anterior maxilla/mandible region • Symphysis bone graft evaluation
  52. 52. PANORAMIC RADIOGRAPHY ADVANTAGES DISADVANTAGES INDICATIONS • Single image of maxilla and mandible obtained • Convenience, ease, and speed in performance • Distortion and magnification • Lack of cross-sectional imaging • Bucco-lingual width can not be measured • Spatial relation can not be established • Bone density can not be evaluated • Single implant site (middle, posterior maxilla/mandible) • Multiple implant site • Implant overdenture site • Alignment and orientation during surgery (interventional phase) • Post- prosthetic stage evaluation
  53. 53. DENTASCAN/ CBCT ADVANTAGES DISADVANTAGES INDICATIONS • Negligible magnification • High contrast • Axial, coronal sagittal views • Buccolingial width determined • Spatial relation can be established • Interactive treatment planning • High radiation exposure • Cost • Technique sensitive • Single implant site (anterior, middle, posterior maxilla/mandible) • Multiple implant site • Implant overdenture site • Unless any complication, not advisable for interventional and post prosthetic evaluation • Bone density
  54. 54.  Carl E. Misch, Conmtemporary implant dentistry, 3rd edition  Textbook Of Dental And Maxillofacial Radiology By Freny Karjodkar  White & Pharoah, 6th Edition  Lingeshwar D, Dhanasekar B, Aparna -Diagnostic Imaging In Implant Dentistry In International Journal Of Oral Implantology And Clinical Research, September-December 2010;1(3):147-153  Aishwarya Nagarajan, Rajapriya Perumalsamy, Ramakrishnan Thyagarajan, Ambalavanan Namasivayam- Diagnostic Imaging For Dental Implant Therapy In Journal Of Clinical Imaging Science | Vol. 4 | Dental Suppl 2 | Oct-Dec 2014  Dale A. Miles* And Ronald K. Shelle- Pre-Surgicalimplant Site Assessment ,Part I - Precise And Practical Radiographic Stent Construction For Cone Beam Ct Imaging  Martin J. Bourgeois Dds, M.Ed., Dip. Oral Rad. 20000701, Radiology: PreSurgical Radiographic Imaging For The Placement Of Dental Implants  S. J. J. Mccrea- Pre-Operative Radiographs For Dental Implants – Are Selection Criteria Being Followed British Dental Journal Volume 204 No. 12 Jun 28 2008  Maxillofacial Radiology On Selection Criteria For The Use Of Radiology In Dental Implantology With Emphasis On Cone Beam Computed Tomography By Donald A. Tyndall, Dds, Msph, Phd,Scott D. Ganz, Dmd,Jeffery B. Price, Dds, Ms,Charles Hildebolt, Dds, Phd,Sotirios Tetradis, Dds, Phd,And William C. Scarfe, Bds, Ms Position Statement Of The American Academy Of Oral .OOO, Vol. 113 No. 6 June 2012

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