From 2D to 3D: A Comparative Accuracy Assessment of Periapical and Panoramic Radiography Versus Cone Beam CT for Bone Height Evaluation in Pre-surgical Implant Planning

ObjectiveThis study aimed to compare the accuracy of bone height measurements obtained from periapical and panoramic radiography against cone-beam CT (CBCT) in pre-surgical implant planning, assessing their reliability and measurement discrepancies, as well as their impact on treatment planning and clinical decision-making. Materials and methodsThe study involved a sample of 60 implant sites, divided into three groups of 20 each.The key anatomical landmarks for the groups were the floor of the maxillary sinus, the roof of the mental foramen, and the roof of the inferior alveolar nerve canal.Acrylic stents bearing radiographic markers were used to take measurements at each site.Bone height was measured using three imaging modalities: intraoral periapical (IOPA) radiography, orthopantomogram (OPG), and CBCT.The measurements were compared for accuracy across these modalities. ResultsDescriptive analysis revealed mean bone height measurements of 7.95 ± 4.18 mm (IOPA), 8.86 ± 3.91 mm (OPG), and 9.00 ± 4.88 mm (CBCT) at the maxillary sinus floor; 15.81 ± 4.88 mm (IOPA), 15.17 ± 3.59 mm (OPG), and 15.13 ± 3.96 mm (CBCT) at the inferior alveolar nerve canal; and 12.98 ± 3.89 mm (IOPA), 12.15 ± 3.40 mm (OPG), and 12.31 ± 3.75 mm (CBCT) at the mental foramen.Analysis of variance (ANOVA) and Tukey's HSD (honestly significant difference) test showed no statistically significant differences among the imaging modalities (p > 0.05). ConclusionsCBCT provides greater three-dimensional accuracy for implant planning than either periapical or panoramic radiography and allows a more detailed bone assessment, whereas conventional methods remain useful for screening.