CT Scan and Dental Implants

nettlesoup

I am just wondering if a CT Scan is necessary for the Placement of a Dental Implant. A lot clinics want you to have them and a lot of articles I read online refer to them. On the other side of the coin if you don't have one how can the surgeon determine Bone Density and width.
My preference would be not to have one as I have had a lot of X-Rays over the years both dental and Non Dental and I am just a bit worried about the cumulative effect of all these otherwise I would have no problem. The tooth in question is an upper front Incisor. If it is necessary I will.

Also at what point does the surgeon determine that you need a Bone graft ?Initial Consultation, after the tooth is out or before placing the implant.

Thanks.

davo10

OS will answer the bone graft part of your post.

CT scans are used to identify the exact location of surrounding anatomical features like nerves, sinus, bone height and width etc. The implant software used to read the scan can aid in deciding what type/length/width of implant can be used for optimal results. The surgeon can also plan the insertion plane for the implant and whether grafting is necessary. A standard x ray gives you a 2D view, a CT gives 3D so provides more info. The more info the surgeon has, the better they can plan, the better the result in most cases.

Trust the surgeon, they wouldn't ask for the CT unless (s)he felt is was necessary.

btkm8unsl0w5r4

OP dental X-rays do contain ionizing radiation, however you expose yourself to a lot of ionizing radiation on a day to day basis. A dental CBCT scan is about the same extra dose of radiation as a plane trip to London (you get more radiation the higher you are up in the air from the solar radiation). Its a minor dose.

Not every dental implant needs a CT scan, in some cases its obvious that the bone is sufficient or insufficient. Its in the borderline cases or very large scale cases that a scan may be beneficial.

CBCT cannot tell about bone density (yes you can get QR values but that have no clinical correlation to insertion torque) they do tell about nerves, sinus position, bone volume.

You have to trust the person doing the job. they should know a lot more about this than you. If you don't trust their opinion regarding whether you should have a scan or not, you must ask yourself do you trust them to drill into your skull and insert a piece of metal.

Oral Surgeon

Is it necessary for all single tooth implant cases- certainly not.
Plain film (small xray) or panoramic (full mouth) xrays can predictably tell the clinician the height of bone that they have to work with.
Width can often be judged clinically by just looking at the site and feeling the area.

As already said, a dentist can often tell you if the site is good and likely will not need bone grafting or if the site is terrible and will need bone grafting. It's the grey area in the middle that a CT scan "may" be justified.

I say may be justified as logical thinking can avoid the scan.
In situations like this, I often do a loose consent for patients where;
if the site is good, place implant
If site is ok, place implant with some graft simultaneously
If site is terrible, do graft alone and plan implant later
if site is god awful, then no treatment but really we should know this in advance of treatment!!

As mentioned, if you trust the implant surgeon, then you should trust them to order a scan or not.... If not, then walk....

I order scans on a case by case basis.

You often find that clinics who have a €100k scanner onsite will order more scans....!!

nettlesoup wrote: »

I am just wondering if a CT Scan is necessary for the Placement of a Dental Implant. A lot clinics want you to have them and a lot of articles I read online refer to them. On the other side of the coin if you don't have one how can the surgeon determine Bone Density and width.
My preference would be not to have one as I have had a lot of X-Rays over the years both dental and Non Dental and I am just a bit worried about the cumulative effect of all these otherwise I would have no problem. The tooth in question is an upper front Incisor. If it is necessary I will.

Also at what point does the surgeon determine that you need a Bone graft ?Initial Consultation, after the tooth is out or before placing the implant.

Thanks.

nettlesoup

Thanks for the replies, much appreciated. I was on here over 2 years ago asking about dental implants and crowns but due to unusual circumstances I had the teeth re-crowned in the end. Both teeth are RC'ed with a long time. The crowns are still intact but one tooth has got a bit loose due to an infection. It is not painful but I don't think it will stabilize again. I expect an implant will be needed. The other tooth has been RC'ed for over 25 years with no issue.

I had almost identical situation as you with crown on upper front incisor . It had low grade infection under it for years which damaged the bone , significant bone loss. I definitely needed a bone graft which thankfully worked .

No CT scan was ever mentioned ....I'm surprised you would need one ... Maybe that's a new development ?? I have an excellent dentist in NI and his wife is the orthodontist with him in the surgery . She did most of the work . Best job I ever had done and it's the strongest most stable tooth I have .
It was relatively inexpensive but that was 5 years ago ....when the exchange rate was more favourable !

Good luck with it .

Oral Surgeon

nettlesoup wrote: »

Thanks for the replies, much appreciated. I was on here over 2 years ago asking about dental implants and crowns but due to unusual circumstances I had the teeth re-crowned in the end. Both teeth are RC'ed with a long time. The crowns are still intact but one tooth has got a bit loose due to an infection. It is not painful but I don't think it will stabilize again. I expect an implant will be needed. The other tooth has been RC'ed for over 25 years with no issue.

Get that looked at asap, infection is damaging the bone and ultimately will compromise the result of any implant….

Oral Surgeon

Deleted User wrote: »

I had almost identical situation as you with crown on upper front incisor . It had low grade infection under it for years which damaged the bone , significant bone loss. I definitely needed a bone graft which thankfully worked .

No CT scan was ever mentioned ....I'm surprised you would need one ... Maybe that's a new development ?? I have an excellent dentist in NI and his wife is the orthodontist with him in the surgery . She did most of the work . Best job I ever had done and it's the strongest most stable tooth I have .
It was relatively inexpensive but that was 5 years ago ....when the exchange rate was more favourable !

Good luck with it .

The orthodontist did the bone graft and implant???!!!

Oral Surgeon

Oral Surgeon wrote: »

The orthodontist did the bone graft and implant???!!!

Everything ....no hospitals , nothing !

Over the course of a few months. It was done in stages .... but a brilliant job . I've used this dental surgery for years .... it's excellent .

Oral Surgeon

Deleted User wrote: »

Everything ....no hospitals , nothing !

Over the course of a few months. It was done in stages .... but a brilliant job . I've used this dental surgery for years .... it's excellent .

You do know that an orthodontist is a specialist in providing braces and in moving teeth??

Oral Surgeon

Oral Surgeon wrote: »

You do know that an orthodontist is a specialist in providing braces and in moving teeth??

I meant periodontist ....apologies

Oral Surgeon

Deleted User wrote: »

I meant periodontist ....apologies

That makes more sense….