Novel Marker-based CBCT Registration for Enhanced Accuracy in Dental Implant Planning

STATEMENT OF PROBLEM: Accurate image registration is essential for successful digital dental implant planning. Surface-based registration, commonly used in clinical software, is sensitive to CBCT artifacts and relies on manual landmark selection, potentially reducing accuracy. Marker-based registration offers improved precision but is underused due to its technical complexity and time demands. PURPOSE: The purpose of this ex-vivo study was to evaluate the accuracy of a novel marker-based registration method using limited-view CBCT reconstructions derived from two orthogonal projection images and to compare it with a conventional surface-based registration method. MATERIAL AND METHODS: An ex-vivo model consisting of a maxillary arch with removable 3D-printed teeth and a radiographic guide containing radiographic markers was used to simulate five metal artifact conditions. Full-view CBCT scans were acquired for each condition. For the conventional method, three examiners independently performed dual-scan registrations using user-defined surface landmarks on full CBCT reconstructions. For the proposed method, examiners selected orthogonal projection images where markers were clearly visible and limited-view reconstructions were generated to identify marker centroids. Registration error was measured as the point-to-point distance between corresponding surface reference points, standardized to a common frame of reference. Inter-rater reliability was also assessed. RESULTS: Both methods maintained consistent performance across all artifact conditions. The proposed method demonstrated greater accuracy, with lower point-to-point registration errors and less spatial variation. Inter-rater reliability was excellent for the proposed method and good for the conventional approach. CONCLUSIONS: The proposed marker-based registration method using orthogonal projection images and limited-view CBCT reconstructions showed higher accuracy than conventional surface-based registration under controlled ex vivo conditions. Although the workflow currently requires additional examiner input, it may improve precision in dual-scan protocols for implant planning. Future clinical studies and software developments are required to support clinical implementation.