Is Cone-Beam Computed Tomography Always Necessary for Dental Implant Placement?

Published:November 15, 2016DOI:https://doi.org/10.1016/j.joms.2016.11.005

      Purpose

      The use of cone-beam computed tomography (CBCT) for evaluation of patients for dental implants has gained considerable popularity. This retrospective cohort study was designed to determine whether using a clinical examination and a panoramic radiograph (Panorex) for implant selection and determining the need for bone grafting would be comparable to using CBCT in routine implant cases.

      Patients and Methods

      Implant size and need for bone grafting were initially determined in 82 patients using a panoramic radiograph and clinical examination. These patients subsequently underwent CBCT and their treatment was re-planned by the same surgeon using Simplant treatment planning software (DENTSPLY Implants, Mölndal, Sweden) in addition to clinical examination. The length and width of implants selected by each method and the need for bone grafting were recorded and the results were compared statistically with each other and with the actual treatment subsequently rendered.

      Results

      The Panorex method and the CBCT method accurately predicted implant width to within 1.5 mm of the implant actually placed in 100% of cases and length to within 1.5 mm in more than 95% of cases. For bone graft prediction, the results indicated that neither the Panorex method nor CBCT method differed substantially from the actual treatment rendered.

      Conclusions

      The results of this study indicate that the CBCT is more accurate in predicting implant length and width and the need for bone grafting procedures. However, for routine unguided implant placement in sites where anatomic structures and bone grafting are not a concern, the use of a panoramic radiograph could be adequate for determining the length and width of the implant.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hatcher D.C.
        • Dial C.
        • Mayorga C.
        Cone beam CT for pre-surgical assessment of implant sites.
        J Calif Dent Assoc. 2003; 31: 825
        • Schulze D.
        • Heiland M.
        • Thurmann H.
        • et al.
        Radiation exposure during midfacial imaging using 4- and 16-slice computed tomography, cone beam computed tomography systems and conventional radiography.
        Dentomaxillofac Radiol. 2004; 33: 83
        • Carter J.B.
        • Stone J.D.
        • Clark R.S.
        • et al.
        Applications of cone-beam computed tomography in oral and maxillofacial surgery: An overview of published indications and clinical usage in United States academic centers and oral and maxillofacial surgery practices.
        J Oral Maxillofac Surg. 2016; 74: 668
        • Bornstein M.
        • Scarfe W.
        • Vaughn V.
        • et al.
        Cone beam computed tomography in implant dentistry: A systematic review focusing on guidelines, indications, and radiation dose risks.
        Int J Oral Maxillofac Implants. 2014; 29: 55
        • Casselman J.W.
        • Deryckere F.
        • Hermans R.
        • et al.
        Denta scan: CT software program used in the anatomic evaluation of the mandible and maxilla in the perspective of endosseous implant surgery.
        Rofo. 1991; 155: 4
        • Bolin A.
        • Ellasson S.
        • Von Beetzen M.
        • et al.
        Radiographic evaluation of mandibular posterior implant sites: Correlation between panoramic and tomographic determinations.
        Clin Oral Implants Res. 1996; 7: 354
        • Tal H.
        • Moses O.
        A comparison of panoramic radiography with computed tomography in the planning of implant surgery.
        Dentomaxillofac Radiol. 1991; 20: 40
        • Guerrero M.E.
        • Jacobs R.
        • Loubele M.
        • et al.
        State-of-the-art on cone beam CT imaging for preoperative planning of implant placement.
        Clin Oral Invest. 2006; 10: 1
        • Kan J.Y.
        • Roe P.
        • Rungcharassaeng K.
        • et al.
        Classification of sagittal root position in relation to the anterior maxillary osseous housing for immediate implant placement: A cone beam computed tomography study.
        Int J Oral Maxillofac Implants. 2011; 26: 873
        • Sackett D.L.
        • Strauss S.E.
        • Richardson W.S.
        • et al.
        Evidence-Based Medicine: How to Practice and Teach EBM.
        Churchill Livingstone, Edinburgh, UK2000
        • World Health Organization
        Global Programme on Evidence for Health Policy.
        World Health Organization, Geneva, Switzerland2003 (Available at:) (Accessed September 30, 2016)
        • Guerrero M.E.
        • Noriega J.
        • Castro C.
        • et al.
        Does cone-beam CT alter treatment plans? Comparison of preoperative implant planning using panoramic versus cone-beam CT images.
        Imaging Sci Dent. 2014; 44: 121
        • Correa L.R.
        • Spin-Neto R.
        • Stavropoulos A.
        • et al.
        Planning of dental implant size with digital panoramic radiographs, CBCT-generated panoramic images, and CBCT cross-sectional images.
        Clin Oral Implants Res. 2014; 25: 690
        • Jacobs R.
        • Adriansens A.
        • Verstreken K.
        • et al.
        Predictability of a three-dimensional planning system for oral implant surgery.
        Dentomaxillofac Radiol. 1999; 28: 105
        • Deeb G.R.
        • Deeb J.G.
        • Wilson G.H.
        • et al.
        Is the tunnel technique more effective than open augmentation with a titanium-reinforced polytetrafluoroethylene membrane for horizontal ridge augmentation?.
        J Oral Maxillofac Surg. 2016; 74: 1752
        • Ludlow J.B.
        • Ivanovic M.
        Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106: 106
        • Hirsch E.
        • Wolf U.
        • Heinicke F.
        • et al.
        Dosimetry of the cone beam computed tomography Veraviewepocs 3D compared with the 3D Accuitomo in different fields of view.
        Dentomaxillofac Radiol. 2008; 37: 268
        • Rottke D.
        • Patzelt S.
        • Poxleitner P.
        • et al.
        Effective dose span of ten different cone beam CT devices.
        Dentomaxillofac Radiol. 2013; 42: 20120417
        • Theodorakou C.
        • Walker A.
        • Horner K.
        • et al.
        • SEDENTEXCT Project Consortium
        Estimation of paediatric organ and effective doses from dental cone beam CT using anthropomorphic phantoms.
        Br J Radiol. 2012; 85: 153
        • Geist JR
        ICRP 129 and cone beam computed tomography.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2016; 121: 345
        • Pauwels R.
        • Beinsberger J.
        • Collaert B.
        • et al.
        Effective dose range for dental cone beam computed tomography scanners.
        Eur J Radiol. 2012; 1: 267

      Linked Article