Accuracy of peri-implant bone evaluation using cone beam CT, digital intra-oral radiographs and histology.
OBJECTIVE
The present study assesses the accuracy of three-dimensional (3D) cone beam CT (CBCT) and intra-oral radiography (CR) in visualizing peri-implant bone compared with histology.


METHODS
26 titanium dental implants were placed in dog jaws with chronic type vestibular defects. After a healing period of 2 and 8 weeks (n = 12 dogs) the animals were sacrificed. CBCT scans and CR of the specimen were recorded. Dissected blocks were prepared, and histomorphometric analysis was performed. Both modalities were measured twice by two observers and compared with histomorphometry regarding bone levels and thickness around implants as well as length and diameter of implants.


RESULTS
Measurements of CBCT correlated well with histomorphometry of the vestibular bone level, oral bone thickness and implant length (all p-values <0.05). Compared with histomorphometry, the mean differences between CBCT and histomorphometry were between 0.06 and 2.61 mm. Mesial bone level (MBL) and distal bone level (DBL) were underestimated by both CR and CBCT. CR and histology measurements were only significantly correlated for implant length measurements. All intraclass correlations were highly significant.


CONCLUSIONS
3D CBCT provides usable information about bone in all dimensions around implants with varying accuracy. CR and CBCT perform similar in assessing MBL and DBL, but, within its limits, the CBCT can assess oral and buccal bone. Metallic artefacts limit the visualization quality of bone around implants and further research could elucidate the value of post-processing algorithms. When information about osseous perforation of implants is needed, CBCT may still provide clinically valuable information.
1 Department of Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, North Rhine-Westphalia, Germany.
L
L
Ritter
M C
MC
Elger
D
D
Rothamel
T
T
Fienitz
M
M
Zinser
F
F
Schwarz
J E
JE
Zöller
D016301:Alveolar Bone Loss / Q000000981:diagnostic imaging / Q000473:pathology; D000539:Alveolar Process / Q000000981:diagnostic imaging* / Q000473:pathology; D000818:Animals; D016477:Artifacts; D054893:Cone-Beam Computed Tomography / Q000379:methods* / Q000706:statistics & numerical data; D015921:Dental Implants; D003764:Dental Materials / Q000737:chemistry; D017267:Dental Prosthesis Design; D004285:Dogs; D007091:Image Processing, Computer-Assisted / Q000379:methods / Q000706:statistics & numerical data; D021621:Imaging, Three-Dimensional / Q000379:methods; D008334:Mandible / Q000000981:diagnostic imaging / Q000473:pathology; D016348:Osseointegration / Q000502:physiology; D019252:Radiography, Dental, Digital / Q000379:methods* / Q000706:statistics & numerical data; D014025:Titanium / Q000737:chemistry
D015921:Dental Implants; D003764:Dental Materials; D014025:Titanium
cone beam computed tomography; dental implants; digital intra-oral radiographs; osseo-integration