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ORIGINAL ARTICLE

Comparative evaluation of three different methods for

evaluating alveolar ridge dimension prior to implant
placement: An in vivo study
Anshul Chugh, Poonam Bhisnoi1, Divya Kalra2, Sarita Maggu3, Virendera Singh4

ABSTRACT

Background: During treatment planning for dental implant placement, there is a need for assessment
of alveolar bone. Bone evaluation limited to the use of panoramic and or periapical radiographs may
be insufficient, as it provides only two‑dimensional information about the implant sites. Computed
tomography (CT) provides three‑dimensional information. The measurement of alveolar ridge
dimensions can be accomplished using ridge‑mapping technique. This technique involves penetrating
the buccal and lingual mucosa down to the alveolar bone (following the administration of local
anesthetic) with calipers and measures the bucco‑lingual width of the underlying bone.
Purpose: The aim of the study is to compare the techniques, i.e. ridge mapping, direct surgical
exposure, and CT scan, which are used to measure the alveolar ridge bone width, and determine their
accuracy in the clinical application.
Materials and Methods: The study was conducted on 20 patients who reported to the Out‑patient
Department (OPD) of Prosthodontics and Crown and Bridge, PGIDS, Rohtak (Haryana) for replacement
of edentulous span with dental implant. Width of alveolar ridge was studied by three techniques, i.e. CT
scan procedure, ridge mapping, and direct surgical exposure at two points (3 mm from the crest of
ridge and 6 mm from the crest of ridge), and then taking measurements of surgical exposure as the
control group, the measurements obtained from the other two techniques were compared and then
accuracy of these methods was assessed. The mean, standard deviation, standard error of mean, and
degree of freedom were calculated and subjected to statistical analysis using Student’s unpaired “t” test.
Results: Results suggested that there is no significant difference in the measurements obtained by
direct surgical exposure technique, ridge‑mapping technique, and CT technique.
Conclusion: Use of ridge‑mapping technique along with panoramic and intraoral radiograph is adequate
in cases where the pattern of resorption appears more regular and where mucosa is of more even thickness.
It is suggested to use CT scan technique in situations where the alveolar ridges are resorbed, there is presence
of maxillary anterior ridge concavities, vestibular depth is inadequate, and ridge mapping is not feasible.

KEY WORDS: Computed tomography scan, direct surgical exposure, implants’ alveolar ridge height
and width, ridge mapping

