Cone Beam Computed Tomography (CBCT) to Assess Bone Density

Cone Beam Computed Tomography (CBCT) to Assess Bone Density INTRODUCTION Implantology has witnessed an explosive growth during the last few years, from a technique practiced on the fringe of acceptability to one embraced by the mainstream dentistry and dental implants have emerged as a widely accepted form of teeth replacement. Implants are bio-acceptable materials with an inherent capacity to osseointegrate into the jaw bone to support a dental prosthesis to restore adequate function and esthetics without affecting adjacent hard and soft tissue structures. The Success of any implant procedure depends on a series of patient related and procedure dependent parameters, which include general health conditions, biocompatibility of the implant material, feature of the implant surface, surgical procedure and the quality and quantity of the local bone1. Careful recording and analysis of clinical and radiological information, interdisciplinary communication and detailed planning play an important role in determining the final successful outcome. Bone density is a key factor to take into account when predicting implant stability2 Clinical studies show greater implant survival in the mandible than in the upper maxilla, due to the bone characteristics. This survival is influenced by bone quality i.e. bone density2 .The bone density is an important determining factor in implant treatment and can be assessed fairly using different imaging techniques3. The quality of bone in the proposed implant site in terms of relative proportion and density of cortical and medullary bone has frequently been assessed by using a grading scheme proposed by Lekholm and Zarb, which is applicable only to cross sectional images. This classification system has been utilized worldwide because it is easy to use without considerable investment. Misch (2008) used computed tomography (CT) to objectively classify bone density into 5 types based on Hounsfield units (HU). This method allows for a precise and objective assessment of bone quality2 Several imaging techniques are currently available for presurgical and postsurgical examination, including devices developed specifically for dental implant imaging. Computerized tomograms are one of the best available radiographs for determining the bone quality. With the advancement of radiographic technology, computed tomography (CT), as well as cone- beam computed tomography (CBCT) are increasingly being considered essential for optimal implant placement , especially in the case of complex reconstructions4 Unlike conventional two-dimensional  radiographs, techniques like CBCT offer 3-D views of the mouth, face, and jaw from any direction. The cone beam configuration is ideal for the maxillofacial region because the dimensions of the beam allow for a panoramic view, sparing patients the radiation exposure of separate scans of the maxilla and mandible5.The overall advantages of CBCT are in its high resolution, potentially lower radiation dose and reduced cost compared with standa rd Computerized Tomography2 The past two decades have seen continual efforts by manufacturers, researchers and clinicians to improve the success of implant treatment outcomes through evolution in implant designs, materials and clinical procedures6. One such aspect is co-relation of available bone density with primary implant stability. Primary implant stability denotes the stability of a dental implant immediately after placement. Implant stability can be evaluated objectively, noninvasively, and easily by the insertion torque test.7 The insertion torque measurement technique, which records the torque after the implant has been placed, provides information on the local bone quality8. A High initial stability may be an indication for immediate loading with prosthetic reconstruction. A low primary stability following implantation, can cause the implants mobility leading to failure. Bone density and implant stability are important factors for implant osseointegration, and has been widely demonstrated by several au thors3. The insertion torque measurement technique, which records the torque during implant placement, provides information on the local bone quality.1 A number of studies have shown the relationship between bone density based on CT and primary implant stability 9,10. However, there are few studies about the relationship between bone density estimated by CBCT and primary implant stability. The possibility of predicting the primary implant stability and bone quality during the pre-surgical assessment of the implant placement site may produce an implant treatment protocol with higher predictability. The bone density and Implant stability can be evaluated using CBCT and the insertion torque test which records the torque during implant placement and provides information of the local bone quality6, 8. Keeping in mind the aforesaid goals the present study was designed to compare and evaluate the relationship between the bone density estimated by CBCT and the primary implant stability of t he dental implants by measurements of the insertion torque and to determine their correlation. MATERIALS AND METHODS Twenty out- patients with missing single/ multiple teeth who visited the Department of Oral Maxillofacial Surgery, Dayananda Sagar College of Dental Sciences, Bangalore and who were suitable for implant rehabilitation were considered and taken up for the study. Patients with uncontrolled systemic/ psychiatric illness, previous history of undergoing radiotherapy or chemotherapy, pregnant patients, cases of post implant removal and implants placed in sinus lift and immediate extraction sites were excluded from the study. pre-operative assessment: Patients selected based upon the above criteria underwent a thorough clinical examination, and the details were recorded using custom-made case proforma. A written informed consent was obtained from all patients and a standardized pre-surgical and surgical protocol was followed for all the patients. Pre-operative bone density of implant sites were evaluated using cone beam computerized tomographic scans. Bone density measurements were derived using 3DiagnoSys version 4.1 Software (3DIEMME Bio imaging Technologies). 