Influence of vertical X-ray beam angulation and receptor-holders on the radiographic detection of implant abutment–prosthesis misfit

ABSTRACT Statement of problem Periapical radiographs have been the primary adjunctive diagnostic method of evaluating abutment-prosthesis misfit. However, whether different radiographic receptor‑holders interfere with diagnostic accuracy depending on the vertical X-ray beam angulation remains unclear. Purpose The purpose of this in vitro study was to correlate the success rate in detecting misfits in implant-supported prostheses with the vertical X-ray beam angulation used with different receptor-holders. Material and methods Twenty maxilla-mandible prototypes with dental implants inserted in the region of the right maxillary central incisor were used. Four situations were simulated: absence of misfit at the abutment–prosthesis interface (control group — 0 µm) and presence of misfits (test groups: 50 µm, 100 µm, and 150 µm). Radiographs were acquired using bisecting angle (Cone Indicator; Indusbello Co) and standard paralleling technique (Rinn XCP; Dentsply Sirona) receptor-holders. The values of the vertical angle of the X-ray beam were recorded. Five dental clinicians evaluated the radiographs for the presence or absence of misfits. The values associated with success rate and vertical angle were submitted to the Spearman correlation coefficient followed by a Bonferroni correction (α=.006). Results The bisecting angle technique receptor-holder had a mean angulation of 50 degrees, while the standard paralleling technique receptor-holder had a mean angulation of 45 degrees. As the magnitude of the misfit increased, its presence became more evident, regardless of the receptor-holder used. Across all simulated conditions, no statistically significant correlation was identified between the success rate and vertical angulation of the X-ray beam (P>.006). Conclusions In all scenarios tested, the vertical X-ray beam angulation had no significant correlation with the success rate of the radiographic detection of misfits in implant-supported prostheses when receptor-holders were used.