Pre-surgical dental implant assessment by magnetic resonance imaging

The use of magnetic resonance imaging (MRI) for pre-surgical implant assessment of available bone in the maxilla and mandible is described. An acrylic surgical template with suitable MRI reference markers allows potential implant sites, as chosen on the MR images, to be accurately identified at surgery. MRI is a tomographic modality capable of giving accurate information on the three-dimensional relationships of all the relevant anatomic structures. Our results show that MRI is reasonably tolerant of artifacts caused by metal pins and amalgam fillings. Unlike computerized tomography (CT) and other x-radiographic techniques, MRI uses no ionizing radiation, and is capable of angulating and offsetting its scan plane at will. Good bone detail is available because cancellous bone yields a strong signal from the marrow fat, while cortical bone and dental enamel are dark. The excellent anatomic detail provided by thin-slice high-resolution MRI allows for assessment of the suitability of sites to receive an implant in terms of bone quality and thickness, and the relative position of the site to important structures such as the inferior dental nerve and nasal sinuses. The MRI technique used is described in detail. The principles underlying image contrast are outlined where appropriate and examples shown. To date, we have used MRI in conjunction with rotational panoramic x-rays (OPG) to plan 26 implants (21 maxillary, 5 mandibular) in 12 patients.