Clinical and radiological classification of the jawbone anatomy in endosseous dental implant treatment

Gintaras Juodzbalys, Marius Kubilius, Gintaras Juodzbalys, Marius Kubilius

Abstract

Objectives: The purpose of present article was to review the classifications suggested for assessment of the jawbone anatomy, to evaluate the diagnostic possibilities of mandibular canal identification and risk of inferior alveolar nerve injury, aesthetic considerations in aesthetic zone, as well as to suggest new classification system of the jawbone anatomy in endosseous dental implant treatment.

Material and methods: Literature was selected through a search of PubMed, Embase and Cochrane electronic databases. The keywords used for search were mandible; mandibular canal; alveolar nerve, inferior; anatomy, cross-sectional; dental implants; classification. The search was restricted to English language articles, published from 1972 to March 2013. Additionally, a manual search in the major anatomy and oral surgery books were performed. The publications there selected by including clinical and human anatomy studies.

Results: In total 109 literature sources were obtained and reviewed. The classifications suggested for assessment of the jawbone anatomy, diagnostic possibilities of mandibular canal identification and risk of inferior alveolar nerve injury, aesthetic considerations in aesthetic zone were discussed. New classification system of the jawbone anatomy in endosseous dental implant treatment based on anatomical and radiologic findings and literature review results was suggested.

Conclusions: The classification system proposed here based on anatomical and radiological jawbone quantity and quality evaluation is a helpful tool for planning of treatment strategy and collaboration among specialists. Further clinical studies should be conducted for new classification validation and reliability evaluation.

Keywords: classification.; cross-sectional anatomy; dental implants; inferior alveolar nerve; mandible.

Figures

Figure 1
Figure 1
Classification system of the jawbone anatomy in endosseous dental implant treatment. H = height; W = width; L = length; RVP = Alveolar ridge vertical position; ME BPH = Mesial interdental bone peak height; DI BPH = Distal interdental bone peak height; MC = mandibular canal; IAN = inferior alveolar nerve; MSR = maxillary sinus region (all linear measurements are expressed in mm).
Figure 2
Figure 2
Edentulous jaw segments (A = maxillary, B and C = mandibular) that consists of alveolar and basal bone. A = the vertical dimension (H) of the EJS is determined by the distance between the alveolar ridge crest and maxillary sinus. B = the vertical dimension (H) of the EJS is determined by the distance between the alveolar ridge crest and mandibular canal. C = the vertical dimension (H) of the planned implant is determined by the distance between the alveolar crestal ridge and mental foramen. The horizontal EJS dimensions: length (L) in all cases is determined by the distance between neighbouring teeth or implants and width (W) is determined by the alveolar process width measured at the level of 3 mm (W1) and 6 mm (W2) from the crest of alveolar process.
Figure 3
Figure 3
Thin crestal ridge was reduced to create wide recipient bed for planned implant installation. In such cases, the heights of EJSs would have been shortened by 1 to 3 mm at least.
Figure 4
Figure 4
A = Upper jaw first right molar EJS on CBCT cross-sectional image is more than 10 mm in height and classified as Type I with no requirement of vertical alveolar process bone height augmentation prior endosseous dental implant treatment (all CBCT images in this article were obtained with I-CAT® (Imaging Sciences International LLC, Hatfield, PA USA) CBCT, a letter "b" on cross-sectional CBCT image means buccal side). B = Type I height (> 10 mm) of lower jaw first left molar EJS on CBCT cross-sectional image. C = Type II height (> 8 to ≤ 10 mm) of lower right first molar EJS on CBCT cross-sectional image. Simultaneous implantation with sinus floor augmentation are recommended. D = Type II height (> 4 to ≤ 10 mm) of upper right first molar EJS on CBCT cross-sectional image. Simultaneous implantation with vertical alveolar process augmentation are recommended. E = Type III height (≤ 8 mm) of lower left second molar EJS on CBCT cross-sectional image. Vertical alveolar process augmentation and late implantation are recommended. Mandibular canal walls have proper identification with D2 bone quality. F = Type III height (≤ 4 mm) of upper left premolar EJS on CBCT cross-sectional image. Sinus floor augmentation and late implantation are recommended.
Figure 5
Figure 5
A = Type I width (> 6 mm) of lower molar EJS on CBCT cross-sectional image at the level of 3 mm and 6 mm with no requirement of horizontal alveolar process augmentation prior endosseous dental implant treatment. B = Type II width (> 4 to ≤ 6 mm) of lower right molar EJS on CBCT cross-sectional image. Endosseous dental implant treatment with simultaneous alveolar process horizontal augmentation are recommended. C = Type III width of lower premolar EJS on CBCT cross-sectional image. Horizontal alveolar process augmentation and late implantation are recommended.
Figure 6
Figure 6
The length of EJS in non aesthetic zones on CBCT image (panoramic reconstruction): measurement "1" - Type I, measurement "2" - Type II, measurement "3" - Type III.
Figure 7
Figure 7
Alveolar ridge vertical position in non aesthetic zone: the distance between the lowest point of alveolar ridge crest to the cervicoenamel line of the adjacent teeth.
Figure 8
Figure 8
Alveolar ridge vertical position in aesthetic zone: the distance between the lowest point of alveolar ridge crest to the cervicoenamel line of the adjacent teeth.
Figure 9
Figure 9
Type II (measurement "2") and Type III (measurement "3") bone peak heights of the first upper premolar EJS on CBCT image reconstruction.
Figure 10
Figure 10
Bone quality according to Lekholm and Zarb classification. A = D1 on the CBCT cross-sectional image (mental region EJS); B = D2 on the CBCT cross-sectional image (36 tooth EJS); C = D3 in the EJS of upper second molar (CBCT cross-sectional image); D = D4 in the EJS of 17 tooth on CBCT cross-sectional image.
Figure 11
Figure 11
The part of reconstructed panoramic radiograph with unidentified superior MC wall in the EJS of 36 tooth (the same CBCT as Figure 10B).

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