3Diagnosys ® is a diagnostic imaging, analyses and 3D simulation software, tailored for the Clinician. 3Diagnosys ® software helps to interact with the 3D-model of the Patient, which is obtained by importing TC/CBCT/RM images in DICOM format, in a simple and intuitive way. The tools included in this software are not bound to morphological reconstructions but are also able to extract from the DICOM data the densitometric values for a bone funct ional evaluation.)Pre-operative evaluation of bone height and bone width was done using Cone Beam Computed Tomographic scan and appropriate implants were selected to be placed. The bone height and width measurements were achieved using the â€Å"Carestream Dental Imaging Software v6.13.3.3 CS imaging software†(Fov-15x9cm)† .All CBCT scans were obtained using the â€Å"KODAK 9500machine† (10ma 90 Kvp, 200 micron resolution, 10.9sec exposure, 605mgy per cm2). STATISTICAL ANALYSIS The statistical analyses were performed using SPSS version 16.0 software (SPSS Inc., Tokyo,Japan). Spearman’s correlation coefficient (rs) was calculated to evaluate the correlation among density values and insertion torques. A value of P RESULTS The density value ranged from 209.91 to 667.13Hu. The mean density value and insertion torque of all implants were 464.69 + 135.74 Hu and 49.0 + 8.20 respectively. There was highly significant correlation between bone density and insertion torque (rs 0.89, P DISCUSSION Over the last decade, there has been significant changes in reconstruction with dental implants. Rather than merely focusing on the tooth or teeth to be replaced, today’s implant practitioner considers a broad and complex set of interwoven factors before formulating an implant treatment plan4. Proper treatment planning comprises of pre – operative depiction and quantification of accurate bone height and contour which can be established by radiographic examination.11 The success of dental implants relies heavily on both the quality and the quantity of available bone for implant placement3. Studies have shown higher failure rates for implants placed in bone of poor quality and quantity.3 Bone density is a key factor to take into account when predicting implant stability2 Clinical studies show greater implant survival in the mandible than in the upper maxilla, due to the bone characteristics. This survival is influenced by bone quality i.e. bone density2 The bone density is an important determining factor in implant treatment and can be assessed fairly using different imaging techniques5. The quality of bone in the proposed implant site in terms of relative proportion and density of cortical and medullary bone has frequently been assessed by using a grading scheme proposed by Lekholm and Zarb, which is applicable only to cross sectional images. This classification system has been utilized worldwide because it is easy to use without considerable investment. Misch (2008) used computed tomography (CT) to objectively classify bone density into 5 types based on Hounsfield units (HU). This method allows for a precise and objective assessment of bone quality3 Several imaging techniques are currently available for presurgical and postsurgical examination, including devices developed specifically for dental implant imaging.12 They are used to visualize the internal anatomy of the jaws in 3-dimensional perspectives, including the proximity of  nasal fossae, neurovascular bundles, pneumatization of the maxillae, soft tissue morphology and bone quality. Computerized tomograms are one of the best available radiographs for determining the bone quality. Periapical and panoramic radiographs are the least viable options as the subtle changes between the different bone types can’t be quantified using them, also the lateral cortical plates tend to obscure the trabecular density . With the advancement of radiographic technology, computed tomography (CT), as well as cone- beam computed tomography (CBCT) are increasingly being considered essential for optimal implant placement , especially in the case of complex reconstructions 13. Unlike conve ntional two-dimensional radiographs, techniques like CBCT offer 3-D views of the mouth, face, and jaw from any direction.1 The cone beam configuration is ideal for the maxillofacial region because the dimensions of the beam allow for a panoramic view, sparing patients the radiation exposure of separate scans of the maxilla and mandible14. The overall advantages of CBCT are in its high resolution, potentially lower radiation dose and reduced cost compared with standard Computerized Tomography15 The past two decades have seen continual efforts by manufacturers, researchers and clinicians to improve the success of implant treatment outcomes through evolution in implant designs, materials