Use of cone beam computed tomography in implant dentistry: current concepts, indications and limitations for clinical practice and research

Abstract

Diagnostic radiology is an essential component of treatment planning in the field of implant dentistry. This narrative review will present current concepts for the use of cone beam computed tomography imaging, before and after implant placement, in daily clinical practice and research. Guidelines for the selection of three-dimensional imaging will be discussed, and limitations will be highlighted. Current concepts of radiation dose optimization, including novel imaging modalities using low-dose protocols, will be presented. For preoperative cross-sectional imaging, data are still not available which demonstrate that cone beam computed tomography results in fewer intraoperative complications such as nerve damage or bleeding incidents, or that implants inserted using preoperative cone beam computed tomography data sets for planning purposes will exhibit higher survival or success rates. The use of cone beam computed tomography following the insertion of dental implants should be restricted to specific postoperative complications, such as damage of neurovascular structures or postoperative infections in relation to the maxillary sinus. Regarding peri-implantitis, the diagnosis and severity of the disease should be evaluated primarily based on clinical parameters and on radiological findings based on periapical radiographs (two dimensional). The use of cone beam computed tomography scans in clinical research might not yield any evident beneficial effect for the patient included. As many of the cone beam computed tomography scans performed for research have no direct therapeutic consequence, dose optimization measures should be implemented by using appropriate exposure parameters and by reducing the field of view to the actual region of interest.

The Use of Cone‐Beam Computed Tomography in Management of Patients Requiring Dental Implants: An American Academy of Periodontology Best Evidence Review

“…Monitoring the bone and tissue condition around dental implants is essential not only during follow‐up evaluation under functional loading but also during the assessment of strategies for regenerating peri‐implant bone 39 . However, the use of CBCT for this particular application remains questionable as it is known that periapical radiographs with a strict projection protocol can assess mesial and distal peri‐implant bone levels almost as accurately as histologic studies, assuming that the projected level of peri‐implant bone is located in the sectioning plane of the implant or is of uniform height around the implant 3 . Moreover, the visualization of buccal or lingual bone defects with CBCT is also limited, as it is with periapical radiographs, but for different reasons 44 .…”

“…However, the specificity of CBCT is lower than that found when intraoral periapical radiographs are used. Although CBCT may represent an accurate diagnostic tool to estimate the histologic extent of advanced peri‐implantitis defects in some cases, intraoral radiography is still recommended as a favorable method of evaluating bone loss around dental implants 3,42 …”

“…Apart from replacing teeth lost due to injury, disease, or developmental disorders, increased life expectancy and esthetic concerns have accelerated the widespread acceptance of dental implants and other associated surgical procedures 2 . In dentistry, CBCT has been positioned as the modality of choice for cross‐sectional imaging as an application that certainly has tangible implications for implant therapy 3 . Generally speaking, CBCT technology is perceived as a radiographic tool with increased accuracy, higher resolution, lower radiation dose, and reduced cost for patients compared with other volumetric imaging modalities for the assessment of mineralized tissues 4 .…”

“…The American Academy of Oral and Maxillofacial Radiology (AAOMR) as well as other organizations have already acknowledged the benefit of cross‐sectional imaging for implant patients 28‐30 . They emphasize that the decision to order a CBCT scan should be based strictly on the diagnostic and treatment planning needs with a conscious effort to minimize the patient's radiation dose, as also pointed out by Bornstein et al 3 In other words, when acquiring a CBCT scan on an implant patient, it is important to limit the FOV to the implant site and the adjacent areas that require evaluation. Furthermore, high‐resolution scans are generally not required for most implant treatment planning applications (e.g., bone dimensional assessment, general evaluation of bone quality, and visualization of adjacent structures).…”

Modern implant dentistry based on osseointegration: 50 years of progress, current trends and open questions

“…Up‐to‐date information on cone‐beam computed tomography is offered in the review paper by Bornstein et al. .…”