1. Kakumoto T, Barsoum A, Forum SJ. Accuracy of Cone-Blan Computed Tomography Versus Periapical Radiography Measuremwnts When Planning Placement of Implants in the Posterior Maxilla: A Restrospective Study. Compend Contin Educ Dent. 2021 Jul;42(7):e1-e4. PMID: 34270273.
“the use of PA radiograps to assess alveolar ridge height can minimize cost and reduce radiation exposure compared with CBCT Scans.”
“The findings demostrated that at 90-degree angulation the measurement error of PAs was 0.3 mm to 0.6 mm, which was similar to the CT measurement error of 0.2 mm to 0.8 mm.”
“Accurate measurement of the residual ridge height during implant treatment planning in the posterior maxilla is critical, as precise control of the length of the osteotomy is vital to avoid inadvertent sinus complications following sinus perforation.”
“Thus, the observations of PAs measured on cadavers should be regarded as difficult if not impossible to reproduce in live patients.”
“Intraoperative PA radiographs should be captured using extension cone paralleling (XCP) to ensure proper long cone paralleling technique. After the initial (2 mm twist drill) is performed, a direction indicator should be used to confirm positioning, and the radiographic measurement could confirm wheter there is any distortion in the radiograph as the length of the indicator is predetermined from the implant manufactured.”
2. Schneider D, Sancho-Punchades M, Mir-Marí J, Mühlemann S, Jung R, Hämmerke C. A Randomized Controlled Clinical Tríala Comparing Conventional and Computer-Assisted Implant Planning and Placement in Partially Edentulous Patients. Part 4: Accuracy of Implant Placement. Int J Periodontics Restorative Dent. 2019 Jul/Aug:39(4):e111-e122. doi: 10.11607/prd.4147.
“The results of the present study demostrate that inaccuracies are inevitable between implant planning and placement when using any of the investigated protocols.”
“the exact amount of bone can be misjudged, as published in a series of studies on CT image accuracy.”
“the authors cannot recommend a “blind” execution of the surgical protocol based on the virtual planning without intrasurgical verification and clinical judgment of the complete clinical situation.”
3. Froum SJ, Bergamini M, Reis N, Wang W, Leung M, Kaufman Z, Cho SC. A New Concept of Safety Distance to Place Implants in the Area of the Inferior Alveolar Canal to Avoid Neurosensory Disturbance. Int J Periodontics Restorative Dent. 2021 Jul-Aug;41(4):e139-e146. doi: 10.11607/prd.5626. PMID: 34328468.
“Thus, it is suggested that every clinician systematically perform surgical radiographic imaging with a direction indicator and/or a drill following the first osteotomy in order to evaluate the direction and depth of the drills, localize the position of the nerve, and re-angulate the osteotomies. This should help reduce the incidence of nerve injuries.”
4. Wakoh M, Harada T, Otonari T, Otonari-Yamamoto M, Ohkubo M, Kousagw Y, Kobayashi N, Mizuta S, Kitagawa H, Sano T. Reliability of linear distance measurement for dental implant length with standardized periapical radiographs. Bull Tokyo Dent Coll. 2006 Aug;47(3):105-15. doi: 10.2209/tdcpublication.47.105. PMID: 17344618.
“PA radiographs have minimal disortion when they are well-angulated applying the standardized projection geometry previously described by Duckworth et al. Additionally, exposure dose of PA radiography is extremely low compared with other of the modalities.”
“The results of this study demonstrated that the measured distance on the PA radiograph was the closest to the actual length of the implant fixture without regard to implantation site, and measurement accuracy radiograph was almost the same as, or better than, that of CT-CS image.”
“This is probably due to the sharpness and resolution of images obtained with standardized PA radiography. Furthermore, the standardized PA radiograph probably provides the highest reliability and reproducibility in terms of linear measuring distance between the alveolar ridge and other anatomical structures in pre-surgical assessment, where anatomical structure is described on radiographs.”
“In conclusion, standardized PA radiographs should be utilized for longitudinal measurement depending on implant length at local sites, due to the highest linear measurement precision with
dose limitation available.”
5. Gher ME, Richardson AC. The accuracy of dental radiographic of implant fixture Placement. Int J Periodontics Restorative Dent. 1995 Jun;15(3):268-83. PMID: 7558660.
“The 90-degree PA radiograph provided the sharpest, most detailled images. This resulted in the most consistently accurate measurements with the least variation of al the techniques evaluated. After distortion was accounted for, measurements of implant fixture length from the 90 degree PA radiograph varied from actual dimensiones by 0.0 to 0.3 mm.”
“The use of metallic reference balls was helpful in establishing the amount of distortion and correcting for that distortion.”
“The reference balls can also provide valuable information regarding the quality of the radiograph.”
6. Dave M, Davies J, Wilson R, Palmer R. A comparison of cone beam computed tomography and conventional periapical radiography at detecting peri-implant bone defects. Clin Oral Implants Res.2013 Jun;24(6):671-8. doi: 10.1111/j.1600-0501.2012.02473.x. Epub 2012 Mar 27. PMID: 22458628.
