A comparative evaluation of the metallic artifact generated by a ceramic dental implant and a titanium dental implant imaged on cone-beam computed tomographic scans

Background

Dental implants are becoming the treatment of choice for restoring edentulous sites. Dental implants are typically made of a titanium alloy, and this produces a metallic artifact that obscures adjacent anatomy when imaged using x-radiation, specifically on cone-beam computed tomographic (CBCT) scans. This artifact makes it challenging to evaluate peri-implant bone levels and any associated pathology. It was hypothesized that the introduction of ceramic implants would help in overcoming this challenge due to the nature and composition of the ceramic. The objective of this study was to compare the metallic artifact produced by ceramic and titanium dental implants when imaged with CBCT.

Methods

Dental implants were placed in the edentulous sites of 2 dry human skulls, and CBCT scans with a standard 360° acquisition and a low-dose 180° acquisition were obtained. The metallic artifact generated by the implants was measured quantitatively using pixel intensity values and qualitatively using a modified Likert scale.

Results

Average pixel intensity values, by gnathic region, ranged from 123.5 through 507 for titanium implants and 500 through 1,088.5 for ceramic implants. Qualitative analysis showed that ceramic implants produced more metallic artifact than titanium implants. Intraoperator and interoperator reliabilities assessed using Cronbach α showed consistency for both qualitative and quantitative analyses.

Conclusion

Ceramic dental implants produced significantly more metallic artifact when imaged on CBCT scans than titanium implants.