THE ROLE OF CBCT IN THE PLACEMENT OF DENTAL IMPLANTS

Uvod: Sve šira primjena radiologije u dentalnoj medicini stvorila je zahtjeve za razvoj radioloških uređaja specijaliziranih za rad u tom području. Razvojem kompjutorizirane tomografije konusnim zrakama omogućen je trodimenzionalni prikaz orofacijalnog područja. CBCT snimanje je motoda izbora prilikom planiranja postavljanja dentalnih implantata. Cilj rada: Cilj ovog rada je opisati primjenu CBCT uređaja u procesu planiranja i postavljanja dentalnih implantata. U radu su opisane prednosti i nedostatci radiološke metode te artefakti i doze zračenja koje su od velikog značaja za kvalitetu slike. Rasprava: Potpuna ili djelomična bezubost negativno utječe na kvalitetu života i održavanje optimalnog zdravlja. Dvodimenzionalne radiološke metode nisu se pokazale optimalnima prilikom prikaza trodimenzionalnih struktura. CBCT uređaj omogućuje generiranje multiplanarnih rezova područja od interesa i njihovu 3D rekonstrukciju. Prije postavljanja dentalnih implantata, ključna je procjena anatomskih struktura te kvalitete i volumena kosti. Potrebno je odrediti kvalitetu i kvantitetu kosti, 3D topografiju alveolarnog grebena, identificirati i lokalizirati vitalne anatomske strukture, izraditi kirurški vodič i moguće implantološke opcije kako bi zahvat na kraju bio uspješan. Prednosti CBCT uređaja su trodimenzionalni pregled struktura glave i vrata, generiranje dvodimenzionalnih struktura, smanjenje pogreške povećanja, doza zračenja, artefakti i cijena. Uz brojne prednosti, CBCT uređaj ima i određene nedostatke. Nedostatci CBCT uređaja su nizak raspon kontrasta, ograničeni FOV i volumen snimanja, artefakti pomicanja, mjerenje gustoće kosti i nijansi sive skale i doza zračenja. Osim za predkiruršku procjenu i planiranje, CBCT uređaj se koristi i postoperativno za procjenu cijeljenja implantata, komplikacija koje su najčešće povezane s neurovaskularnim oštećenjima. CBCT snimanje se treba provoditi uz održavanje ravnoteže između cijene i doze zračenja s jedne strane i svih neophodnih kliničkih informacija s druge strane. Zaključak: Primjena CBCT uređaja u planiranju i postavljanju dentalnih implantata postaje sve više osnovna dijagnostika bez koje se ne može zamisliti ozbiljna implantologija, a isto tako koristi se sve više kao svakodnevna pretraga u oralnoj kirurgiji, endodonciji, ortodonciji i parodontologiji.Introduction: All wider application of radiology in dental medicine has created a demand for the development of radiological devices specialized for that field. The development of Cone Beam Computed Tomography has enabled a three-dimensional view of the orofacial area. CBCT screening is the method of choice during the planning of placement of dental implants. Aim: The aim of this paper is to describe the application of CBCT devices in the process of planning and placing dental implants. The paper illustrates the advantages and disadvantages of this radiological method, artifacts, and radiation dosage which are significant factors for the quality of the image. Discussion: Complete or partial toothlessness has a negative impact on the quality of life and maintenance of optimal health. Two-dimensional radiological methods have not been proven optimal for the view of three-dimensional structures. The CBCT device enables the generation of multiplanar slices of the areas of interest and their 3D reconstruction. The assessment of anatomical structures and the quality and volume of bone is key to the placement of dental implants. It is necessary to determine the quality and quantity of bone, 3D topography of the alveolar ridge, to identify and localize vital anatomical structures, make a surgical guide as well as possible implantological options so that the intervention is successful. The advantages of the CBCT device are three-dimensional overview of the head and neck, the generation of two-dimensional structures, the reduction of the increase error, the dose of radiation, artifactxs, and price. Alongside many advantages, the CBCT device has certain flaws as well. Its disadvantages are the low span of contrast, limited FOV and volume of screening, artifacts of movement, measuring the density of bone and the shades of gray scale and the dose of radiation. The CBCT device is used not only for presurgical assessment and planning, but also for postoperative assessment of healing of the implants, complications which are usually connected to neurovascular damage. CBCT screening should be conducted while taking into account the balance between price and dose of radiation on one side, and all necessary clinical information on the other. Conclusion: The application of CBCT devices in planning and placement of dental implants is increasingly becoming fundamental diagnostics without which serious implantology cannot be pictured. It is also being used increasingly more as a daily examination in oral surgery, endodontics, orthodontics and parodontology