“The PA views were statistically significantly better in diagnostic accuracy than both types of CBCT.”
“The results clearly demostrated that PA has excellent sensitivity and specificity in the detention of simulated peri-implant bone defects and that PA performs significantly better than CBCT in this regard.”
7. Vandenberghe B, Jacobs R, Yang J. Detection of periodontal bone loss using digital intraoral and cone beam computed tomography images: an in vitro assessment of bony and/or infrabony defects. Dentomaxillofac Radiol. 2008 Jul;37(5):252-60. doi: 10.1259/dmfr/57711133. PMID: 18606746.
“The present results demostrate an equal accuracy of periodontal bone level measurements using intraoral 2D digital CCD images (mean error of 0.56 mm) or using a panoramic reconstrution image with 5.2 mm slice thickness of 3D CBCT (mean error of 0.47 mm).”
“However, because of the lower resolution compared with intraoral digital images, details like trabecular pattern were better visualized using intraoral radiography.”
8. Tahmaseb A, Wu V, Wismeijer D, Coucke W, Evans C. The accuracy of static computed-aided implant surgery: A systematic review and meta- analysis. Clin Oral Implants Res. 2018 Oct;29 Suppl 16:416-435. doi: 10.1111/clr.13346. PMID: 30328191.
“considerable errors may still accur when using static drill guides. These errors can be of a magnitude which could jeopardise the aesthetic outcome, the safety of surrounding anatomical
structures or prevent the final prosthetic treatment plan from being executed as planned.”
9. Schneider D, Sancho-Punchades M, Benic GI, Hämmerle CH, Jung RE. A Randomized Controlled Clinical Trial Comparing Conventional and Computered-Assisted Implant Planning and Placement in Partially Edentulous Patients. Int J Periodontics Restorative Dent. 2018:38(Suppl):s49-s57. doi:
“Numerous clinical inconsistencies in the planned vertical or axial position were noticed and corrected intrasurgical.”
“These results confirm the necessity to systematically perform a strict intraoperative implant position control in every case, even when using CAIPP protocols.”
“The rate of complications and unexpected events was high for both protocols. Therefore, a strict intraoperative implant position monitoring is mandatory for both conventional and CAIPP protocols.”
10. Gelb DA. Gelb depth gauge: a diagnostic aid in implant placement. Int J Periodontics Restorative Dent. 1992;12(4):300-9. PMID:1428610.
“When the Rinn bite b lock has been used properly, the radiograph to anatomic structures will be 1:1 in magnification. This can be ascertained by measuring the depth gauge and identifying that it has not been elongated or foreshortened. The proximity from the apex of the diagnostic depth gauge to adjacent vital structures can then be measured in millimeters.”
“Implant placement should be executed with as much precision as possible.”
“The diagnostic depth gauge contributes to heightened precision in implant placement. It provides information that enables the surgeon to drill with confidence in proximity to anatomic structures and fulfill implant placement objectives.”
11. Van Assche N, van Steenberghe D, Guerrero ME, Hirsch E, Schutyser F, Quirynen M, Jacobs R. Accuracy of implant placement based on pre- surgical planning of three-dimensional cone-beam images: a pilot study. J Clin Periodontol. 2007 Sep;34(9):816-21. doi: 10.1111/ j.1600-051X.2007.01110.x. PMID: 17716317.
“There is no consensus about the precision needed for an acceptable precision of an image-based transfer to surgery. What really matters is the worst-case scenario where all deviations add up in the same direction. Indeed, this may potentially occur and cause damage to some anatomical structures.”
12. Larheim TA, Eggen S. Determination of tooth length with standardized paralleling technique and calibrated radiographic measuring film. Oral Sure Oral Med Oral Pathol. 1979 Oct;48(4):374-8. doi: 10.1016/0030-4220(79)90038-0. PMID: 291863.
“The mean difference between the radiographic and real lengths was not significant. From a clinical point of view, the most important result was that in 95 percent of the cases the real length was approximately the observed radiographic length ± 1 mm. (2SD)”
13. Larheim TA, Eggen S. A method for radiographic determination of vertical and horizontal dimensions in the alveolar process. Dentomaxillofac Radiol. 1979;8(2):94-6. doi: 10.1259/dmfr.1979.0012. PMDI:296088.
“It appears that the radiographic length was on an average slightly in horizontal (-0.11mm) and vertical (-0.04mm) direction, but the differences were not significant different from 0. The radiographic method described is a simple and expedient means for determining dimensions in the alveolar process both in the vertical and horizontal direction.”
14. Fokas G, Vaughn VM, Scarfe WC, Bornstein MM. Accuracy of linear measurements on CBCT images related to presurgical implant treatement planning: A sysrtematic review. Clin Oral Implants Res. 2018 Oct;29 Suppl 16:393-415. doi:10.1111/clr.13142. PMID: 30322804
“All guided surgery systems incoporate some degree of imprecision resulting in horizontal and particularly vertical deviations of the actual position of the implantcompared to the presurgical virtual position.”