and clinical procedures2. One such aspect is co-relation of available bone density with primary implant stability. Primary implant stability refers to the stability of a dental implant immediately after implantation. Implant stability can be evaluated objectively, noninvasively, and easily by the insertion torque test.16 The insertion torque measurement technique, which records the torque after the implant has been placed, provides information on the local bone quality. High initial stabilization may be an indication for immediate loading with prosthetic reconstruction. If primary stability is not high enough following implantation, the implants mobility is high and can cause failure. A number of devices and techniques have been developed to assess implant stability, including cutting torque resistance analysis, the reverse torque test, the insertion torque test, the mobility measurement test, and resonance frequency (RF) analysis2. Implant stability can be evaluated objectively, noninvasively, and easily by the insertion torque test and RF analysis.17 The insertion torque measurement technique, which records the torque during implant placement, provides information on the local bone quality1. A number of studies have shown the relationship between bone density based on CT and primary implant stability .9,10However, there are few studies about the relationship between bone density estimated by CBCT and primary implant stability.In a study conducted by Isoda k et al; The bone quality evaluated by specific CBCT showed a high correlation with the primary stability of the implants.8 CBCT is one of the significant imaging modalities that can be used to assess the relat ionship between primary implant stability and bone density which can further give an insight into the prognosis of the implant treatment. Implant stability can be evaluated objectively, non-invasively and easily by using the insertion torque test which records the torque during implant placement and provides information of the local bone quality 1. Keeping in mind the aforesaid goals the present study was designed to compare and evaluate the relationship between the bone density estimated by CBCT and the primary implant stability of the dental implants by measurements of the insertion torque. It also aims to determine the correlation between bone density and primary stability of implant by insertion torque value. In all cases Implants were placed under local anesthesia. Different implant systems were used and all were root form implants. Surgical preparation and isolation of surgical field was accomplished according to standard operative protocols. A Crestal incision was placed and Mucoperiosteal flap was reflected and alveolar bone was exposed, and the implant placement site was identified by the marking made with the aid of the surgical probe. Osteotomy site preparation was done with a Reduction gear hand piece (1:16/64) with an external Irrigation attached to the handpiece. Implant osteotomy was performed using standard sequential drill bits as per the dimensions of the implant. The osteotomy was proceeded till the desired depth as per the selected implants. The Implant was driven into the osteotomy site using the manual torque wrench till the final depth was reached. All Implants placed were of tapered design and their lengths ranging from 8 to 16 mm and diameters from 3-5 mm. After placi ng the implant, the implant stability was measured manually using the insertion torque test by a torque wrench with calibrations .The insertion torque reading was measured and recorded at the maximum torque resistance achieved. The cover screw over the implant was then placed and Flap closure was done. Post-operative OPG and IOPA was taken. Routine Antibiotics and anti-inflammatory drugs were prescribed along with oral hygiene maintenance instructions. Patients were recalled for regular follow ups. Permanent prosthesis was given after 3 months. SUMMARY CONCLUSION The study assessed the bone quality with density values obtained by cone beam computed tomography (CBCT) pre-operatively and determined their correlation with the insertion torque values recorded during the Implant placement procedure.From the observations and results obtained ,We can conclude that, the present study demonstrates the relationship between the bone density values derived from Cone Beam computerized tomography (Hu), located in the maxilla and mandible , and bone quality according to the Lekholm Zarb classification. The primary implant stability measured with the insertion torque test (ITV) depends on bone density values, bone quality and implant location. Implants Placed in location with higher bone density have more stability, and we can probably predict the implant insertion torque based on the bone density values (Hu) and the implant location. Finally, with higher bone density values (Hu) and higher primary implant stability measured in ITV values; Hounsfield units can be used as a diagnostic parameter to predict possible implant stability. The results of our study indicate that CBCT can be used to assess the bone quality. Also attaining a good insertion torque and thereby enhancing the implant stability aids successful osseointegration and prosthetic rehabilitation. Hence CBCT can be used as a predictor diagnostic tool for implant success. We suggest that a larger number of patients with a larger follow up might help a conclusive determining factor that pre-operative CBCT is a predictor for primary implant stability.

