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Bone Defects

Is CBCT or intraoral radiology better for finding bone defects?

In Tony Edward’s article, Is CBCT or intraoral radiology better for finding bone defects?, it focuses its lens on a study conducted by Lauren Oliveira Lima Bohner, D.D.S. Ms. Bohner studied whether cone-beam CT (CBCT) imaging is better than intraoral radiology imaging in detecting peri-implant bone defects. Peri-implant bone defects, also called peri-implantitis, can lead to bone loss after prosthodontic rehabilitation, and could result in osseointegration loss without treatment. One of the best ways of diagnosing peri-implantitis is the presence of suppuration and bleeding when probing radiographic bone loss greater than one-third of the implant height. Thus, clinically evaluating a patient’s bone condition is of upmost importance during follow up examination of implant placement.
Since the research literature did not have a consensus on what technique is the most accurate in evaluating bone surrounding dental implants, Ms. Bohner and her research team decided to find out. Intraoral radiography is the most common technique to diagnose peri-implantitis, and utilizes 2-dimension imaging to analyze the peri-implant bone defect. Alternatively, CBCT provides a 3-dimensional view when attempting to locate the bone defect. There are major differences for both techniques, including cost, radiation exposure, and presence of metal artifacts. When comparing both techniques, the study sought to determine the sensitivity (chance the test identifies a condition) and specificity (chance the test reveals a patient is free of a condition) of each technique. The study created a rating scale for both sensitivity and specificity: above 80% is excellent, 60%-80% is good, and below 60% is poor.

Study Summary
Overall, the study determined that although both techniques are clinically acceptable in assessing peri-implant bone defects, they both do not present a high accuracy rate. Pouring through 680 articles published between 1991 and 2016, they determined that CBCT had a sensitivity rate of 59%, and specificity rate of 67%. While intraoral radiography scored a 60% chance for sensitivity, and 59% chance for specificity. Although the study acknowledges that CBCT’s 3-dimensional imaging provides better visibility, the accuracy and performance of CBCT was lower or at least comparable to intraoral radiography’s imaging.
So which X-ray is appropriate for me you might ask? The short answer is “it depends”. If your dentist is looking for the “why” you have per-implantitis, then CBCT may be the best technology to use. And as far as to minimize any complication from implant such as nerve damage, there is no doubt that CBCT is far better and gives your dentist the tool to pre-plan your implant, including to “virtually placed” the implant in 3D.


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