Is Intraoral Radiography an Appropriate Method to Assess the Feasibility of Immediate and Early Implant Placement in the Premaxilla?

Abstract

Objectives: To estimate the feasibility of immediate (IIP) and early (EIP) implant placement based on retrospectively collected intra-oral radiographic data, and to compare their 'estimated' feasibility to the 'true' feasibility based on optimal virtual implant planning in CBCT software.

Materials and methods: Data from 100 patients (59 women, 41 men, all Caucasians) aged between 19 and 81 years old who had been consecutively treated with a single implant in the premaxilla (13-23) in one private periodontal practice were retrospectively collected. Demographic data, diagnostic information and linear measurements were extracted from patient files, CBCTs and intra-oral radiographs. The 'true' feasibility of IIP and EIP was determined on the basis of optimal virtual implant planning in CBCT software and pre-defined selection criteria. The feasibility of both treatment options was estimated based on intra-oral radiography.

Results: The positive predictive value and negative predictive value for intra-oral radiography in assessing the feasibility of IIP amounted to 0.70 (95% CI [0.57-0.81]) and 0.70 (95% CI [0.55-0.81]), respectively. Fourteen percent false negatives and 16% false positives were found. False negatives could be explained by significant overestimation of the true root length (0.84mm) and by a buccal position of the tooth in the alveolar process in all cases, masking critical bone for implant anchorage at the palatal aspect of the root. False positives could be explained by significant overestimation of the availability of apical bone (2.57mm) and by significant underestimation of the dimension of an apical lucency (0.85mm). Similar data were found for EIP.

Conclusion: Intra-oral radiography may be considered an appropriate method to assess the feasibility of IIP and EIP in the premaxilla, yet clinicians should be aware of missing information and possible misinterpretations in about one third of the cases.