Department of Prosthodontics, Demonstrator Department of

1,4 INTRODUCTION
Prosthosdontics, 3Department of Oral and Maxillofacial Surgery,
PGIDS, 2Department of Radiology, PGIMS, Rohtak, Haryana, India
Throughout history, humans have attempted to replace
Address for correspondence: Dr. Anshul Chugh, missing or diseased tissues with natural or synthetic
Department of Prosthodontics, PGIDS, Rohtak, Haryana, India.
E‑mail: dr.anshulchugh@rediffmail.com substances. There are two elements in tooth replacement,
the materials for the replacement of tooth and some form
Access this article online
of attachment mechanism. Various materials have been
Quick Response Code:
Website: used for replacement of missing teeth, including carved
www.jdionline.org ivory and bone, and also natural extracted teeth. As a
mechanism of attachment, clinicians have long sought
DOI: an analog for periodontal ligament. An alternative
10.4103/0974-6781.118872 attachment mechanism was discovered by means of
an accidental finding by Prof. Per Ingvar Branemark
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Chugh, et al.: Comparative evaluation of three different methods for evaluating alveolar ridge dimension prior to implant placement
and his colleagues during 1950s-1960s. The metallic
structure became incorporated in the living bone in a
way formerly believed to be impossible, and Branemark
called it osseointegration.
Use of osseointegrated implants is a widely accepted
procedure in the rehabilitation of edentulous spaces.[1,2]
Treatment planning for implants includes a radiographic
and clinical examination that provides information
about the location of anatomical structures, the quality
and quantity of available bone, the presence of bone
lesions,[1‑4] the occlusal pattern, and the number and size
of implants, as well as prosthesis design, all of which are
essential for successful implant treatment.[1,3]
Many types of radiographic imaging are recommended
for treatment planning for implants, such as panoramic,
intraoral periapical and occlusal radiographs, conventional
tomography, and computed tomography  (CT). Bone
evaluation limited to the use of panoramic and or
intraoral periapical radiographs may be insufficient
because it only provides two‑dimensional information
about the implant sites. [5] The two‑dimensional
information obtained from standard dental radiographs
allows the clinician to make an initial assessment of the
bone levels available for implant treatment, but they
give no indication of bone width. The clinicians need to
identify the best method for each clinical situation.[6-11]
Since CT provides three‑dimensional information, it is
useful in diagnosis prior to dental implant treatment.[12]
CT has several advantages over other imaging techniques
that produce cross‑sectional views of the jaws, and
it has been found to most accurately reflect the true
osseous morphologic condition of the jaws.[13] In order
to optimize the information provided by more advanced
radiographic techniques, it is necessary to provide
information about the planned final restoration.
A stent that mimics the desired tooth setup is
constructed and radiographic markers usually made of
Gutta Percha or another radiopaque material are placed
within it. Alternatively, if the patient has a suitable
acrylic denture, radiographic markers may be placed
within occlusal or palatal cavities cut in the acrylic teeth.
The denture can also be replicated in clear acrylic to
provide the radiographic stent. The radiopaque marker
or rod can be placed in the position and angulations of
the planned prosthetic setup. Thus, for a screw‑retained
prosthesis, the marker would indicate the access hole
for the screw retaining the restoration. Alternatively,
the relation of the bone ridge to the proposed tooth
setup can be shown by painting the labial surface of
the stent with a radiopaque varnish. The choice of
radiographic marker is important in that it should be
visible on the radiographic image but not interfere with
the scan. When using CT, metal markers should be
102 Journal of Dental Implants | Jul - Dec 2013 | Vol 3 | Issue 2
avoided as they can produce scattering on the image.
Stents are also useful in the edentulous patient as they
serve to stabilize the position of the jaws while the
radiographs are being taken. The stent can also provide
the radiographer with a true occlusal plane from which
to orientate the axial scans.
The measurement of alveolar ridge dimensions can be
accomplished using ridge‑mapping calipers.[14-17] This
technique involves penetrating the buccal and lingual
mucosa down to the alveolar bone (following the
administration of local anesthetic) with calipers designed
for this purpose. The pointed tips of the instrument
penetrate the buccal and lingual soft tissue layers and
measure the bucco‑lingual width of the underlying bone.
A series of measurements of the proposed implant site can
be made prior to reflection of a mucoperiosteal flap. The
technique has been advocated by Wilson[18] and Traxler
et al.,[19] as a convenient and reliable method for assessing
suitability of potential implant sites. This procedure is
performed chairside and provides instant information.
The direct caliper measurement following surgical
exposure of alveolar bone of the ridge gives the most
accurate measurement.[16,17] However, the efficiency and
accuracy of these techniques still need to be assessed.
Hence, the aim of this study is to compare the techniques,
i.e. ridge mapping, direct surgical exposure, and CT scan,
which are used to measure the alveolar ridge bone width,
and determine their accuracy in the clinical application.
MATERIALS AND METHODS
Study sample
Twenty‑five patients were selected from the Out‑patient
Department of Prosthodontics and Crown and Bridge,
