Assessment of Circumferential Peri-Implant Bone Defects Using CBCT and Periapical Radiography: An In-Vitro Study

Malekzadeh, Meysam; Rezayi, Golbarg; Mihandoust, Sanaz; Seyed-Monir, Ali

Meysam Malekzadeh¹

, Golbarg Rezayi²

, Sanaz Mihandoust ^*³

, Ali Seyed-Monir²

1- Dental Sciences Research Center, Department of Periodontology, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
2- Dental Sciences Research Center, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
3- Dental Sciences Research Center, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran , mihandoust.sanaz3@gmail.com

Abstract: (94 Views)

Introduction: Regular assessments of dental implants are essential for long-term success. This study aimed to assess and compare the diagnostic accuracy—including sensitivity, specificity, and measurement deviation—of cone-beam computed tomography (CBCT), paralleling and bisecting angle periapical radiographs in detecting circumferential peri-implant bone defects at different implant angulations. Additionally, the ability of each radiographic technique to characterize defect morphology was evaluated.

Materials and Methods: In this in-vitro study, 132 titanium implants were placed in bovine rib blocks at 0° and 30° lingual angulation. Bone defects of 1-2 mm and 3-4 mm depths were created, along with a control group. Three imaging techniques—CBCT, paralleling, and bisecting-angle periapical radiography—were evaluated. CBCT scans were acquired with metal artifact reduction (MAR) disabled to allow unfiltered assessment of metal-induced artifacts. Data were statistically analyzed (α = 0.05).
Results: CBCT demonstrated the highest diagnostic accuracy (sensitivity: 100%; specificity: 100%). Paralleling (sensitivity: 95.45%; specificity: 100%) and bisecting-angle techniques (sensitivity: 94.32%; specificity: 97.73%) showed slightly lower accuracy. Although periapical radiographs reliably detected the presence of bone loss, they were unable to classify circumferential defect morphology. As the depth of defects increased, sensitivity improved for all three techniques. Increased implant angulation reduced sensitivity across all three imaging techniques. Significant differences were observed among imaging modalities (P < 0.001).
Conclusions: CBCT provides superior diagnostic performance and enables three-dimensional classification of circumferential peri-implant defects. While two-dimensional periapical radiography can detect the presence of peri-implant bone loss, it cannot determine defect type, limiting its interpretive value in circumferential defectsIntroduction: Regular assessments of dental implants are essential for long-term success. This study aimed to assess and compare the diagnostic accuracy—including sensitivity, specificity, and measurement deviation—of cone-beam computed tomography (CBCT), paralleling and bisecting angle periapical radiographs in detecting circumferential peri-implant bone defects at different implant angulations. Additionally, the ability of each radiographic technique to characterize defect morphology was evaluated.
Materials and Methods: In this in-vitro study, 132 titanium implants were placed in bovine rib blocks at 0° and 30° lingual angulation. Bone defects of 1-2 mm and 3-4 mm depths were created, along with a control group. Three imaging techniques—CBCT, paralleling, and bisecting-angle periapical radiography—were evaluated. CBCT scans were acquired with metal artifact reduction (MAR) disabled to allow unfiltered assessment of metal-induced artifacts. Data were statistically analyzed (α = 0.05).
Results: CBCT demonstrated the highest diagnostic accuracy (sensitivity: 100%; specificity: 100%). Paralleling (sensitivity: 95.45%; specificity: 100%) and bisecting-angle techniques (sensitivity: 94.32%; specificity: 97.73%) showed slightly lower accuracy. Although periapical radiographs reliably detected the presence of bone loss, they were unable to classify circumferential defect morphology. As the depth of defects increased, sensitivity improved for all three techniques. Increased implant angulation reduced sensitivity across all three imaging techniques. Significant differences were observed among imaging modalities (P < 0.001).
Conclusions: CBCT provides superior diagnostic performance and enables three-dimensional classification of circumferential peri-implant defects. While two-dimensional periapical radiography can detect the presence of peri-implant bone loss, it cannot determine defect type, limiting its interpretive value in circumferential defects

Keywords: Cone-Beam Computed Tomography, Dental Implants, Dental Radiography, Peri-Implantitis

Type of Study: Original article | Subject: Surgery
Received: 2025/10/14 | Accepted: 2025/12/26

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