In vitro diagnostic accuracy of low-dose CBCT for evaluation of peri-implant bone lesions

Abstract

Objectives: To investigate the in vitro diagnostic accuracy of low-dose cone-beam computed tomography (LD-CBCT) for the detection, classification, and measurement of peri-implant bone lesions. Material and methods: Titanium dental implants with all-ceramic single crowns (n = 24) were inserted into bovine bone. At twelve implants, four types of peri-implant bone lesions were created. Radiographic imaging was performed using three techniques: LD-CBCT, high-definition CBCT (HD-CBCT), and intraoral radiography (IR). The datasets were presented twice to four observers in a random order. Diagnostic accuracy was measured by calculating sensitivity and specificity, and analyzed using the McNemar's test at a significance level of 0.05. Absolute agreement between the defect sizes was assessed by means of intraclass correlation coefficients (ICC). Results: For all three techniques, diagnostic accuracy and reliability for the detection of defects were almost perfect. The following order was found for classification of the different defect types (sensitivity/specificity): HD-CBCT (0.96/0.99) > LD-CBCT (0.93/0.98) > IR (0.71/0.95). No significant difference was found between the two CBCT techniques. Their performance was superior to that of IR. With regard to absolute agreement of defect size, LD-CBCT agreement with HD-CBCT (ICC, 95% confidence interval) was slight for defect depth (0.342, 0.181–0.625) and substantial for defect width (0.911, 0.775–0.963). Conclusion: Intraoral radiography is useful for detecting peri-implant bone lesions. LD-CBCT provides additional information regarding the geometry of defects. The even higher diagnostic accuracy of the HD-CBCT protocol tested needs to be carefully weighed against its radiation dose, which is 14 times higher than that of LD-CBCT.