A common sense approach to TMJ and implant imaging

During the last two decades, computer-based imaging technology has contributed significantly to our assessment of patients with head and neck anomalies. For instance, magnetic resonance imaging has given us a modality for visualizing the hard and soft tissues of the temporomandibular joint. We are fortunate that this has led to the refinement of the concepts of normality and the characterization of non-normal conditions. In the pre-surgical assessment of alveolar bone prior to implant placement, tomography in its various forms has provided the possibility of three dimensional bony assessment thus potentially optimizing fixture placement and minimizing potential failure. Unfortunately, there has been a reluctance to employ these techniques as they are either not available or both the equipment and the cost of image acquisition time is too expensive. Until recently, there has been a lack of consensus as to the selection of imaging modalities appropriate to patient presentation and the clinical value of the information obtained. The more recent development of computer-controlled panoramic imaging has made available to us many special projections which are capable of producing hard tissue images of either the TMJ or a potential implant site in multiple dimensions at lower cost (both financially and in terms of X-ray dose) than the more advanced modalities. These projections can now be incorporated into a clinically determined patient-based protocol and thus provide the clinician with both an economical and common sense approach to diagnostic imaging.