In recent years, the predictability and success rate of dental implants has improved exponentially. This is largely due to improved techniques as a result of improved technology. As implants have become more sophisticated, most dentists are using CBCT technology to plan dental implant materials and procedures. Often, a surgeon will work with a restorative dentist, who examines the patient and determines the optimal placement of the tooth for the best aesthetic and restorative effect. The surgeon then determines if that placement is possible given the patient’s unique bone and tooth structure and what steps would need to be taken before the implant is placed (such as a bone graft). A radiographic guide for dental implants is typically used by both surgeons and restorative dentists to transfer the desired tooth placement to the mouth in a form that can be used with CBCT. A radiographic guide is not a surgical guide, but rather, it is a guide that helps determine if the optimal implant placement is achievable.
A radiographic marker is a radiopaque structure of known dimension. The term also applies to a material incorporated in, or applied to, a radiographic template in order to yield positional or dimensional information. The importance of radiographic markers is due in part to their function: they mark the position of specific x-ray images or areas of interest in an x-ray image. Pro X-ray markers provide dental and medical offices with a variety of marker options that can be personalized according to color, style, font, and initials. These types of personalized markers can help identify the technician who performed the x-ray and aid in x-ray tracking. X-ray marker holders can also be ordered to provide a safe and organized way to store x-ray markers. Some medical or dental offices may choose to select a personalized marker holder that reflects the style, design, or marketing scheme of their practice.
A radiographic template, or radiographic guide, is a type of dental appliance that is designed to convey the desired position of the teeth needing to be implanted in a way that can be included in a cone-beam computed tomography (CBCT) scan. Radiographic templates are typically made by dental professionals for implanting one or more teeth using a type of acrylic to replicate the approximate shape and size of the final crown. When worn during a CBCT, the prosthetic teeth should align with where the dental implants need to be placed. A channel through the teeth replicates where the dentist plans to put the screw head of the abutment egress the incisal or occlusal of the implant. The rest of the template is made from a radiolucent material, which will not show on the scan and helps to hold the radiopaque teeth in place without moving during the CBCT scan.
Radionecrosis, or radiation necrosis, is a term used in the medical industry to describe the aftereffects of radiation therapy. It refers to the breakdown of body tissue at the original tumor site and occurs some time after radiation has been completed. It takes the form of a focal structural lesion that may potentially be a long-term complication of radiosurgery or radiotherapy that affects the central nervous system (CNS). If radiation necrosis occurs, the body may not be able to replace the damaged tissue. While radionecrosis can occur in any type of body tissue treated with radiation, the most common form of this condition found in dentistry is osteoradionecrosis, or the necrosis (death) of bone tissue. Osteoradionecrosis is quite rare, but when it does develop, it typically does so in the lower mandible or jawbone because this area has a lower blood supply than other bony structures of the mouth and jaw.
The word “radiopaque” simply means that a substance is opaque, or cannot be seen through, under radiation. The most common example of something radiopaque is the human skeleton. Bones cannot be seen through under radiation, which is why x-rays are such an effective way of visualizing bones. Human skin, eyes, and other soft tissues are radiotransparent or radiotranslucent, which means they either will not be visible under radiation or they will be faint and easily seen through. Radiopaque substances are often used in the medical field for diagnostic purposes, such as drinking barium before an x-ray to visualize the normally radiotranslucent intestines. In dentistry, radiopaque materials include dental implants, braces, amalgam fillings, and some cosmetic restorative materials. The different levels of radiopacity of fillings, enamel, pulp, tooth decay, gums, and other oral structures help dental professionals diagnose a number of conditions including caries, cysts, gum disease, impacted wisdom teeth, and more.
The term “ramus” refers to the branch or arm of a bone, such as in the pubic bone or the jaw bone. The jawbone has two; one ramus on each side that connects with the skull. In the field of implant dentistry, the ramus is of particular significance to bone grafting procedures. Autogenous bone is often more successful than allograft bone during grafting procedures, and the mandibular ramus provides cortical bone that is suitable for building the alveolar ridge after bone loss prior to dental implant placement. Using grafts from the ramus are highly successful and have a number of advantages, including a low morbidity rate and easy intraoral access. Ramus bone grafts need only a short time to heal, maintain their density after implantation, and exhibits minimal resorption by surrounding bone. Complications of a ramus graft include the possibility of damaging the mandibular neurovascular bundle.
Single dental implants are costly and may not be the best option for patients who need multiple teeth replaced. In the case of patients missing an entire set of top or bottom teeth, dentures are often recommended. For patients who do not want to put in or take out their dentures every day and keep them clean, a special stainless steel implant called a ramus frame implant. This device is shaped like a horseshoe and is implanted into the mandible from the retromolar pad on one side all the way to the retromolar pad on the other. The front of the frame is also implanted into the alveolar ridge above the chin, providing three-point stability. A portion of the device will remain outside the gums, which is what the dentures “clip” or “snap” onto. This may be uncomfortable for some patients, who often choose to wear their dentures over the ramus frame with the exception of removing them for cleaning.
One of the biggest contributing factors to the need for periodontal surgery is the loss of bone. In cases where periodontal disease is very advanced, so much bone may be lost that there is not enough to support a dental implant. In this case, bone grafting may be an option. A bone graft involves the implantation of bone tissue from another source into the area needing bone. The graft heals, integrating with whatever existing bone is present and increasing the amount of bone in the area of the mouth where the implant will be. The Ramus Bone Graft uses a patient’s own bone from the mandibular ramus instead of synthetic (lab-created) or donated bone, meaning that this procedure is considered an autogenous bone graft. This reduces the risk of rejection and other potential complications associated with bone grafts from foreign sources, and encourages the body to generate new bone.
A ramus implant, or a ramus frame implant, is a stainless steel denture anchor that is implanted directly into the bone of the mandible. A ramus implant is one of the earlier types of implants and were originally seen in the mid-1970s. Although large and cumbersome, this type of implant had a 91% success rate over a decade post-surgery. The ramus implant is horseshoe-shaped and is implanted into the retromolar pads on both sides of the mandible and in a third area in the alveolar ridge just above the chin in the center of the mandible. The dentures then “snap” or “clip” onto the part of the implant that sits above the gums. When the dentures are removed, the frame can be felt in the mouth, which some patients may not like. Often, patients will only remove dentures from their ramus frame implant when they need to be cleaned or serviced.
A randomized controlled trial, or RCT, is a study where people are selected completely by random or chance to either receive a treatment or clinical intervention, or to receive the control or standard of comparison. The standard of comparison is often a placebo or sugar pill in the case of medication trials, or it may be a standard practice or no actual intervention at all. A randomized controlled trial is used to measure the outcome of individuals, or participants, who receive treatments or clinical interventions. To assess the nature of the outcomes of participants, they must be compared to the participants who did not receive the intervention or treatment being studied. RCTs are, in short, controlled, comparative trials that are an extremely powerful tool within medical research. Randomized controlled trials are simple to organize and often easy to conduct; the most important factor is that the participants’ selection is absolutely by chance.