The current role and future potential of digital diagnostic imaging in implant dentistry: A scoping review

A Multifunctional Guide for Non-Carious Cervical Lesion Restoration and Root Coverage Using a Coronally Advanced Flap in the Treatment of Combined Lesions

OBJECTIVES

This case report describes a digital workflow that integrates restorative and surgical planning through the design and fabrication of a multifunctional guide to optimize outcomes in the treatment of combined lesions.

CLINICAL CONSIDERATIONS

Gingival recessions frequently occur alongside non-carious cervical lesions (NCCLs), forming combined defects that complicate cementoenamel junction (CEJ) identification and treatment planning. A 40-year-old male presenting with gingival recession and NCCLs on teeth #14 and #15. A restoration was planned to reconstruct the lost CEJ using clinical reference points. A custom surgical guide was subsequently designed to replicate the planned restoration's contour and to delineate the intended incision patterns for the coronally advanced flap (CAF) procedure. The CEJ restoration was executed using composite resin, with the guide assisting in achieving precise contouring. Root coverage was then performed using a CAF combined with a connective tissue graft, with the guide facilitating accurate scalpel blade placement during flap preparation. At the one-year follow-up, complete root coverage was observed and the restoration maintained stability in terms of marginal adaptation, color, and surface integrity.

CONCLUSIONS

The use of a multifunctional digital guide can enhance the precision of both restorative and surgical procedures in the management of combined gingival recession and NCCL defects, potentially improving treatment predictability and outcomes.

CLINICAL SIGNIFICANCE

This case report highlights the benefits of a 3D-printed multifunctional digital guide for precise CEJ restoration and flap design in treating gingival recessions associated with NCCLs.

Cone beam computed tomography in dentistry: clinical recommendations and indication-specific features

OBJECTIVES

To provide a narrative overview of commercially available CBCT devices, highlight the wide range of technical features and their impact on image quality and diagnostic performance, and develop decision support charts to guide clinicians in selecting appropriate CBCT parameters for different dental specialties.

DATA AND SOURCES

Data collection involved reviewing published articles on CBCT devices and accessing manufacturer websites. Additional manufacturers were identified through a literature search and by attending scientific and commercial events held in 2023 and 2024. Information on CBCT features was obtained from websites, manuals, and inquiries until February of 2025. Data were categorized and analyzed descriptively and quantitatively to recommend device requirements for dental specialties. Decision support charts were developed for each specialty based on common indications and technical parameters (e.g., field-of-view, scout need, spatial resolution, X-ray exposure parameters, and post-processing tools).

RESULTS

Eighty-seven commercially available CBCT devices from 34 manufacturers across 11 countries were identified, with information confirmed for only 10 companies. Missing data varied, however FOV and voxel size were commonly reported. Tube voltage ranged from 50-120 kV, and tube current mostly varied between 1-17 mA. Dose considerations varied widely, with dose-product-area ranging from 10 to 5600 mGy.cm2 and typical effective dose estimates from 3 to 500 µSv. Decision support charts were created, outlining necessary image acquisition and reconstruction-related parameters for prosthodontics and implant dentistry, periodontology, oral and maxillofacial surgery, pediatric dentistry and orthodontics, and endodontics.

CONCLUSION

This study provides an overview of the technical features of commercially available CBCT devices, highlighting gaps in reconstruction parameters and dose considerations. Tailored recommendations based on patient-specific needs are essential, with clinicians individualizing CBCT acquisition to optimize diagnostic accuracy and minimize biological risks.

CLINICAL SIGNIFICANCE

This study provides valuable insights into commercially available CBCT devices in terms of their features and provides decision support chart to help clinicians select optimal technical parameters tailored to specific dental specialties.

