Placing a maxillary first premolar implant can be tricky when it comes to knowing whether or not the adjacent canine root was contacted. In radiograph A, implant #12 looks like it is contacting the distal of #11. This was certainly cause for concern. But a more parallel and and distally positioned film demonstrated that it was safely distant from the adjacent canine (phew!). Do you encounter situations like this when placing maxillary first premolar implants? What strategies do you use to make sure you are getting an accurate view of the root to implant relationship?
Excellent point of discussion. This happens often and as a result I don’t ever get excited about the visual perception of a premolar fixture colliding with an adjacent root. I trained before the days of guided surgery so I still do surgery when I place implants and this provides the very best actual 3D view of the surgery site. By physically locating and seeing these adjacent structures I feel confident that these images are merely a function of the BAMA/SLOB rule and thus pay no attention to them. So to respond appropriately to your question of “What Strategies” I use, I simply use the concept of conventional surgery as a conformation.
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I would recommend Guided Surgery always, and if not possible, at least Cone Beam study. I use the Cowellmedi LODESTAR PLUS kit for guided surgery. Forgot about the positioning headaches ever since!!
Certainly see this quite often. As the canine tends to be almost outside the bony envelope, buccally (canine eminence) and the implant is place more palatially it’s hard not to get an image that appears to show them in contact. Good reason not to judge others placement based on a radiograph alone.
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I’ve trained a lot of assistants over the years on xray techniques. Superimposing #12 over #11 (or vice-versa) is not uncommon. I always recommend they approach #12 at almost 90 degrees otherwise the canine root frequently gets superimposed or looks too close. RINN kits are good but not infallible in this situation, still needs to be nudged. and yes I primarily do guided surgery, but you still want your xray to look as good as the work you do.