Comparison of Virtual Dental Implant Planning Using the Full Cross-Sectional and Transaxial Capabilities of Cone Beam Computed Tomography vs Reformatted Panoramic Imaging and 3D Modeling

Purpose: To compare the choice and placement of virtual dental implants in the posterior edentulous bounded regions using the full cross-sectional and transaxial capabilities of cone beam computed tomography (CBCT) vs reformatted panoramic images and three-dimensional (3D) virtual models. Materials and Methods: Fifty-two cases with posterior bounded edentulous regions (61 dental implant sites) were identified from a retrospective audit of 4,014 radiographic volumes. Two image sets were created from selected CBCT data: (1) a combination of reformatted panoramic imaging and a 3D model (PIref/3D), and (2) the full 3D power in CBCT image volume analyses (XS). One virtual implant was placed by consensus of three prosthodontists in each image set: PIref/3D and XS. The choice of implant length and the perceived need for ridge augmentation were recorded for implant placement in both test situations. All the virtual implant placements from both PIref/3D and XS image sets were inspected retrospectively using virtual 3D models, and the number of exposed threads on both the buccal and lingual/palatal aspects of the virtual dental implant was evaluated. The chi-square and paired t tests were used with the level of significance set at α = .05. Results: Shorter implants were chosen more often using XS than PIref/3D (P = .001). Fewer threads were exposed when placed with XS than with PIref/3D (P = .001). The use of XS reduced the perceived need for ridge augmentation compared with PIref/3D (P = .001). Conclusion: The use of the full 3D power of CBCT (including cross-sectional images in all three orthagonal planes and transaxially) provides supplemental information that significantly changes the choice of virtual implant length and vertical position of the implant, and reduces the frequency of perceived need for ridge augmentation before implant placement. Keywords: computed tomography, dental implants, digital image processing, reformatted panoramic imaging, virtual study model, virtual surgical planning, x-ray cone beam