Post Graduate Institute of Dental Sciences, Rohtak. Out
of these, 20 cases were selected for the study and 5 cases
were excluded during treatment planning procedure 
(2 after ridge‑mapping procedure and 3 after CT scan
procedure). After explanation of the proposed study
criteria, including alternate treatment, potential risks and
benefits, the participants were asked to sign a consent
form prior to the implant surgery.
Inclusion criteria
1. Partially edentulous ridge
2. At least one periodontally healthy and stable tooth
adjacent to the edentulous ridge to serve as abutment
for radiographic stent
3. Healing period of at least 3 months after tooth
extraction
4. Good oral hygiene
5. Partially edentulous ridge
6. At least one periodontally healthy and stable tooth
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Chugh, et al.: Comparative evaluation of three different methods for evaluating alveolar ridge dimension prior to implant placement
adjacent to the edentulous ridge to serve as abutment
for radiographic stent
7. Healing period of at least 3 months after tooth
extraction
8. Good oral hygiene.
Exclusion criteria
1. Pregnancy
2. Smoking habits
3. Debilitating diseases
4. Immunocompromised patients
5. Pregnancy
6. Smoking habits
7. Debilitating diseases
8. Immunocompromised patients.
Study design
Twenty implants were placed in patients requiring
replacement of missing teeth. Study participants were
divided into following groups based on the method of
measurements of alveolar ridge width dimensions.
1. Based on direct surgical exposure (Group 1)
a. Measurement of alveolar width dimension at
point 1 (3 mm from the crest of ridge)
b. Measurement of alveolar width dimension at
point 2 (6 mm from the crest of ridge)
2. Based on CT scan procedure (Group 2)
a. Measurement of alveolar width dimension
at point 1 (3 mm from the crest of ridge)
b. Measurement of alveolar width dimension
at point 2 (6 mm from the crest of ridge)
3. Based on ridge‑mapping procedure (Group 3)
a. Measurement of alveolar width dimension at
point 1 (3 mm from the crest of ridge)
b. Measurement of alveolar width dimension at
point 2 (6 mm from the crest of ridge).
MATERIALS AND METHODOLOGY
Study sample
25 patients were selected from the Out Patient Department
of Prosthodontics and Crown and Bridge, Post Graduate
Institute of Dental Sciences, Rohtak. Out of these, 20 cases
were selected for the study and 5 cases were excluded
during treatment planning procedure (2 after ridge
mapping procedure and 3 after CT scan procedure). After
explanation of proposed study criteria including, alternate
treatment, potential risks and benefits, the participants were
asked to sign a consent form prior to the implant surgery.
Study design
20 implants were placed in patients requiring replacement
of missing teeth. Study was divided into following
groups based on the method of measurements of alveolar
ridge width dimensions.
Journal of Dental Implants | Jul - Dec 2013 | Vol 3 | Issue 2 103
1. Based On Direct Surgical Exposure (Group‑1)
a. Measurement of alveolar width dimension at
point 1 (3 mm from crest of ridge)
b. Measurement of alveolar width dimension at
point 2 (6 mm from crest of ridge)
2. Based On Ct Scan Procedure (Group‑2)
a. Measurement of alveolar width dimension
at point 1 (3 mm from crest of ridge)
b. Measurement of alveolar width dimension at
point 2 (6 mm from crest of ridge)
3. Based On Ridge Mapping Procedure (Group‑3)
a. Measurement of alveolar width dimension at
point 1 (3 mm from crest of ridge)
b. Measurement of alveolar width dimension at
point 2 (6 mm from crest of ridge).
Methods
Detailed medical and dental history of each patient was
taken. Clinical pre‑operative photographs were taken as
diagnostic records. Edentulous area selected for implant
placement was evaluated clinically for bucco‑ lingual
and mesio‑distal width and any undercuts. Complete
haemogram, blood sugar test, were done to evaluate the
fitness of the patient for implant placement. Complete
oral prophylaxis was done before the implant placement.
Patients were advised to use 0.2% chlorhexidine gluconate
mouthwash, twice daily for a period of 15 days. Adequate
instructions were given on oral hygiene maintenance.
The diagnostic impression was made of the maxillary
and mandibular ridges with irreversible hydrocolloid.
Study models were prepared with these impressions. On
the study model (with edentulous span) one point was
marked on the crest of ridge (reference point) in reference
to the adjacent teeth. Then another point (point 1) was
marked at 3  mm distance from the reference point at
the crest of ridge. Another point (point 2) was marked
at 3mm from point 1 i.e. at 6 mm distance form the
reference point at the crest of ridge. Point 1 and 2 were
marked on both buccal as well as on lingual/palatal
aspect [Figure 1]. A line was drawn on the study model
taking these points as reference and further extended on
buccal and lingual/palatal aspect to serve as a reference
for the sectioning of ridge mapping stent [Figure 2].
On the study model, a self cure acrylic resin custom
tray was fabricated with wax spacer [Figure 3]. After
removal of the wax spacer, impression was made of
the edentulous ridge portion of the cast, including
adjacent teeth using vinyl polysiloxane impression
material [Figure 4]. The reference line was marked with
marker over special tray to cut along that line. The special
tray with putty was cut by using electric saw in reference
to the line marked and the points were transferred to the
impression for ridge mapping [Figure 5].
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Chugh, et al.: Comparative evaluation of three different methods for evaluating alveolar ridge dimension prior to implant placement

