Abstract:Background:
Beam hardening and scattering artifacts from high-density objects such as dental implants adversely affect the image quality and subsequently the detection of fenestration or dehiscence around dental implants.
Objective:
This study aimed to assess the efficacy of metal artifact reduction (MAR) algorithm of two cone-beam computed tomography (CBCT) systems for detection of peri-implant fenestration and dehiscence.
Material and Methods:
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“…This is in accordance with the present study, in which, DMFR showed a higher agreement with the correct diagnosis, which can be attributed to their higher degree of experience and training for this task. Salemi et al, 2021, showed, for two experienced radiologists, a poor to moderate agreement with MAR ON and good to excellent agreement with MAR OFF, which is in accordance with the results found in this study. Fontenele et al, 2021, involving three oral radiologists, found that intra‐ and inter‐examiner agreement ranged from slight (weighted kappa = 0.10 and 0.13 respectively) to substantial (weighted kappa = 0.64 and 0.69 respectively) in the detection of buccal and lingual peri‐implant dehiscences.…”
Section: Discussionsupporting
confidence: 92%
“…Comparing our results with diagnostic studies on MAR involving dental implants, Salemi et al, 2021 found that sensitivity, specificity and accuracy of diagnosing fenestration and dehiscence were higher with MAR OFF for both CBCT equipment used. Similarly, De‐Azevedo‐Vaz et al, 2016 found no improvement for the same diagnostic task when using MAR and Fontenele et al, 2022, found no influence of MAR and kV on the diagnosis of buccal and lingual peri‐implant dehiscence for titanium and zirconia implants.…”
Objective
To evaluate the influence of metal artefact reduction (MAR) in the diagnosis of dental implant contact with the mandibular canal (MC) using cone beam computed tomography (CBCT).
Methods
Dental implants were installed with surgical guides in the posterior hemiarches of 10 dry human mandibles: 0.5 mm above to the MC cortex (G1/n = 8) and 0.5 mm inside the MC (G2/n = 10). The experimental set‐up was scanned with two CBCT equipment using 85 kV and 90 kV, MAR ON or OFF, and different tube currents (4 mA, 8 mA and 10 mA). Two dentomaxillofacial radiologists (DMFRs) and two dentists (DDS) scored the relation between the dental implant and MC. Descriptive statistics were used to observe the absolute frequency of scores. Sensitivity, specificity and accuracy were calculated considering the known relation between the dental implant and the MC interior. McNemar's test (α = .05) was applied to compare the diagnostic efficacy of MAR ON versus MAR OFF.
Results
Overall specificity was higher than sensitivity for both DDS and DMFR (97% vs. 50% and 92.0% vs. 78.0% respectively). There was a significant effect of MAR (p = .031) for DMFR in the case of contact between the dental implant with the MC interior, in which sensitivity decreased with MAR activation from 90% to 40%. DMFR observers showed a better diagnostic performance compared with the DDS observers (accuracy of 84.0% and 71.0%, respectively).
Conclusions
Due to the limited efficacy of MAR, it should not be used when conducting CBCT scans for the evaluation of contact between the implant and the mandibular canal.
“…This is in accordance with the present study, in which, DMFR showed a higher agreement with the correct diagnosis, which can be attributed to their higher degree of experience and training for this task. Salemi et al, 2021, showed, for two experienced radiologists, a poor to moderate agreement with MAR ON and good to excellent agreement with MAR OFF, which is in accordance with the results found in this study. Fontenele et al, 2021, involving three oral radiologists, found that intra‐ and inter‐examiner agreement ranged from slight (weighted kappa = 0.10 and 0.13 respectively) to substantial (weighted kappa = 0.64 and 0.69 respectively) in the detection of buccal and lingual peri‐implant dehiscences.…”
Section: Discussionsupporting
confidence: 92%
“…Comparing our results with diagnostic studies on MAR involving dental implants, Salemi et al, 2021 found that sensitivity, specificity and accuracy of diagnosing fenestration and dehiscence were higher with MAR OFF for both CBCT equipment used. Similarly, De‐Azevedo‐Vaz et al, 2016 found no improvement for the same diagnostic task when using MAR and Fontenele et al, 2022, found no influence of MAR and kV on the diagnosis of buccal and lingual peri‐implant dehiscence for titanium and zirconia implants.…”
Objective
To evaluate the influence of metal artefact reduction (MAR) in the diagnosis of dental implant contact with the mandibular canal (MC) using cone beam computed tomography (CBCT).
