Ceramic Dental Implants Produce More Metallic Scatter Than Titanium Implants
Objectives: The objective of this study was to evaluate and compare metallic scatter artifact produced by ceramic and titanium dental implants when imaged with cone-beam computed tomography (CBCT). A secondary objective was to evaluate the scatter on a conventional 360° CBCT acquisition compared with a low-dose 180° acquisition. Methods: Partially edentulous dry human skulls were used for implant sites. Implants were placed in various combinations to simulate clinical scenarios. All implant combinations were imaged with a standard 360° CBCT acquisition and a low-dose 180° acquisition. All CBCT scans were evaluated using a post-processing program, Invivo6 (Anatomage, Inc., Sanjose, CA). Metallic scatter artifact was measured quantitatively by pixel intensity values (PIVs), and qualitatively using a modified Likert scale to assess image quality. Statistical analyses were done comparing average PIVs with independent t-tests. Inter-operator reliability was done using Cronbach’s alpha. Results: In both the standard 360° protocol and the low-dose 180° protocol, the ceramic implant had significantly higher PIVs compared to the titanium implant (p=0.016, 360°; p=0.009, 180°). There was no significant difference between the PIVs produced on the standard 360° acquisition compared to the low-dose 180° acquisition with either the ceramic or titanium implants (p=0.557, ceramic; p=0.332, titanium). When comparing PIVs by gnathic region, there was no significant difference between the average PIVs in any of the regions. Qualitatively, the ceramic implant produced scatter that affected the overall scan quality and obscured adjacent anatomy. Scatter from titanium implants affected the overall quality of the scan, but did not obscure any proximal anatomy. The inter-operator reliability was excellent for both quantitative (Cronbach’s alpha score: 0.958, 360° protocol; 0.987, low-dose 180° protocol) and qualitative assessment (Cronbach’s alpha score: 1). Conclusions: Ceramic dental implants produce significantly more metallic scatter than titanium dental implants when imaged with CBCT.