CBCT vs. Panoramic Imaging in Detecting Sinus Perforations During Closed Sinus Lift: An In Vitro Study

Abstract So this study explored how effectively Cone-Beam Computed Tomography (CBCT) and panoramic radiography (OPG) detect sinus membrane perforations during closed maxillary sinus lift procedures. Using in vitro simulation models with 32 implant sites, we aimed to replicate realistic surgical conditions. All sites were evaluated with both CBCT and panoramic imaging, and assessments were made by four independent raters with varying levels of radiographic experience. While statistical analysis didn’t show a significant difference in detection rates (p = 0.063), CBCT consistently produced clearer images and higher detection scores across all raters. More importantly, inter-rater agreement was notably stronger when evaluating CBCT scans, suggesting that it delivers more consistent and reliable diagnostic data. Panoramic radiographs, in contrast, showed variability and lower agreement levels highlighting their limitations in identifying fine anatomical changes like small membrane perforations. These findings support the growing clinical preference for CBCT in pre-surgical planning, especially for procedures requiring precise visualization of sinus structures. Although OPG still has a role in preliminary assessment due to its accessibility and lower radiation exposure, it lacks the resolution needed for confident decision-making in complex cases. Overall, this research reinforces the importance of CBCT as a tool that not only improves diagnostic accuracy but also builds greater consensus among clinicians for reducing complications and improving implant outcomes.