CBCT Versus MDCT and Panoramic Radiography for Preoperative Dental Implant Planning: A Prospective Comparative Study

Abstract

Introduction: Accurate preoperative imaging is fundamental to successful dental implant therapy. This study compared the diagnostic performance of CBCT, MDCT, and digital panoramic radiography for preoperative implant planning.

Methods: A prospective cross-sectional study enrolled 80 adults (mean age: 47.5 ± 12.3 years) with partial edentulism. Each patient underwent all three modalities within one week. Two oral radiologists independently assessed alveolar bone height and width, anatomical landmark visibility, bone density, image quality (5-point Likert scale), radiation dose, and interobserver agreement (Cohen’s κ; intraclass correlation coefficient [ICC]).

Results: MDCT and CBCT showed significantly higher measurement accuracy (95% and 93%, respectively) and anatomical landmark detection (97% and 95%, respectively) than panoramic radiography (72% and 74%; p < 0.001). Image quality scores were higher for MDCT (4.8 ± 0.3) and CBCT (4.6 ± 0.4) versus panoramic radiography (3.7 ± 0.6; p < 0.001). Radiation dose was highest for MDCT (36 ± 3.8 μSv), followed by CBCT (24 ± 2.1 μSv) and panoramic radiography (14 ± 2.5 μSv; p < 0.001). Interobserver agreement was excellent for MDCT (κ = 0.92; ICC = 0.96) and CBCT (κ = 0.89; ICC = 0.94), and moderate for panoramic radiography (κ = 0.64; ICC = 0.71).

Conclusions: CBCT provides an optimal balance between diagnostic accuracy, image quality, and radiation safety, supporting its role as the preferred modality for routine implant planning. MDCT remains valuable for complex cases requiring precise bone density quantification.