Diagnostic accuracy of CBCT versus intraoral imaging for assessment of peri‐implant bone defects

Abstract

Background Early detection of marginal bone loss is vital for treatment planning and prognosis of teeth and implant. This study was conducted to assess diagnostic accuracy of CBCT compared to intra-oral (IO) radiography for detection, classification, and measurement of peri-implant bone defects in an animal model. Methods Fifty-four mandible blocks with implants were harvested from nine male health adult beagle dogs with acquisition of IO, CBCT and micro-CT images from all samples. Peri-implant bone defects from 16 samples were diagnosed using micro-CT and classified into 3 defect categories: dehiscence (n = 5), infrabony defect (n = 3) and crater-like defect (n = 8). Following training and calibration of the observers, they asked to detect location (mesial, distal, buccal, lingual) and shape of the defect (dehiscence, horizontal defect, vertical defect, carter-like defect) utilizing both IO and CBCT images. Both observers assessed defect depth and width on IO, CBCT and micro-CT images at each side of peri-implant bone defect via CT-analyzer software. Data were analyzed using SPSS software and a p value of < 0.05 was considered as statistically significant. Results Overall, there was a high diagnostic accuracy for detection of bone defects with CBCT images (sensitivity: 100%/100%), while IO images showed a reduction in accuracy (sensitivity: 69%/63%). Similarly, diagnostic accuracy for defect classification was significantly higher for CBCT, whereas IO images were unable to correctly identify vestibular dehiscence, with incorrect assessment of half of the infrabony defects. For accuracy of measuring defect depth and width, a higher correlation was observed between CBCT and gold standard micro-CT (r = 0.91, 95% CI 0.86–0.94), whereas a lower correlation was seen for IO images (r = 0.82, 95% CI 0.67–0.91). Conclusions The diagnostic accuracy and reliability of CBCT was found to be superior to IO imaging for the detection, classification, and measurement of peri-implant bone defects. The application of CBCT adds substantial information related to the peri-implant bone defect diagnosis and decision-making which cannot be achieved with conventional IO imaging.

Peri-Implant Bone Loss Measurement Using a Region-Based Convolutional Neural Network on Dental Periapical Radiographs

“…Cone-beam computed tomography (CBCT) is helpful when assessing the peri-implant bone loss since it can provide a threedimensional relationship between a dental implant and the surrounding alveolar bone. Some previous studies have sought to identify bone conditions around implants using periapical radiographs and CBCT images together [38,39], and other studies have reported that CBCT has a high accuracy for detecting peri-implant bone defects [40,41]. Thus, it will be more meaningful if a machine learning system can utilize the information from the CBCT as well as two-dimensional radiographs when evaluating the peri-implant bone conditions.…”

Influence of Exposure Parameters and Implant Position in Peri-Implant Bone Assessment in CBCT Images: An In Vitro Study

“…Despite the undeniable advantages of the aforementioned two-dimensional (2D) imaging modalities, they do not allow the assessment of the buccal bone, which is crucial for successful implant treatment. It is possible to evaluate the buccal bone level and its thickness by bone sounding using a periodontal probe, which is an invasive procedure, as well as ultrasonography and cone beam computed tomography (CBCT), which is a three-dimensional (3D), non-invasive imaging modality [10][11][12].…”

“…Several studies recommend the use of CBCT for early evaluation of periodontal bone defects. However, due to artifact formation around dental implants, few studies recommend CBCT for bone assessment around dental implants [12][13][14][15][16][17]. Contemporary recommendations for the clinical use of CBCT in implant dentistry developed by indicate that although intraoral radiographs are still considered to be the primary tool for postoperative implant monitoring, we should realize that we need to evaluate threedimensional bone healing, including morphological, volumetric, and trabecular remodelling [18].…”

“…Current guidelines recommend further work on the development of 3D imaging techniques, such as CBCT, which will allow for accurate measurements of peri-implant bone tissue [18,19]. Screening for peri-implant defects at early stages would allow for adequate treatment, such as debridement of the implant surface, bone, and/or soft tissue augmentation procedures or even removal of the dental implant [12,18,20].…”

Accuracy of bone‐level assessments following reconstructive surgical treatment of experimental peri‐implantitis

“…Thus, the use of CBCT results in exposure of higher radiation levels to patients than that of intra‐oral radiographs (Kadesjö et al, 2018 ). In addition, analyses of data from pre‐clinical studies have revealed conflicting results on the accuracy of assessments of bone levels when comparing intra‐oral radiographs, CBCT and histology (Corpas et al, 2011 ; Ritter et al, 2014 ; Song et al, 2021 ; Stokholm et al, 2016 ).…”