Effect of Milliamperage Reduction on Pre-surgical Implant Planning Using Cone Beam Computed Tomography by Surgeons of Varying Experience

Abstract

Background Differences in CBCT units and the lack of standardization result in exposure to radiation doses beyond what is required for diagnostic purposes, especially when planning the surgical placement of dental implants. Aim To assess the influence of low-and high-dose milliamperage settings on CBCT images for objective and subjective implant planning among senior specialists (5 years of experience) and juniors (fresh graduates). Materials and Methods Two dry skulls (4 hemi-maxillary segments of the maxilla and 4 hemi-maxillary segments of the mandible) were scanned under low (2 mA) and high (6.3 mA) dosage settings using the Carestream CS 9300 machine. Cross-sectional slices of both image qualities were evaluated by the 5 seniors and the 5 juniors for subjective image utility for implant planning and for objective linear bone measurements.Results There were no significant differences in bone measurements taken on high-or low-dose images by all seniors and by the majority of juniors (p [ 0.05). In qualitative image assessments, there was independence between assessment and image quality for almost all observers. For planning posterior mandibular implant placement, increased dosage improved concordance and kappa values between low-and high-dose images for senior observers (from K = 0.287 at low dose to K = 0.718 at high does) but not for juniors (K = 0.661 and K = 0.509 for low and high dose, respectively). Conclusion Reduction in milliamperage did not affect diagnostic image quality for objective bone measurements and produced sufficient concordance for qualitative assessment. Judicious optimization of milliamperage settings based on individual diagnostic requirements can result in significant dose reduction without compromising diagnostic decision-making.

Detectability of Osseous Lesions with a Pre-Programmed Low-Dose Protocol for Cone-Beam Computed Tomography

“…For the assessment of anatomical landmarks such as the buccal lamella and the maxillary sinus or the diagnosis of fractures, 3D information can be crucial for clinical decision-making. Low-dose CBCT has been shown to be sufficient for adequately diagnosing midfacial fractures as well as for pre-surgical implant planning [34][35][36]. Low-dose protocols also have potential application in the radiological follow-up of bone pathologies (e.g., fibro-osseous lesions), as 3D data may reveal changes earlier than 2D information collected with conventional radiography.…”

In Vivo Accuracy of Implant Placement Using a Full Digital Planning Modality and Stereolithographic Guides

“…It is therefore advisable to reduce mAh to reduce the dose to the patient. A moderate reduction of mAh will not affect bone measurements for implant planning (173).…”