Do Artifacts From Dental Implants Impair the Diagnosis of Simulated Internal Root Resorption in Cone-Beam CT?

To evaluate the influence of artifacts generated by dental implants on the diagnosis of simulated internal root resorption (IRR) in cone-beam computed tomography (CBCT), considering implant number and composition.

Thirty-five single-rooted teeth were allocated into two groups: with simulated IRR (n = 15) and without IRR (n = 20). IRR was simulated using 37% hydrochloric acid for 3 h. Teeth were inserted into a human maxilla and scanned with two CBCT units (Axeos-Dentsply Sirona, Germany and X1-Copenhagen Imaging, Copenhagen) under three conditions: control, one adjacent implant, and two adjacent implants composed of titanium or zirconia. Three blinded observers independently assessed the CBCT volumes for IRR using a 5-point scale. After 30 days, 15% of volumes were re-evaluated. Sensitivity, specificity, and area under the curve (AUC) were calculated. Two-way ANOVA with Tukey post hoc tests analyzed the effects of implant number and composition (α = 0.05). Weighted Kappa assessed intra- and inter-observer agreement.

Intra- and inter-observer agreements ranged from 0.84 to 0.93 and 0.83-0.84, respectively. For Axeos, two zirconia implants significantly reduced sensitivity and AUC compared with control (p < 0.05) and titanium implants (p < 0.05). For X1, two zirconia implants reduced sensitivity and AUC (p < 0.05), while two titanium implants reduced specificity compared with control, one titanium, and two zirconia conditions (p < 0.05).

The presence of dental implants, particularly two zirconia implants, reduces the detection of IRR in CBCT.