Sample Technique demonstration · a sample video article of IJDPMS, not part of an issue
Reading a CBCT before implant placement: bone, nerve, sinus and density
This sample shows how a video article of the journal looks, made with the journal's template. How to make one
Background
Implant planning rests on what the CBCT shows: the bone available, the nerve, the sinus and the quality of the bone. A step missed on the scan becomes a problem at surgery.
Objective
After this video, the viewer can measure the bone, trace the mandibular canal from the mental foramen, recognise a thickened sinus membrane, and read grey values with caution.
Case, study or procedure
Teaching cases planned for implants in the posterior maxilla and the posterior mandible, read live on the CBCT viewer (cross-sections, the measuring tool and the grey value tool). The scans are shown without patient details.
Key findings
- Posterior maxilla: about 3 mm of bone under the sinus floor, so an indirect (transcrestal) sinus lift with graft is planned.
- Grey values differ sharply between trabecular and cortical bone in an osteoporotic patient: about 85 in the planned site, about 1600 on the cortex.
- The mental foramen is found first; the mandibular canal is then traced back, section by section.
- A thickened sinus membrane, about 6 mm, and a polyp in the same maxilla.
Limitation
CBCT grey values are not true Hounsfield units: they change with the machine and its settings, so they guide and do not measure (ref. 1). Teaching cases of one clinician; no follow-up is shown.
Take-home message
Read every CBCT in the same order: bone, nerve, sinus, density.
Disclosures
No patient can be identified: names, dates and numbers are hidden on every scan. No funding. Dr Kedar Bakshi is the inventor of OsseoSure, a mechanical osteotome; it is not shown in this video. Clips from Implant4U Level 1, day 1 (Dr Kedar Bakshi). Narration by an AI voice.