Evaluation of Exomass-Related Artefacts Caused by Dental Implants of Different Materials in Cone-Beam Computed Tomography Scans: An Ex Vivo Study

Objectives: To evaluate the influence of different dental implant materials within the exomass on the image quality in cone-beam computed tomography (CBCT).

Material and methods: Five pig jaws were scanned using four CBCT devices, first without any dental implants, followed by scans with three dental implants of the same material-pure titanium, titanium-zirconium alloy, and zirconium dioxide. Two fields of view (FOVs) were used for each device to position the implants in the exomass of a small FOV and within a large FOV. Voxel values were obtained from tubes containing a radiopaque solution to calculate mean voxel value (MVV), voxel value inhomogeneity (VVI), and image noise (IN), which were compared across implant materials and FOVs using repeated measures analysis of variance (α = 0.05). Three observers independently scored image quality using a 5-point scale.

Results: In general, MVV remained unaffected, except for a significant increase in the X800 device when titanium or titanium-zirconium alloy implants were in the exomass of a small FOV (p ≤ 0.05). A trend of increased VVI was observed when implants were in the exomass of a small FOV, with a greater effect for zirconium dioxide, followed by titanium-zirconium alloy and titanium. IN was higher when implants were in the exomass, especially for zirconium dioxide implants (p ≤ 0.05). Image quality perception was consistent overall, though zirconium dioxide implants in both FOVs resulted in diminished quality.

Conclusions: The presence of implants in the exomass can negatively affect CBCT image quality, with zirconium dioxide having the greatest impact.