Price, AlbertGonnerman, WayneAmir Aslani, Amir Ali2024-06-072024-06-072024https://hdl.handle.net/2144/49003INTRODUCTION: Effective diagnosis and treatment planning are necessary for attaining favorable results in immediate implant placement and restoration following tooth extraction. In assessing a patient's suitability for dental implants, a comprehensive approach is imperative, tailored to the needs of the individual. These may include detailed medical and dental histories, clinical imagery such as photographs, study casts, and radiographic assessments including periapical and panoramic views, along with linear or computerized tomography scans specifically targeted to the intended implant sites. Each of these components contributes crucial insights, guiding the treatment process towards optimal outcomes. AIM: The primary aim of this study was to analyze anatomic variations of the maxillary bicuspid root as a reflection of its socket for insight in immediate implant placement. The secondary goal was to assess the relationship of the immediate implant placement to the apices of maxillary bicuspid teeth and implant crown restoration. MATERIALS & METHODS: DICOM files from the periodontal department's CBCT library, containing de-identified data, were examined using Invivo 6 software to analyze the maxillary premolars anatomy. Root dimensions were assessed, as a reflection of the residual socket, assuming no bone loss post-extraction, with specific anatomic considerations reviewed and measured. A total of 83 CBCT files from adult patients treated at Boston University Henry M. Goldman School of Dental Medicine were randomly selected from the Periodontology database. Sixty-one of these patients were found to have intact premolar dentition. No demographic information was provided. In total, 200 maxillary first and second premolars from these patients were evaluated for root morphology, length, dimensions, and their distance from the maxillary sinus floor using Invivo CBCT software. Roots (sockets) were classified as Type 1, 2 or 3. RESULTS: Maxillary 1st premolar socket types: Amongst a total of 104 Maxillary 1st premolars, 67 were Type-1, 30 were Type-2 and 7 were Type-3. Maxillary 2nd premolar socket types: Amongst total of 97 Maxillary 2nd premolars, 12 of were Type-1, 38 were Type-2 and 47 were Type-3. The average root length of the maxillary 1st and 2nd Premolars were measured from CEJ to Apex in Mesial/Distal cross-section view on the Invivo CBCT Software. The average length of the Maxillary 1st Premolars was 14.01mm whereas the Maxillary 2nd premolar length was 12.60mm. Average distances from apex of Maxillary 1st Premolars to sinus floor were measured in both Buccal/Lingual and Mesial/Distal views in CBCT (Invivo software). The average distance from the apex to the floor of the sinus in M/D view was 5.28mm and in B/L view it was 7.44mm. The average distance from the apex of the Maxillary 2nd Premolars to the sinus floor were measured in both B/L and M/D views in CBCT (Invivo software). Distance from apex to floor of the sinus in M/D view was 2.66mm and in B/L view it was 3.73mm. CONCLUSION: To optimize esthetic and functional outcomes, treatment plans should be based on comprehensive knowledge of the root socket anatomy. Immediate implant placement in the maxillary premolars presents challenges due to variations in root morphology, anatomical landmarks, and alveolar bone availability and quality. Type I root form, predominantly found in first premolar sites, offers substantial alveolar bone support, making it suitable for immediate implant placement with high primary stability. The presence of a narrow palatal root in the first premolar Type I root with a corresponding narrow socket can enhance stability and facilitate proper prosthetically driven of the implant positioning. Conversely, the Type III root form, common in the maxillary second premolar sites, offers less alveolar support. The proposed root form classification system discussed in the current study enhances understanding and aids in treatment planning, emphasizing the importance of evaluating internal bone socket geometry during implant placement. Precise consideration of root anatomy and the root form classification presented in this study informs decision-making, and will foster effective communication among clinicians.en-USDentistryThesis/Dissertation2024-06-06