Dental-dedicated magnetic resonance imaging in the follow-up of lower third molar removal

The objective is to present a dental-dedicated magnetic resonance imaging (ddMRI)-based follow-up of inferior third molar removal over 12 months. A 30-year-old female presented with recurrent pain and bleeding from her lower right third molar. With adding diagnostic information from a panoramic image, the tooth was referred for removal. The patient underwent ddMRI using a dental coil with a proton density (PD) weighed turbo spin echo (TSE) sequence and a PD-TSE-STIR with fat suppression to highlight possible inflammatory processes. The scans were performed pre-operatively, immediately post-operatively, and in a rigorous follow-up (weekly basis for the first 6 weeks, bi-weekly from 7 to 12 weeks, and once at 6 and 12 months post-operatively). Using ImageJ software, circular ROIs were selected in the extraction alveolus coronary, middle, and apical regions. Mean grey values (MGVs) and standard deviation (SD) were obtained. A trend of decreasing MGVs in the PD (TSE) pulse sequence was observed over time, irrespective of the root third. Considering the PD-STIR (TSE), no trend was observed. ddMRI is feasible in the follow-up assessment of inferior third molar removal. Further clinical trials with larger samples are needed to define the usability of follow-up with ddMRI, considering a potential added diagnostic value.

Methods for assessing peri-implant marginal bone levels on digital periapical radiographs: a meta-research

OBJECTIVES

This meta-research assessed methodologies used for evaluating peri-implant marginal bone levels on digital periapical radiographs in randomized clinical trials published between 2019 and 2023.

METHODS

Articles were searched in four databases. Data on methods for assessing peri-implant marginal bone levels were extracted. Risk of bias assessment was performed.

RESULTS

During full-text reading, 108 out of 162 articles were excluded. Methodological issues accounted for these exclusions, including the absence of radiograph-type information, the lack of radiographic positioners, the missing anatomical references, and the use of panoramic radiographs or tomography. Fifty-four articles were included, most from Europe (70%) and university-based (74%). Radiographic positioners were specified in 54% of articles. Examiner calibration was unreported in 54%, with 69% lacking details. In 59%, no statistical measure assessed examiner agreement. Blinding was unreported or unused in 50%. Marginal bone level changes were the primary outcome of 61%. Most articles (59.3%) raised "some concerns" regarding bias, while 37% showed a high risk of bias, and only two articles (3.7%) demonstrated a low risk of bias.

CONCLUSIONS

Several limitations and areas for improvement were identified. Future studies should prioritize protocol registration, standardize radiographic acquisitions, specify examiner details, implement calibration and statistical measures for agreement, introduce blinding protocols, and maintain geometric calibration standards.

Interference of titanium and zirconia implants on dental-dedicated MR image quality: ex vivo and in vivo assessment

OBJECTIVES

To assess the impact of titanium and zirconia implants on dental-dedicated MR image (ddMRI) quality ex vivo (magnetic field distortion [MFD]) and in vivo (artefacts).

METHODS

ddMR images were acquired (MAGNETOM Free.Max, 0.55 T, Siemens Healthineers AG, Forchheim, Germany) using a dental-dedicated coil (Rapid Biomedical, Rimpar, Germany). Ex vivo: three phantoms were manufactured: one agar-embedded titanium implant, one agar-embedded zirconia implant, and one control phantom (agar 1.5%). Field map analysis of images acquired at 0.55 T, 1.5 T, and 3.0 T (MAGNETOM Sola and MAGNETOM Lumina, respectively, Siemens Healthineers AG, Forchheim, Germany) was done to illustrate the extent and severity of MFD caused by the implants. In vivo (0.55 T only): a splint was designed to serve as an implant carrier, allowing diverse implant positions (0, 1, 2, or 5 implants). A volunteer was imaged using multiple pulse sequences. Three blinded observers scored the images twice for the presence, severity, and type of artefacts, illustrated by descriptive statistics and inter- and intra-observer reproducibility (kappa statistics).

RESULTS

Ex vivo: titanium produced more severe MFD than zirconia. MFD extent and amplitude increased with field strength (0.55 T < 1.5 T < 3.0 T). In vivo: titanium produced more artefacts than zirconia, generally as signal voids in tooth crowns close to implants. Inter- and intra-observer reproducibility ranged from 0.28 to 0.64 and 0.32 to 0.57, respectively.

CONCLUSIONS

The prevalence of artefacts increased with magnetic field strength. Titanium generated larger MFD than zirconia. For both materials, artefacts were visible mainly in the crown area. Observer reproducibility needs improvement by dedicated ddMRI training.