Figure 1: Markings of point 1 and point 2 done on cast Figure 2: Marking of reference line

Figure 3: Two thickness wax spacer adapted over cast Figure 4: Transfer of refernce points from cast onto the ridge
mapping stent

The cut half of the impression with the markings was

then traced on a graph paper to give the shape of the
ridge. The points on the impression were transferred on
the graph paper [Figure 6]. The same impression after
disinfecting with Nanzidone Povidone‑Iodine Solution
I.P Microbial solution (5%) was then transferred to the
patient’s mouth. William’s periodontal probe was used
to get the thickness of mucosa (under local anesthesia)
on point 1 and point 2 on both buccal and lingual/palatal
aspect. Recordings done of thickness of mucosa on all the
points were then transferred to the graph paper having
ridge tracing [Figure 7]. Now the exact contour of the
alveolar bone was obtained after probing and the width
of ridge was measured from two points on buccal side
to the two points on lingual side.
filled with radiopaque Gutta Percha material [Figure 8].
Due to the radiopaque property of Gutta Percha material,
the acrylic stent was converted into radiographic stent.
The radiographic stent after disinfection with Nanzidone
Povidone‑Iodine Solution I.P Microbial solution (5%) was
then inserted in the patient’s mouth. The CT machine
SEIMEN SOMATOM was set at 120kV, 70mAs and the
CT scan was done with the patient in supine position and.
The sectioning of the region of interest (ROI) (Edentulous
span) was done using Diacom viewer software [Figure 9]
and the paraxial section with all GP points was
selected [Figure 10]. The width of the alveolar ridge was
measured on this section.

For radiographic stent fabrication, a clear acrylic resin stent
was fabricated over the study model with reference points.
The reference points were visible over the stent through the
transparent acrylic resin material; a 1 mm diameter hole
was then made over these 5 points. The points were then
The stent which was used for radiograph was then
modified by removing the GP material from the
stent [Figure 11]. After reflection of mucoperiosteal flap
on the buccal and lingual aspect, the ridge was exposed.
The modified stent was now placed on the exposed

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Chugh, et al.: Comparative evaluation of three different methods for evaluating alveolar ridge dimension prior to implant placement

Figure 5: Recordings done on all points transferred to Figure 6: Cut half of the impression with markings transferred
graph paper and width of ridge measured onto the graph paper

Figure 8: Slice no. having all five reference points selected and
Figure 7: Slicing of region of interest done measurements made

Figure 9: Measurements made using caliper Figure 10: Dental implant placed

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Chugh, et al.: Comparative evaluation of three different methods for evaluating alveolar ridge dimension prior to implant placement

ridge and the measurements were taken on the same
points on which the other recordings were done using
a caliper [Figure 12]. Hence, this gave the width of the
ridge during the surgical exposure.
All the reading of alveolar ridge width obtained from the
three techniques i.e. ridge mapping, CT scan and direct
surgical exposure were then assessed and compared.
The results obtained were subjected to statistical analysis.
The mean, standard deviation, standard error of mean,
degree of freedom were calculated and subjected to
statistical analysis using Student’s Unpaired ‘t’ test.
RESULTS
According to the results obtained from the above study,
Table 1 shows that mean alveolar ridge dimensions
obtained from three methods i.e. direct surgical
exposure, CT scan procedure and ridge mapping was
3.9800mm, 4.1250 mm and 3.9600 mm respectively for
point 1 and 6.4050 mm, 6.5700 mm and 6.4250 mm
respectively for point 2. The graph depiction of table
is shown in Graph 1. This data shows that the mean
difference between CT Procedure measurements and
direct surgical exposure at point 1 is 0.1450 mm and at
point 2 is 0.0200 mm and mean difference between ridge
mapping and surgical exposure at point 1 is –0.0200 mm
and at point 2 is 0.0200 mm. The graph depiction
of table is shown in Graph 2. This data suggest that
except mean difference of ridge mapping and surgical
exposure at point 1, rest all measurements were higher
for surgical exposure. At this point the mean difference
was found to be (‑) 0.0200 mm, but is non significant.
This shows that at this point there was underestimation
of bone but was not significant. A  similar study by
Perez et al. [20] suggested that both ridge mapping and
Linear tomography significantly underestimated the
posterior mandibular ridge width when compared to
direct measurements.
Tables 2 and 3 shows mean values of the recorded
alveolar ridge width compared in direct surgical
exposure and ridge mapping procedure at point 1
and 2 respectively. The mean alveolar ridge width for
direct surgical exposure method was 3.9800 mm and
3.9600 mm for ridge mapping procedure at point  1 and
6.4050 mm for direct surgical exposure and 6.4250 mm
for ridge mapping procedure at point 2. The graph
depiction of table is shown in Graphs 3 and  4. The ‘P’
value for group 1 and group 3 was found to be non
significant  (P  <  0.05 is highly statistically significant)

