Abstract Background The aim of this study is to evaluate the impact of different implant materials and arrangements within the field of view (FOV) and exomass on the diagnostic accuracy and image quality of cone‐beam computed tomography (CBCT) for the detection of peri‐implant buccal bone defects of various sizes. Methods A total of 120 CBCT scans with three different implant materials with identical diameter (titanium Ti, titanium‐zirconium TiZr, and zirconium dioxide ZrO 2 ) and three surgically created peri‐implant defect sizes (no defect, small defect: 3 mm, large defect: 6 mm) using two CBCT scanners (X800 and Planmeca) were generated. Three independent examiners assessed the scans for the presence of peri‐implant bone defects, rated the impact of metal artefacts on diagnostic confidence (visual analog scale VAS 0–10), and measured the maximum height and width of the defect, when present. Diagnostic performance (sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve) was calculated by a generalized linear mixed model. Artefact perception (VAS) and measurement error (height and width) were analyzed using analysis of variance, with p < 0.05 considered significant. Results CBCT imaging demonstrated high overall diagnostic accuracy for detecting surgically created peri‐implant bone defects when implants were positioned within FOV and the exomass. Nevertheless, defect size ( p < 0.001) and implant material ( p = 0.019) did affect the diagnostic accuracy significantly. Smaller bone defects (79.4%) were associated with a reduced diagnostic accuracy compared with larger defects (99.1%) and non‐defect sites (95.3%). ZrO 2 dental implants (85.4%) were associated with a reduced diagnostic accuracy compared with Ti (97.5%) and TiZr implants (92.6%). Conclusions CBCT reliably detects peri‐implant bone defects, irrespective of the implant material or the presence in the exomass. While ZrO 2 implants and smaller defects can reduce diagnostic accuracy, its overall performance remains robust, warranting further clinical validation. Plain Language Summary This study explored how well cone‐beam computed tomography (CBCT), a 3D dental imaging technique, can detect bone loss around dental implants. The authors tested three commonly used implant materials—titanium (Ti), titanium–zirconium (TiZr), and zirconium dioxide (ZrO 2 )—and created small and large buccal bone defects around them in a controlled laboratory setting. They also tested the effect of implants outside the CBCT scanning area to mimic real‐world clinical situations. Three trained examiners reviewed 120 CBCT scans to judge whether a bone defect was present, how much the implant material affected image assessment, and how closely their measurements matched the true size of the defects. Overall, CBCT was highly reliable in identifying bone defects, especially when defects were large. However, very small buccal defects were harder to detect, and zirconia implants produced more image distortion, making diagnosis slightly less accurate compared with Ti implants. Importantly, even when implants were positioned at the edge of the scan, CBCT still performed well. These findings support the use of CBCT as a dependable tool for evaluating bone loss around implants, while highlighting situations—such as small defects or zirconia implants—where interpretation should be made with extra care.
Wang et al. (Fri,) studied this question.
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