Kudler Fine Foods Frequent Buyer Program Essay

The intent behind the development of Kudler Fine Foods Frequent Buyer Program is to increase the level of customer loyalty. The system will be broken down into two different levels; the frequency of a buyers shopping with Kudler Fine Foods and the amount of money that the buyer spends with each purchase. A program like this is typically used as a marketing strategy that is â€Å"enabled by point-of-sale technology to record and store customer purchases in exchange for rewards’ (Appel, p. 156, 2006). A web-based shopping program will be used to enhance the Frequent Buyer Program for Kudler Fine Foods. This will be achieved by applying web-based advertising. A projection of frequent buyers growth is expected on the initial employment of the frequent buyer program. It is the estimate of the Sales and Marketing Department that there will be a 5% growth within the first 12 months of this program. The department has also conducted an analysis considering what legal courses of actions, if any, Kudler Fine Foods will need to take to ensure the success of this program. Legal Considerations A study of the consumer trends in this area will have to be conducted. The will enable the Sales and Marketing Department to allow for a smooth and functional program and give them an idea on how to better market the product. â€Å"Market research and demographics data can be used to better target products and produce better or customized products; such data are becoming increasingly valuable: (national Research Council, p. 156, 1994). Some of the legal issues that will be taken in to consideration are costumer privacy as this will have an increased attention in response to the initial data that we will be requesting. It is important that Kudler Fine Foods incorporate some sort of privacy statement into the initial request form stating that the information will not be shared with anyone outside of Kudler Fine Foods, and state the basic reason of why Kudler Fine Foods is requesting such data. Employees of Kudler Fine Foods will need to be trained on the proper handling of such data and what ramifications can happen in the event that costumer information is released without the expressed consent of the costumer. Ethical Considerations The intent of the Frequent Buyers Programs with Kudler Fine Foods is to be one of electronic commerce application. An e-commerce program can provide Kudler Fine Foods another level of costumer shopping and potentially receiving new customers for Kudler’s. As the program grows so will be profit margins of the company. However, internet security will have to be in the foremost thought of the IT Department in the development stages through the employment of the Frequent Buyers Program launch. The IT systems employed will â€Å"gather personal data about customer bases, and use it to support vital functions, such as the authentication of individuals requesting service, verification of credit and accounting information, delivery of services and goods, marketing, decision-making and law enforcement† (Appel, p. 156, 2006). Security Considerations The design and development of the database should not solely be focused on the access to and the protection of the personnel identifiable information that is being stored of the database. This information should be considered sensitive as it could be access in the attempt of identification theft or other forms of fraud. Programs of the nature have shown that they release they sensitive information to third party buyers. (Appel, 2006). Purchases that an individual makes should be held in a private and secure location and should not be shared with anyone outside of Kudler Fine Foods. An implementation of this should help ease a buyers concern that we are sharing their information with anyone who does not need to have it. The development of Kudler’s e-commerce site should be designed to fully secure. This is to help any unethical occurrences form happening; however, it will not prevent them from being attempted. Financial Analysis This initial cost of the startup of this program will be a minimal impact on Kudler Fine Foods. The initial advertisement effort will be done via social media; the companies Facebook page and Twitter account, email and word of mouth. Allowing for a reward system for costumer referrals can be used for current and new customers as the programs is employed and continues to grow. Rajiv and bell argue â€Å"customer retention costs are generally lower than customer acquisition costs, companies are better of focusing attention on their more loyal customers especially since the top 20% of customers account for 80% of revenues and often more than 100% of profits† (p. 180, 2003). Kudler Foods could reduce their marketing expenses by using a customer loyalty system through the use of rewards. The sales increase from this program should be reflected by the increase of new customers and the increased returning customers increased spending. The use of seasonal promotions only available to costumers enrolled into the frequent buyers program could also help in increased sales profits. Conclusion A frequent shopper program can be a successful tool is used correctly by a company. The difficult task will always be bringing in new costumers. This program should allow for the retention of existing customers with Kudler Fine Foods. A rewards points system should be used for the exchange of costume items only available to customers enrolled in the frequent shopper program. This will entice customers to remain loyal to the company and refer the friends and family to the program. The increased awareness of the customers privacy should always stressed from the designing of the program, through the implementation and further in the continuing changes of the program. Ensuring that the customers understand that their information is not shared with any third party organizations and that their information will help in the advancement of this program should minimize conflicts. The paramount concern should always be information security and privacy of customers identifying information will help keep this program a success.