Table 1: Mean, standard deviation and degree of freedom of measurements made in all the three
groups
Point of Standard Degree of
Groups N
measurements Mean (mm) deviation freedom
Point 1 20 3.9800 2.1289 38
Direct surgical exposure group-1
Point 2 20 6.4050 2.3885
Point 1 20 4.1250 2.1545
CT scan procedure group-2 38
Point 2 20 6.5700 2.4401
Ridge mapping procedure Point 1 20 3.9600 2.0899
38
group-3 Point 2 20 6.4250 2.4498

Figure 11: Radiographic stent Modified by removing GP Points Figure 12: Measurements made using caliper

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Chugh, et al.: Comparative evaluation of three different methods for evaluating alveolar ridge dimension prior to implant placement

Thus in this study, the alveolar ridge dimensions
measured by direct surgical exposure and ridge
mapping procedure were same at point 1. The results
of this study are in accordance with the study of Chang
et al.[21] who concluded his study by stating that ridge
mapping provide measurements of the bucco‑lingual
ridge width consistent with those obtained by direct
caliper measurement following surgical exposure
of the bone. A  study by Perez et al. [20] found no
significant difference between ridge mapping and linear
tomography measurements at coronal level, middle
level and apical level of mandibular ridge.
Tables 4 and 5 shows mean values of the recorded
alveolar ridge width compared in direct surgical
exposure and CT can procedure at point 1 and point 2.
The mean alveolar ridge width calculated with direct
surgical exposure and CT Scan procedure was 3.9800 mm
and 4.1250 mm respectively for point 1 and 6.4050 mm
and 6.5700 mm respectively for point 2. The graph
depiction of table is shown in Graphs 5 and 6. The ‘P’
value for group 1 and group 2 was found to be non
significant (P < 0.05 is highly statistically significant) Thus
in this study, the alveolar ridge dimensions measured
by direct surgical exposure and CT Scan procedure were

POINT 1 POINT 2

0.18 0.165

0.16 0.145

0.14

0.12

0.1

MEAN DIFFERENCE (mm)

0.08

0.06

0.04
0.02
0.02

0
GROUP 2 ‐ GROUP 1 GROUP 3 ‐ GROUP 1
‐0.02
‐0.02

GROUPS

Graph 1: Mean measurements made in all the three groups Graph 2: Mean difference in group 1 and 2 and group 1 and 3

3.98 3.96

4 7 6.4 6.42

3.5
6

3
5

2.5
MEAN VALUES (mm)

MEAN VALUES (mm)

3
1.5

2
1

0.5 1

0 0
GROUP 1 GROUP 3 GROUP 1 GROUP 3

GROUPS GROUPS

Graph 3: Comparision of direct surgical exposure and ridge Graph 4: Comparision of direct surgical exposure and ridge
mapping procedure (Group 1 versus group 3) at point 1 mapping procedure (Group 1 versus group 3) at point 2

Table 2: Comparison of direct surgical exposure Table 3: Comparison of Direct surgical exposure
and ridge mapping procedure (group 1 verses and ridge mapping procedure (Group 1 verses
group 3) at point 1 group 3) at point 2
Mean Standard Mean Standard ‘P’
Group N ‘t’ Df ‘P’ value Group N ‘t’ Df
(mm) deviation (mm) deviation value
Group 1 20 3.9800 2.1289 0.2141 Group 1 20 6.4050 2.3885 0.2173
38 0.9762 38 0.9791
Group 3 20 3.9600 2.0899 0.0300 Group 3 20 6.4250 2.4498 0.0263

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Chugh, et al.: Comparative evaluation of three different methods for evaluating alveolar ridge dimension prior to implant placement

