A comparison of cone beam computed tomography and conventional periapical radiography at detecting peri‐implant bone defects

Objective To compare the diagnostic accuracy of conventional periapical radiography and cone beam computed tomography ( CBCT ) at detecting peri‐implant bone defects. Materials and methods Implants were placed in fresh bovine ribs in osteotomy sites of varying diameter (five with no peri‐implant space, five with a 0.35 mm space, five with a 0.675 mm space) and imaged using (i) digital long cone periapical radiographs ( LCPA s), (ii) limited volume CBCT using 3D Accuitomo 80 ® and (iii) large volume CBCT using i‐ CAT Next Generation ® . Images from each were randomly presented to nine examiners on two occasions. Confidence in diagnosing the presence or absence of a peri‐implant radiolucency was recorded on a five‐point scale. Receiver Operating Characteristic ( ROC ) analysis and Kappa tests were performed. Results Digital LCPA s were better at diagnosing a peri‐implant bone defect when the peri‐implant space was 0.35 mm ( P  < 0.02). As the peri‐implant space increased to 0.675 mm, there was no significant difference in diagnostic accuracy between the three imaging methods. Sensitivity of LCPA s (100) and Accuitomo (97.8) was better than i‐ CAT (64.4) ( P  < 0.02). LCPA s and i‐ CAT had significantly better specificity and positive predictive value than Accuitomo. The negative predictive value of LCPA was significantly better than i‐ CAT . LCPA s showed better intra‐examiner and inter‐examiner agreement than CBCT . Conclusion Within the limitations of this study, LCPA s are a reliable and valid method of detecting circumferential peri‐implant bone defects and performed significantly better than CBCT .