Accuracy of radiographic diagnosis of peri‐implant radiolucencies ‐‐ an in vitro experiment

Abstract

The absence of a peri-implant radiolucency on radiographs is used as a criterion for implant success. The purpose of the present study was to evaluate the accuracy of diagnosing peri-implant radiolucencies using an experimental model. Astra Tech fixtures were inserted into 20 bony specimens. Later, the fixtures were removed and the prepared cavities were enlarged in 2 steps. The specimens were radiographed under strictly standardized circumstances in the 3 stages ("press-fit" = simulated osseointegration, and "0.1 mm space" and "0.175 mm space" = simulated connective tissue layer). All specimens were radiographed with 2 vertical angulations (0 degree and 15 degrees). Ten observers read the radiographs and evaluated bone-implant relationship on a 5-point scale. The interobserver agreement was low. Specificity was remarkably low, and sensitivity was moderate. A significant difference in diagnostic accuracy was found for 0.175 mm peri-implant-space compared to 0.1 mm space. The diagnostic accuracy was found to be highest for 0.175 mm peri-implant space specimens. It is concluded, that radiography seems to be an unreliable method for diagnosing peri-implant spaces, although accuracy improved at increasing space widths. Strict orthogonal projection angles did not improve diagnostic accuracy.

Regenerative Treatment of Peri-Implantitis Using Bone Substitutes and Membrane: A Systematic Review

“…The assessment of the crestal bone level on conventional radiographs has been proven to be a highly specific testing method 94 . Thus, an initial peri‐implant defect is not easily detected on the radiograph: Studies show that on conventional radiographs, the sensitivity for identification of smaller defects, as expected for the onset peri‐implant defect, is low 94,95 . Considerable improvements with CT and DVT technique have recently been reported 96 …”

“…Of course, the radiographs provide no information about the nature of bone and interface. It is indeterminable in an augmented site with an apparently dense bone formation at the implant's neck, whether osseointegration on a histological level has actually occured 94 . Putting the main focus on radiographic bone fill relies on a phenomenon of doubtful nature; there is still no evidence showing what kind of structure actually fills the bone defect.…”

“…Putting the main focus on radiographic bone fill relies on a phenomenon of doubtful nature; there is still no evidence showing what kind of structure actually fills the bone defect. Furthermore, there is disagreement in research about the amount of remaining bone substitute and regenerated genuine bone, which can be expected depending on resorption time of the various bone graft materials 94,97–99 . Autogenous bone, defined as the gold standard in bone augmentation, shows a volume loss of approximately 40% during healing time.…”

Theoretical knowledge in implant dentistry for undergraduate students

“…They represent a two‐dimensional representation and the changes visible in radiographs appear later than in reality. Also, it must be recognised that radiographic evidence of bone‐to‐implant contact does not imply osseointegration at the histological level (35).…”

A Novel Approach for Enhanced Nanoparticle‐Sized Bone Substitute Adhesion to Chemically Treated Peri‐Implantitis–Affected Implant Surfaces: An In Vitro Proof‐of‐Principle Study

“…Although considerable bone fill may occur following such a regenerative approach, reosseointegration was reported in many studies to be limited and unpredictable compared to debridement alone 27‐29 . In addition, it cannot be determined whether osseointegration on a histologic level has actually occurred in an augmented site with an apparently dense bone formation at the implant's neck 30 . To optimize the treatment outcomes following the use of regenerative materials, one of the most important factors that must be controlled is the clot‐blended graft material shrinkage away from the implant surface that permits apical migration of epithelial attachment through the microgap that could ultimately appear between the clot‐blended bone substitutes and the implant surface.…”