Table 4: comparison of Direct surgical exposure Table 5: Comparison of direct surgical exposure
and ct scan procedure (Group 1 verses and ct scan procedure (group 1 verses group 2)
group 2) at point 1 at point 2
Mean Standard ‘P’ Mean Standard
Group N ‘t’ df Group N ‘t’ df ‘P’ value
(mm) deviation value (mm) deviation
Group 1 20 3.9800 2.1289 0.2141 Group 1 20 6.4050 2.3885 0.2173
38 0.8316 38 0.8291
Group 2 20 4.1250 2.1545 0.2458 Group 2 20 6.5700 2.4401 0.1900

6.57
7 6.4

4.5 4.12
3.98
6
4

3.5 5

MEAN VALUES (mm)

4
MEAN VALUES (mm)

2.5

3
2

1.5 2

1
1
0.5

0 0
GROUP 1 GROUP 2 GROUP 1 GROUP 2

GROUPS GROUPS

Graph 5: Comparison of direct surgical exposure and CT scan Graph 6: Comparison of direct surgical exposure and CT scan
procedure (Group 1 versus group 2) at point 1 procedure (group 1 versus group 2) at point 2

same at point 1 and point 2. This study is in accordance
with the study done by Goulet et al.[22] who did a human
cadaver study and demonstrated no difference between
real measurements and image measurements made from
CBCT technique which according to author was inferior
to conventional CT Scan.
DISCUSSION
In all phases of clinical dentistry, careful planning
and diagnosis result in a more predictable
outcome.[3] Fabrication of an implant‑supported single
tooth restoration, both esthetically and functionally,
depends on the ridge morphology and the orientation
of implant. The placement of dental implants requires
meticulous planning and careful surgical procedures.
The contour of the residual bone must be evaluated prior
to implant placement in order to assure proper implant
positioning. It can be visualized using study models
along with diagnostic wax‑up.[23] A further important
part of the planning process is to determine the nature
of surgical procedure required to place the implant.[17]
Preoperative radiographic assessment has assumed
an increasingly important role in treatment planning
for implant‑supported prostheses. [13] A panoramic
radiograph gives an overall view; however, it is
incomplete due to the distortions and inconsistent
magnification that it generates.[8,24] Periapical radiographs
of the edentulous region show the bone height, the
inter‑radicular mesio‑distal space, as well as the position
of the anatomical structures in a bucco‑lingual plane.
Nevertheless, these diagnostic methods reveal no
information on the sagittal bony morphology and on the
ideal orientation to give the implant to meet restorative
requirements. Bone quantity and quality will influence
the choice of implants with respect to their number,
diameter, length, and type.[7,8] It often requires a more
extensive radiographic examination than that used
for other types of oral rehabilitation. Many imaging
modalities have been reported to be useful for dental
implant therapy, including periapical, panoramic,
cephalometric, and tomographic radiography, CT,
interactive CT, and magnetic resonance imaging (MRI).[11]
Only a pre‑operative bone evaluation of the arch using a
scan[25] (along with a radiopaque indicator) or a technique
for probing the surface of the bone will allow one to better
visualize the sagittal topography of the bone.[18]
The advantages of CT‑based systems are uniform
magnification, a high‑contrast image with a well‑defined
image layer free of blurring, easier identification
of bone grafts or hydroxyapatite materials used to
augment maxillary bone in the sinus region than
with conventional tomography, multiplanar views,
three‑dimensional reconstruction, simultaneous study of

