Aspects of imaging of the anterior region of the edentulous mandible prior to dental implant placement

Objectives To gain an understanding of the imaging prescription of implant practitioners when placing implants in the anterior edentulous mandible and to investigate the impact of cross sectional imaging on diagnostic thinking, treatment planning and patient outcome. Methods •A web-based questionnaire presented two realistic clinical scenarios of edentulous patients. Participants were asked to prescribe imaging prior to implant placement. •A systematic review was conducted to determine if pre-operative availability of cross-sectional imaging has an impact on diagnostic thinking, therapeutic impact or impact on patient outcome when placing dental implants in the anterior mandible. •A before-after study of osteotomy preparation was undertaken using simulations of four edentulous mandibles, recording the incidence of perforations of the lingual surface. Participants were presented with conventional imaging in the “before” part of the study and conventional imaging with CBCT in the “after” part of the study. Two cases were regarded as “regular” and two as “challenging”. Results •169 dentists were surveyed with an 80% response. The results showed no agreement on prescription of imaging methods. •The systematic review identified only five relevant studies. These were clinically diverse with high risk of bias. •In the before-after study, there were no perforations in the regular cases either before or after the availability of CBCT. There were fewer perforations in the challenging cases after the availability of CBCT but this difference was not statistically significant. Conclusions •The imaging prescription of dentists when planning implant placement in the anterior edentulous mandible is chaotic. •The systematic review found no evidence to support any specific imaging modality when planning implant placement. •The before-after study provided very weak evidence that CBCT may be helpful in avoiding perforations in challenging cases.