Higher Resolution in Cone Beam Computed Tomography Is Accompanied by Improved Bone Detection in Peri-implant Bone Despite Metal Artifact Presence

Purpose: The aim of this study was to determine the possibility and extent of artifact reduction by an optimized use of cone beam computed tomography (CBCT) parameter configuration (geometric resolution, implant geometric parameters, and image analyses). It furthermore sought to determine the distance from correctly reproduced bone tissue to an implant, where the grayscale values are equal to the pre-implantation values. Materials and Methods: Titanium implants were inserted into pig tibia under standardized conditions. CBCT investigations in the form of bone density mapping were performed under various CBCT settings and implantation situations. The circumference of the implants was measured in order to determine the extent of metal artifacts. This was done by determining grayscale and comparing it to the bone area prior to implantation. Results: Using CBCT to determine bone density postimplantation showed a correlation in dependence of CBCT parameter configuration. Higher resolution led to a better detection of correct bone density values in the peri-implant region. Normal bone density values can be recognized at a distance of 370 μm from the implant surface, when the spatial resolution is 125 μm. Therefore, higher resolution in CBCT is accompanied by an improved bone detection in peri-implant bone, despite the presence of metal artifacts. Peri-implant bone defects that extend 400 μm around implants were reliably detected by using a spatial resolution of 125 μm. In specimens, where multiple implants are present in one line, pronounced artifact formations were present. The artifacts were visible as a combination of streak-like hardening and extinction effects. Conclusion: Bone geometric data and density values may be determined correctly in close proximity to the implant surface, and can detect peri-implant bone defects. When multiple implants are placed, the implant radiation direction geometry must be considered. Keywords: CBCT, grayscale, implant, metal artifact, peri-implant defects, spatial resolution