Influence of Metal Artifact Reduction Tool of Two Cone Beam CT on the Detection of Bone Graft Loss Around Titanium and Zirconium Implants-An Ex Vivo Diagnostic Accuracy Study

Clin Oral Implants Res. 2024 Nov 19. doi: 10.1111/clr.14381. Online ahead of print.

Abstract

Objective: The objective of this study is to investigate the influence of metal artifact reduction (MAR) on two cone beam computed tomography (CBCT) units in the evaluation of bone graft loss adjacent to titanium (Ti) and zirconium (Zr) implants.

Material and methods: Twelve Ti and twelve Zr implants were placed in the posterior region of dry human mandibles. Bone graft was applied to the level of the cover screw. Bone graft loss was simulated in half of the sample (6 Ti and 6 Zr) by removing the graft material up to the third implant thread on the buccal surface. CBCT images were acquired on two units, varying the application of MAR (OP300-off and on; Eagle 3D-standard, intermediate, and extreme). The images were assessed by five evaluators that scored the presence of graft loss according to a 5-point scale. The diagnostic values were calculated and compared by non-parametric tests with a significance level of 5%.

Results: Higher diagnostic values were achieved with MAR activated in the OP300 unit, for Ti and Zr (p < 0.05). On the Eagle 3D unit, MAR in extreme mode resulted in lower diagnostic values for both types of implants (p < 0.05). The diagnostic values of Ti implants were higher than Zr implants (p < 0.05).

Conclusion: The application of MAR influences the diagnosis of bone graft loss adjacent to Ti and Zr dental implants. However, the extreme mode of MAR in the Eagle 3D unit can impair the diagnostic task in both types of implants and should be avoided.

Keywords: artifacts; bone graft; cone‐beam computed tomography; dental implants; diagnostic imaging; titanium; zirconium.