Automated Segmentation of Graft Material in 1-Stage Sinus Lift Based on Artificial Intelligence: A Retrospective Study

OBJECTIVES

Accurate assessment of postoperative bone graft material changes after the 1-stage sinus lift is crucial for evaluating long-term implant survival. However, traditional manual labeling and segmentation of cone-beam computed tomography (CBCT) images are often inaccurate and inefficient. This study aims to utilize artificial intelligence for automated segmentation of graft material in 1-stage sinus lift procedures to enhance accuracy and efficiency.

MATERIALS AND METHODS

Swin-UPerNet along with mainstream medical segmentation models, such as FCN, U-Net, DeepLabV3, SegFormer, and UPerNet, were trained using a dataset of 120 CBCT scans. The models were tested on 30 CBCT scans to evaluate model performance based on metrics including the 95% Hausdorff distance, Intersection over Union (IoU), and Dice similarity coefficient. Additionally, processing times were also compared between automated segmentation and manual methods.

RESULTS

Swin-UPerNet outperformed other models in accuracy, achieving an accuracy rate of 0.84 and mean precision and IoU values of 0.8574 and 0.7373, respectively (p < 0.05). The time required for uploading and visualizing segmentation results with Swin-UPerNet significantly decreased to 19.28 s from the average manual segmentation times of 1390 s (p < 0.001).

CONCLUSIONS

Swin-UPerNet exhibited high accuracy and efficiency in identifying and segmenting the three-dimensional volume of bone graft material, indicating significant potential for evaluating the stability of bone graft material.

Combining different metal artifact reduction levels with sharpening filters and slice thickness for the visualization of mandibular canals perforated by implants

OBJECTIVES

To investigate the influence of combining levels of metal artifact reduction (MAR) tool with different filters and slice-thickness in the detection of mandibular canals perforated by implants on CBCT scans and to objectively assess the impact of the aforementioned combinations.

MATERIALS AND METHODS

Implants were placed above (8 implants) and inside (10 implants) mandibular canals of dried-mandibles. CBCT scans were obtained with the Eagle 3D unit (85 kVp, 8 mA, 5 × 5 cm FOV, 130 μm voxel size, and off/medium/high MAR levels). Examiners evaluated the scans under each MAR level and across different conditions: no filter, Sharpen 1×, Sharpen 2×; 0 mm, 1 mm, and 2 mm slice-thickness. The gray values on axial reconstructions were assessed. Area under the receiver operating characteristic curve (AUC), sensitivity, specificity, mean and standard deviation (SD) for gray values were calculated and compared by multi-way Analysis of Variance.

RESULTS

Overall, the AUC and sensitivity decreased with high-level MAR (p < 0.0001), regardless other variables tested. Enabling MAR tool decreased mean gray values (p < 0.01) and increasing MAR levels reduced the SD values on scans with Sharpen 2× (p < 0.012).

CONCLUSIONS

High-level MAR impairs the visualization of mandibular canals perforated by implants. Moreover, enabling MAR tool decreases the mean gray values.

CLINICAL RELEVANCE

MAR tool, filters, and slice thickness influence the image quality of CBCT scans. Therefore, it is important to evaluate the impact of these parameters on the diagnosis of mandibular canals perforated by implants.

Low-dose, standard, and high-resolution cone beam computed tomography for alveolar bone measurements related to implant planning: An ex vivo study in human specimens

AIM

To evaluate the performance of low-dose cone beam computed tomography (CBCT) protocols with regard to linear bone measurements in the posterior mandible for implant planning compared with higher dose protocols.

MATERIALS AND METHODS

Forty-two edentulous posterior sites in human cadaveric mandibles were imaged in three CBCT scanners using three or four protocols with varying exposure parameters to achieve lower dose. Co-registration was performed to generate sagittal and cross-sectional image sections representative of the implant site. Three observers measured bone height, from the alveolar crest to the mandibular canal, and width, three mm from the top of the alveolar crest. Intra- and interobserver reproducibility were assessed for the cases rated as nonmeasurable as well as for completed measurements. The measurements were analyzed using paired t-tests for differences among the CBCT protocols and the frequency distribution of nonmeasurable cases with a Pearson Chi-square test.

