Validating cone-beam computed tomography for peri-implant bone morphometric analysis

Abstract

Cone-beam computed tomography (CBCT) has been recently used to analyse trabecular bone structure around dental implants. To validate the use of CBCT for three-dimensional (3D) peri-implant trabecular bone morphometry by comparing it to two-dimensional (2D) histology, 36 alveolar bone samples (with implants n=27 vs. without implants n=9) from six mongrel dogs, were scanned ex vivo using a high-resolution (80 µm) CBCT. After scanning, all samples were decalcified and then sectioned into thin histological sections (∼6 μm) to obtain high contrast 2D images. By using CTAn imaging software, bone morphometric parameters including trabecular number (Tb.N), thickness (Tb.Th), separation (Tb.Sp) and bone volume fraction (BV/TV) were examined on both CBCT and corresponding histological images. Higher Tb.Th and Tb.Sp, lower BV/TV and Tb.N were found on CBCT images (P<0.001). Both measurements on the peri-implant trabecular bone structure showed moderate to high correlation (r=0.65–0.85). The Bland–Altman plots showed strongest agreement for Tb.Th followed by Tb.Sp, Tb.N and BV/TV, regardless of the presence of implants. The current findings support the assumption that peri-implant trabecular bone structures based on high-resolution CBCT measurements are representative for the underlying histological bone characteristics, indicating a potential clinical diagnostic use of CBCT-based peri-implant bone morphometric characterisation.

Bone quality: Three-dimensional scanning shows promise

Using an advanced approach of cone-beam computed tomography (CBCT) scanning and elaborate analysis to measure bone quality accurately and safely could help enhance the survival rate of dental implants. Traditionally, time-consuming microscopy is used to measure the internal structure and quality of bones. MRI and traditional CT scanning can be used prior to dental surgery but are associated with problems with metal artefacts and increased radiation doses. Now, Reinhilde Jacobs at the Department of Imaging and Pathology at the University of Leuven, Belgium, together with international colleagues, has conducted an analysis of 36 jawbone biopsies from dogs to compare traditional microscopic techniques with high-resolution, three-dimensional CBCT. The team found that CBCT was a potentially safe and useful clinical method for assessing the bone quality at dental implant sites, although further trials and testing are needed.

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