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Chugh, et al.: Comparative evaluation of three different methods for evaluating alveolar ridge dimension prior to implant placement
multiple implant sites, and the availability of software
for image analysis.
The disadvantages of CT include limited availability
of reconstructive software, expense, higher doses of
radiation compared with conventional tomography,
lack of understanding of the dentist’s imaging needs by
the radiologic technologists and medical radiologists
who acquire and interpret the CT images, and lack of
usefulness for implant‑interface follow‑up because of
metallic streak artifacts.
Some studies concluded that CT is better than conventional
tomography. Linear tomography has been reported
to significantly overestimate the distance between the
alveolar crest and the top of the canal.[7,8] Lam et al.[26] (1995)
have commended the use of CT imaging for assessing
bucco‑lingual bone dimensions, but they did, however,
indicate problems inherent with the use of this technique.
These included the length of time to produce an image (20-
25 min), the cumulative radiation dose to the head and
neck area, and the possibility of a distorted image with
metallic tooth restorations and/ or patient movement.
A further consideration with CT imaging is financial cost.
Methods of dose reduction for implant imaging
include: (a) lowering the mill amperes, (b) changing
the spiral CT pitch from 1:1 to 2:1, and (c) reducing the
number of slices to the very minimum needed.[27-29]
The measuring of ridge width can also be accomplished
using ridge‑mapping calipers. This technique involves
penetrating the buccal and lingual mucosa down to
bone (following the administration of local anesthetic) with
calipers designed for this purpose. A series of measurements
of the proposed implant site can be made prior to reflection
of a mucoperiosteal flap. The technique has been advocated
by Wilson[18] (1989) and Traxler et al.[19] (1992), who suggest
that it is a convenient and reliable method for assessing
suitability of potential implant sites. The ridge‑mapping
method has the advantage of being simple to use, and
avoids exposure to radiation for the patient.
In the majority of cases in the study, surgery proceeded
uneventfully, with the bony ridge widths predicted prior
to surgery proving to be reasonably accurate at surgery.[30]
It is suggested that in situations where marked concavity
of the labial aspect of the bony ridge is evident, one
should consider using CT scanning to supplement clinical
assessment. In cases where the pattern of resorption
appears more regular, and where mucosa is of a more
even thickness, ridge mapping with panoramic and
intraoral radiography may prove adequate.
The ridge‑mapping procedure has the advantage of
being simple to use and avoids exposure of the patient
Journal of Dental Implants | Jul - Dec 2013 | Vol 3 | Issue 2 109
to radiation. According to the results obtained from
the study, there is no significant difference in direct
surgical exposure and ridge‑mapping measurements,
which supports the use of ridge‑mapping procedure
for the evaluation of alveolar ridge width for partially
edentulous ridges. Ridge mapping has provided
measurements of bucco‑lingual width consistent with
those obtained by direct caliper measurements following
surgical exposure of the bone. The results obtained are
in accordance with the study done by Perez et al.[20] and
Goulet et al.[22]
According to the results obtained from our study, there
is no significant difference in CT and direct surgical
exposure measurements, which supports the use of
CT method for the evaluation of alveolar ridge width
measurements in areas where the ridges are resorbed,
there are maxillary anterior ridge concavities, high
lingual frenum areas, and vestibular depth is less and
ridge mapping is not feasible.
Since the sample size was relatively small, further studies
are recommended with data of larger size.
CONCLUSION
The aim of this study was to assess alveolar ridge width
obtained from direct surgical exposure, ridge mapping,
and CT, and compare and, hence, evaluate the accuracy
of these methods in determining the alveolar ridge width
during the treatment planning procedure for implant
placement.
Thus, this study measured the alveolar ridge width
dimensions for pre‑surgical planning of implant
placement and compared the ridge mapping technique
and the CT scan technique with the direct surgical
exposure technique and further analyzed based on three
parameters selected.
Within the limitations of the study, the following
conclusions were drawn:
1. There is no significant difference in the measurements
obtained by direct surgical exposure technique and
ridge mapping technique
2. There is no significant difference in the measurements
obtained by CT technique and direct surgical
exposure technique
3. Thus, the measurements of alveolar ridge width
dimensions obtained by all the three techniques,
i.e. ridge mapping, CT scan, and direct surgical
exposure are found to be the same at point 1 and
point 2.
Based on the results obtained from this study, the
following measures may be recommended for the
[Downloaded free from http://www.jdionline.org on Thursday, January 24, 2019, IP: 188.138.214.30]
Chugh, et al.: Comparative evaluation of three different methods for evaluating alveolar ridge dimension prior to implant placement
measurement of alveolar ridge width dimensions for
pre‑surgical planning of implant placement.
1. Use of ridge mapping technique along with
panoramic and intraoral radiograph is adequate in
cases where the pattern of resorption appears more
regular and where mucosa is of more even thickness
2. It is suggested to use CT scan technique in situations
where the alveolar ridges are resorbed, there is
presence of maxillary anterior ridge concavities, there
are high lingual frenum areas, vestibular depth is
inadequate, and ridge mapping is not feasible.
Since the sample size was relatively small, further studies
are recommended with data of larger size.
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How to cite this article: Chugh A, Bhisnoi P, Kalra D, Maggu S, Singh V.
Comparative evaluation of three different methods for evaluating alveolar
ridge dimension prior to implant placement: An in vivo study.
J Dent Implant 2013;3:101-10.
Source of Support: Nil, Conflict of Interest: None.