RESULTS

Reproducibility for registering nonmeasurable cases varied among observers; however, no consistent significant differences were found in the frequency distribution of these cases among observers, units, and protocols. Intraclass correlation coefficients (ICC) were >0.9 for all measurements of bone height and width. Mean differences of <0.5 mm were found regardless of protocol; however, one observer did in some cases produce larger differences.

CONCLUSION

Linear bone measurements did not differ significantly and could be performed with excellent reliability, using low-dose CBCT protocols compared with standard and high-resolution ones. Varying approaches for rating nonmeasurable cases were found, indicating differences in diagnostic strategies related to implant planning among observers.

Accuracy analysis of robotic-assisted immediate implant placement: A retrospective case series

OBJECTIVES

This study aimed to investigate the accuracy of a robotic computer-assisted implant surgery (r-CAIS) for immediate implant placement.

METHODS

Patients requiring immediate implant placement in the maxillary anterior region were enrolled for r-CAIS. Before surgery, the patients underwent a cone beam computed tomography (CBCT) scan with a positioning marker. Virtual implant placement position and drilling sequences were planned. Following spatial registration and calibration, the implants were placed with the robotic system under supervision. A postoperative CBCT was taken to control the actual implant positions. The DICOM data of the virtually planned and the actually placed implant were superimposed and registered through the accuracy verification software of the robotic system. The accuracy was calculated automatically. The deviation at the mesial-distal, labial-palatal, and apico-coronal directions were recorded.

RESULTS

Fifteen patients with 20 implants were included. No adverse surgical events or postoperative complications were reported. The global platform, apex, and angular deviation were 0.75 ± 0.20 mm (95 % CI: 0.65 to 0.84 mm), 0.70 ± 0.27 mm (95 % CI: 0.57 to 0.82 mm), and 1.17 ± 0.73° (95 % CI: 0.83 to 1.51°), respectively. Moreover, the vertical platform and apex deviation were 0.50 ± 0.31 mm, (95 % CI: 0.35 to 0.64 mm) and 0.48 ± 0.32 mm, (95 % CI: 0.33 to 0.63 mm), respectively. All the placed implant positions were further labial and apical than the planned ones, respectively.

CONCLUSIONS

High accuracy of immediate implant placement was achieved with the robotic system.

CLINICAL SIGNIFICANCE

Our study provided evidence to support the potential of the robotic system in implant placement, even in challenging scenarios.

Radiographic diagnosis of periodontal diseases - Current evidence versus innovations

Accurate diagnosis of periodontal and peri-implant diseases relies significantly on radiographic examination, especially for assessing alveolar bone levels, bone defect morphology, and bone quality. This narrative review aimed to comprehensively outline the current state-of-the-art in radiographic diagnosis of alveolar bone diseases, covering both two-dimensional (2D) and three-dimensional (3D) modalities. Additionally, this review explores recent technological advances in periodontal imaging diagnosis, focusing on their potential integration into clinical practice. Clinical probing and intraoral radiography, while crucial, encounter limitations in effectively assessing complex periodontal bone defects. Recognizing these challenges, 3D imaging modalities, such as cone beam computed tomography (CBCT), have been explored for a more comprehensive understanding of periodontal structures. The significance of the radiographic assessment approach is evidenced by its ability to offer an objective and standardized means of evaluating hard tissues, reducing variability associated with manual clinical measurements and contributing to a more precise diagnosis of periodontal health. However, clinicians should be aware of challenges related to CBCT imaging assessment, including beam-hardening artifacts generated by the high-density materials present in the field of view, which might affect image quality. Integration of digital technologies, such as artificial intelligence-based tools in intraoral radiography software, the enhances the diagnostic process. The overarching recommendation is a judicious combination of CBCT and digital intraoral radiography for enhanced periodontal bone assessment. Therefore, it is crucial for clinicians to weigh the benefits against the risks associated with higher radiation exposure on a case-by-case basis, prioritizing patient safety and treatment outcomes.