Methods
Dental implants were installed with surgical guides in the posterior hemiarches of 10 dry human mandibles: 0.5 mm above to the MC cortex (G1/n = 8) and 0.5 mm inside the MC (G2/n = 10). The experimental set‐up was scanned with two CBCT equipment using 85 kV and 90 kV, MAR ON or OFF, and different tube currents (4 mA, 8 mA and 10 mA). Two dentomaxillofacial radiologists (DMFRs) and two dentists (DDS) scored the relation between the dental implant and MC. Descriptive statistics were used to observe the absolute frequency of scores. Sensitivity, specificity and accuracy were calculated considering the known relation between the dental implant and the MC interior. McNemar's test (α = .05) was applied to compare the diagnostic efficacy of MAR ON versus MAR OFF.
Results
Overall specificity was higher than sensitivity for both DDS and DMFR (97% vs. 50% and 92.0% vs. 78.0% respectively). There was a significant effect of MAR (p = .031) for DMFR in the case of contact between the dental implant with the MC interior, in which sensitivity decreased with MAR activation from 90% to 40%. DMFR observers showed a better diagnostic performance compared with the DDS observers (accuracy of 84.0% and 71.0%, respectively).
Conclusions
Due to the limited efficacy of MAR, it should not be used when conducting CBCT scans for the evaluation of contact between the implant and the mandibular canal.
“…In the current study, when MAR tool was applied, the AUC values and the diagnostic values revealed that peri-implant fenestrations were more correctly diagnosed than peri-implant dehiscences. Similar findings have been reported by de-Azevedo-Vaz et al [ 2 , 5 ], Sheikhi et al [ 23 ], and Salemi et al [ 26 ], and they explained these findings by claiming that as dehiscence has just an inferior border, it is more difficult to identify than fenestration, which has both superior and inferior borders.…”
Section: Discussionsupporting
confidence: 86%
“…After that, the bone blocks were coated with a 1.5 mm layer of pink wax to mimic the soft tissue surrounding the alveolar bone and to maintain an equivalent x-ray beam attenuation (Fig. 2 ) [ 3 , 26 , 27 ]. Fig.…”
Background
Early accurate radiographic assessment of peri-implant bone condition is highly important to avoid excessive loss of supporting bone and implant failure. Cone beam computed tomography (CBCT) is the radiographic technique of choice if peri-implant dehiscence and fenestration defects are suspected. The higher radiation dose and the presence of beam hardening artifacts are the main drawbacks of CBCT imaging techniques. This study aims to evaluate the influence of low-dose cone beam computed tomography (LD-CBCT) and metal artifact reduction (MAR) tool on the assessment of peri-implant dehiscence and fenestration.
Methodology
Thirty titanium implants were inserted into bovine rib blocks. Twenty had standardized bone defects (10 with dehiscence and 10 with fenestration), while the remaining 10 were used as control group with no defects. Radiographic examinations held with high‐definition CBCT (HD-CBCT) and LD-CBCT with and without application of MAR tool. Images were assessed by four examiners for the presence or absence of peri-implant defects. The area under the area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, and accuracy were calculated for all radiographic protocols.
Results
In the absence of MAR tool, there was no difference in AUC and diagnostic values between LD-CBCT and HD-CBCT for detection of both defects. When the MAR tool was applied, the AUC values, sensitivity, and accuracy were higher in HD-CBCT than in LD-CBCT for the detection of both defects, especially for the dehiscence, while specificity remained the same.
Conclusion
LD-CBCT can be used in the evaluation of peri-implant dehiscence and fenestration without any decrease in diagnostic accuracy. The application of MAR tool decrease the diagnostic ability of both defects, especially for the detection of dehiscence defects.
Objective. Dental implant artifacts can compromise the quality of cone-beam computed tomography (CBCT) scans and challenge radiographic detection in surrounding regions. This literature review was conducted to examine the impact of implant angle modification on reducing metal artifacts in CBCT scans. Materials and Methods. A scoping review of literature was carried out in PubMed, Embase, Scopus, and Cochrane databases. Results. Different spatial planes, including alpha, beta, gamma, and phi, along with 0°, 5.2°, 9.8°, 14.5°, 15°, 30°, 45°, 60°, 75°, and 90° angles were studied. Changes in the angular position of implants may reduce metal artifacts and improve the quality of CBCT scans. Conclusions. Rotating implants within the alpha plane and angling them at 90° in the alpha plane enables reducing dental implant artifacts.
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