Efficacy of Periapical Radiography and Three Cone-Beam Computed Tomography Systems for Detection of Peri-Implant Dehiscence Defects: An in- Vitro Study

Background: Early detection of peri-implant bone defects is highly important because these defects eventually lead to gingival recession, bone loss and implant failure. Objective: This study aimed to assess and compare the efficacy of periapical radiography and three CBCT systems for the detection of peri-implant dehiscence defects. Material and Methods: In this vitro study, 124 titanium implants were placed in bovine ribs. The bone pieces were then mounted in boxes in the form of mandible and red dental wax was used to simulate the soft tissue. Crestal bone defects with 2, 3, and 4 mm depth were created in the ribs using a round bur. Periapical and CBCT images were then obtained. Images were investigated by two oral and maxillofacial radiologists twice with a two-week interval. The results were analyzed using chisquare, Kappa coefficient, Cochrane’s Q and McNemar tests as well as the receiver operating characteristic (ROC) curve. Results: The two observers showed good agreement in detection of sound and defective samples on periapical radiographs and CBCT scans. The level of agreement was low in detection of two samples with 2 mm defects on CBCT scans taken with Planmeca and NewTom 3G systems at the time of second assessment. NewTom 3G had the highest sensitivity (68.9%, 74.2% and 86.3%, respectively) and specificity (100% for all three) compared to other systems for detection of 2, 3 and 4 mm crestal bone defects. Conclusion: The inter-observer agreement increased with increase in depth of defects. NewTom 3G had the highest accuracy for detection of crestal bone defects.