Cone beam computed tomography artefacts around dental implants with different materials influencing the detection of peri-implant bone defects

Objectives To investigate the diagnostic accuracy of cone beam computed tomography (CBCT) for the diagnosis of peri-implant bone defects of titanium (Ti), zirconium dioxide (ZrO2) or titanium-zirconium (Ti-Zr) alloy implants. Materials and Methods Ti, Ti-Zr or ZrO(2)implants with two diameters (3.3 mm, 4.1 mm) and one length (10 mm) were inserted in the angle of the mandible of six fresh defrosted pig jaws. Out of the 12 implants inserted, 6 served in the test group with standardized buccal peri-implant bone defects, whereas 6 served as control without bone defects. CBCTs were performed with three acquisition protocols (standard, high and low dose) using two devices. Four observers analysed CBCTs as follows: (a) presence of a peri-implant defect; (b) presence of peri-implant artefacts and impact on defect diagnosis; and (c) linear measurements of buccal peri-implant defect including height and width (in mm). Results CBCT device, CBCT settings, implant material, implant diameter and observer background did not significantly influence diagnostic accuracy. The sensitivity and specificity values were high for defect detection. ZrO(2)led to a lower than average diagnostic accuracy (0.781). The linear measurements of peri-implant defect were underestimated by <1 mm on average. The subjective impact of artefacts on defect diagnosis was significantly affected by implant material and observer background. Conclusions CBCT showed high diagnostic accuracy for peri-implant bone defect detection regardless of the device, imaging setting or implant material used. If CBCT is indicated to assess peri-implant bone disease, low dose protocols could be a promising imaging modality.