Is Cone-Beam Computed Tomography Always Necessary for Dental Implant Placement?

The use of cone-beam computed tomography (CBCT) for evaluation of patients for dental implants has gained considerable popularity. This retrospective cohort study was designed to determine whether using a clinical examination and a panoramic radiograph (Panorex) for implant selection and determining the need for bone grafting would be comparable to using CBCT in routine implant cases.

Implant size and need for bone grafting were initially determined in 82 patients using a panoramic radiograph and clinical examination. These patients subsequently underwent CBCT and their treatment was re-planned by the same surgeon using Simplant treatment planning software (DENTSPLY Implants, Mölndal, Sweden) in addition to clinical examination. The length and width of implants selected by each method and the need for bone grafting were recorded and the results were compared statistically with each other and with the actual treatment subsequently rendered.

The Panorex method and the CBCT method accurately predicted implant width to within 1.5 mm of the implant actually placed in 100% of cases and length to within 1.5 mm in more than 95% of cases. For bone graft prediction, the results indicated that neither the Panorex method nor CBCT method differed substantially from the actual treatment rendered.

The results of this study indicate that the CBCT is more accurate in predicting implant length and width and the need for bone grafting procedures. However, for routine unguided implant placement in sites where anatomic structures and bone grafting are not a concern, the use of a panoramic radiograph could be adequate for determining the length and width of the implant.