New Ideas Into Argumentative Essay Topics about Service and Happiness Never Before Revealed

New Ideas Into Argumentative Essay Topics about Service and Happiness Never Before Revealed The Pain of Argumentative Essay Topics about Service and Happiness An argumentative paper is part of the persuasion. Unfortunately, to be able to receive a thriving mark it isn't sufficient to understand what a superior essay resembles. Our essays are wholly written from scratch. If you're looking to purchase argumentative essay, you came to the perfect location. Luckily, there are tons of strategies people may utilize to make happiness, or at least strive for it. Ironically, whilst money can buy you happiness, it may also supply you with the overall opposite. In this way, you can discuss order information and track the progress at any moment. Then place your purchase now! So it makes sense that parents begin the lengthy journey of letting go! All you need to do is give your own comprehension of happiness. Needless to say, a wealthy person has the ability to pay for treatment, but it doesn't guarantee that happiness can be gained. In pursue of creating an excellent family. Facts, Fiction and Argumentative Essay Topics about Service and Happiness The very first section of an essay is the introduction. Then check your essay proved your thesis and don't present a lengthy overview of the essay here. It's possible for you to buy argumentative essay at their site. Your essay on happiness will provide you with a great instance of the way to compose an outstanding essay, therefore it'll be simpler that you compose your assignments later on. If you're not sure about this issue, below are some controversial topics for a definition essay. It's important to always offer a conventional definition of your subject in at the start of the definition essay, even if your definitions vary from the normal meaning. Due to this, many disagree on the way the laws should change (if they ought to change at all) and there are a number of topics to select from. There are millions of topics to select from, and if you aren't sure about which one that you should pick, locate a definition essay topics list and choose what you like from it. We feel that well done is far better than well said. There's so much that you can learn from history. There are invariably a wide variety of opinions on the field of technology, and here are our favourite things to consider on the subject. Before you dive into a research topic, it's vital that you get acquainted with a number of the following advice. To choose which subject you're likely to discuss, it's essential to see the complete collection of good persuasive speech topics from the specific area of study. Simply take a look and see whether there are any research topics in psychology for college students which you would discover useful. What's more, we guarantee your future paper is going to be carried out in compliance with the greatest academic standards, so be certain that applying for our help, you make the ideal option. Considering all the work there is to do, student's minds can get fixated on all types of things. Social Classes The dilemma of social classes and the way in which they divide society is also prominent. What's more, it looks like college program has been made for some super-human beings, since you cannot stand the flow. Happiness comes in the kind of having good wellbeing. Money may also buy expensive goods but they will only give a limited quantity of happiness because after its novelty passes you may have to purchase something better. Therefore, it can't buy happiness for individuals who have poor mental health. It satisfies the physical needs of the person, but people need to understand that happiness is not physical. It's the question of reliability. PressBuy holds an extremely higher prospect for those sellers. The most significant thing that happiness depends on is one's job. It's a yes and no response, because, on the path to joy, you're definitely going to require the money. however, it is not going to be a guarantee that you'll get the happiness that you seek.

Mexico Has Various Water, Energy, And Agricultural...

Mexico has various Water, Energy, and Agricultural sustainability issues. These issues are marginally inter-relating and pose various risks to the socio-economic state of Mexico and Mexicans. This essay will talk about the issues in-depth, and any solutions which could potentially solve these issues. All three of the resource issues are inter-relating. This is mainly due to Water being at a risk of depletion. Surface Water is being consumed at an unsustainable rate, as a result, water is being pumped from under-ground Aquifers, which, uses large amounts of Energy. The subsequent reliance on Energy to pump water has put a strain on the country. However, this is not the only issue which is caused. The agricultural sector(being the largest consumer of water in Mexico) consumes a lot of Energy in order to make use of the Water. Therefore the reliance it places on Water and Energy (which are both at risk) places it at risk, meaning 4% of the GDP and 16% of the work-force is also at risk. 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