Title For Peri-implant Bone Evaluation, Cone Beam CT Offers a 3D View of the Surrounding Bone and Thus More Information than Intraoral Radiography, but Whether this Information Alters Dental Implant-Related Treatment Outcomes is Uncertain
Clinical Question Is CBCT more reliable than periapical radiographs in measuring bone dimensions near implants and implant sites?
Clinical Bottom Line For implant success evaluation, intraoral radiography performs similarly and even significantly better than cone beam CT in detecting peri-implant bone defects due to its better resolution, contrast, and detail on bone quality. In comparison, additional information can be extracted from CBCT such as vestibular and oral measurements. However, this does not support the routine use of CBCT imaging as a replacement for intraoral radiography for the diagnosis of peri-implant bone defects. It can only be justified in situations where the additional information directly impacts treatment.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
24786136Ritter/201426 titanium implants in 12 dog jawsAnimal study
Key resultsThere is a significant correlation (P < .05) between cone beam CT (CBCT) and histomorphometry in vestibular bone level assessment and oral bone thickness. Mesial bone level (MBL) and distal bone level (DBL) were equally accurate for CBCT and intraoral radiography.
22458628Dave/201315 implants placed in 4 blocks of bovine boneLaboratory study
Key resultsFor peri-implant space diagnosis, digital long cone periapical (LCPA) radiographic views were significantly more accurate than the CBCT machines used, 3D Accuitomo and i-CAT, for all planes of view. LCPA also performed significantly better than both types of cone beam CT (CBCT) in all planes of view when comparing zero peri-implant space to 0.35 mm peri-implant space. As the peri-implant space increased to 0.675 mm, CBCT measurements on sagittal and coronal views were as accurate as LCPA.
Evidence Search ("Cone-Beam Computed Tomography"[Mesh] AND "Dental Implants"[Mesh]) AND "Radiography, Dental, Digital"[Mesh]
Comments on
The Evidence
Validity: One article was an in vitro study and one was an in vivo study. The in vivo study (Ritter 2014) only compared measurements from CBCT and intraoral radiography with histological measurements, which was considered as the gold standard. Readings were performed by two reviewers. There was no mention of instructions given ahead for calibration. Readers were able to adjust brightness and contrast to obtain the best objective image presentation. No significant difference could be found between CBCT and histology, as well as between intraoral radiography and histology. In the in vitro article (Dave 2013), peri-implant spaces were artificially created with implant drills to simulate peri-implant bone defects. However, the well-defined, readily imaged outlines do not reflect the true irregularly shaped diffused clinical presentation. Measurements were obtained using intraoral radiography and two different types of CBCT. Readings were performed by nine reviewers that were previously briefed and given instructions ahead. Brightness and contrast could not be adjusted. Perspective: Local bone measurements were compared between intraoral radiography and CBCT. Both articles appeared to have similar acceptable average results. Further clinical studies with larger sample sizes and real patients are needed to strengthen the evidence of peri-implant bone assessment. Future studies also have to evaluate the further development of image artifact-reducing algorithms.
Applicability These studies are representative of the patient population receiving implants. With the advent of CBCT and its almost limitless range of capabilities, many clinicians and practices use or own these new devices. It is important to appreciate the most effective method of assessing peri-implant bone while exposing the patient to the least radiation possible.
Specialty (Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery) (Periodontics)
Keywords implant, cone beam computer tomography, periapical radiography
ID# 3119
Date of submission 11/29/2016
E-mail shahbazi@uthscsa.edu
Author Arezou Shahbazi Moghaddam, DDS
Co-author(s) e-mail
Faculty mentor S.Thomas Deahl, II, DMD, PhD
Faculty mentor e-mail deahl@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available