Accuracy of Crestal Buccal Bone Height Measurements in the Anterior Maxilla Using Cone-Beam Computed Tomography
Abstract
Objectives: Linear measurements play a pivotal role in determining bone quantity. This study aimed to assess the accuracy of cone-beam computed tomography (CBCT) in measuring the height of buccal bone in the maxillary anterior teeth, relative to the cementoenamel junction (CEJ).
Materials and Methods: This Original Research study evaluated 33 maxillary anterior teeth (11 central incisors, 11 lateral incisors, and 11 canines) of 20 patients. Following surgical exposure, the distance between the CEJ and the buccal alveolar bone crest was measured with a digital caliper. Measurements were made by an oral radiologist twice with a 3-week interval on CBCT images. Data were analyzed using SPSS, and P≤0.05 was considered statistically significant.
Results: The mean difference in buccal bone height between CBCT and clinical measurements was 0.45±0.38mm for central incisors, 0.26±0.29mm for lateral incisors, 0.52±0.42 mm for canines, and 0.41±0.37mm overall. No significant difference was detected between the CBCT and direct measurements (P>0.05). The frequency of inaccurate measurements (defined as differences greater than 0.5mm) was 36.4% for central incisors, 9.1% for lateral incisors, and 36.4% for canines. The intraclass correlation coefficient (ICC) between the twice-taken CBCT measurements (with a 3-week interval) was 0.972; while the ICC was 0.824 between the CBCT and direct measurements.
Conclusion: CBCT may not be accurate enough to assess the position and height of thin buccal bone relative to the CEJ in the anterior maxilla. However, CBCT demonstrated sufficient accuracy in assessing the position of buccal bone crest for lateral incisors.
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4. Meng HW, Chien EY, Chien HH. Immediate Implant Placement and Provisionalization in the Esthetic Zone: A 6.5-Year Follow-Up and Literature Review. Case Rep Dent. 2021 Sep 15;2021:4290193.
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6. Jaju PP, Jaju SP. Clinical utility of dental cone-beam computed tomography: current perspectives. Clin Cosmet Investig Dent. 2014 Apr 2;6:29-43.
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8. Fokas G, Vaughn VM, Scarfe WC, Bornstein MM. Accuracy of linear measurements on CBCT images related to presurgical implant treatment planning: A systematic review. Clin Oral Implants Res. 2018 Oct;29 Suppl 16:393-415.
9. Ghoncheh Z, Panjnoush M, Kaviani H, Kharazifard MJ, Zahirnia F. Knowledge and Attitude of Iranian Dentists towards Cone-Beam Computed Tomography. Front Dent. 2019 Sep-Oct;16(5):379-385.
10. Ganguly R, Ruprecht A, Vincent S, Hellstein J, Timmons S, Qian F. Accuracy of linear measurement in the Galileos cone beam computed tomography under simulated clinical conditions. Dentomaxillofac Radiol. 2011 Jul;40(5):299-305.
11. Halperin-Sternfeld M, Machtei EE, Horwitz J. Diagnostic accuracy of cone beam computed tomography for dimensional linear measurements in the mandible. Int J Oral Maxillofac Implants. 2014 May-Jun;29(3):593-9.
12. Tanaka Y, Dutra V, Lin WS, Levon J, Hamada Y. Evaluation of the accuracy of buccal bone thickness measurement from cone beam computed tomography compared with histologic analysis. J Prosthet Dent. 2023 Jul;130(1):68-73.
13. Behnia H, Motamedian SR, Kiani MT, Morad G, Khojasteh A. Accuracy and reliability of cone beam computed tomographic measurements of the bone labial and palatal to the maxillary anterior teeth. Int J Oral Maxillofac Implants. 2015 Nov-Dec;30(6):1249-55.
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15. Freire-Maia B, Machado VD, Valerio CS, Custódio AL, Manzi FR, Junqueira JL. Evaluation of the accuracy of linear measurements on multi-slice and cone beam computed tomography scans to detect the mandibular canal during bilateral sagittal split osteotomy of the mandible. Int J Oral Maxillofac Surg. 2017 Mar;46(3):296-302.
16. Charyeva O, Altynbekov K, Zhartybaev R, Sabdanaliev A. Long-term dental implant success and survival--a clinical study after an observation period up to 6 years. Swed Dent J. 2012;36(1):1-6
17. Ritter L, Elger MC, Rothamel D, Fienitz T, Zinser M, Schwarz F, et al. Accuracy of peri-implant bone evaluation using cone beam CT, digital intra-oral radiographs and histology. Dentomaxillofac Radiol. 2014;43(6):20130088.
18. Walter C, Schmidt JC, Rinne CA, Mendes S, Dula K, Sculean A. Cone beam computed tomography (CBCT) for diagnosis and treatment planning in periodontology: systematic review update. Clin Oral Investig. 2020 Sep;24(9):2943-2958.
19. El-din SA. Accuracy and Reliability of CBCT Scan in Obtaining Digital 3D Model from Dental Plaster Model for Orthodontic Space Analysis: Diagnostic Accuracy Study. Acta Scientific Dental Sciences. 2020;4:01-4.
20. Song D, Shujaat S, de Faria Vasconcelos K, Huang Y, Politis C, Lambrichts I, et al. Diagnostic accuracy of CBCT versus intraoral imaging for assessment of peri-implant bone defects. BMC Med Imaging. 2021 Feb 10;21(1):23.
21. Tyndall DA, Price JB, Tetradis S, Ganz SD, Hildebolt C, Scarfe WC; American Academy of Oral and Maxillofacial Radiology. Position statement of the American Academy of Oral and Maxillofacial Radiology on selection criteria for the use of radiology in dental implantology with emphasis on cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Jun;113(6):817-26.
22. Weiss R 2nd, Read-Fuller A. Cone Beam Computed Tomography in Oral and Maxillofacial Surgery: An Evidence-Based Review. Dent J (Basel). 2019 May 2;7(2):52.
23. Sheerah H, Othman B, Jaafar A, Alsharif A. Alveolar bone plate measurements of maxillary anterior teeth: A retrospective Cone Beam Computed Tomography study, AlMadianh, Saudi Arabia. Saudi Dent J. 2019 Oct;31(4):437-444.
24. Feijo CV, Lucena JG, Kurita LM, Pereira SL. Evaluation of cone beam computed tomography in the detection of horizontal periodontal bone defects: an in vivo study. Int J Periodontics Restorative Dent. 2012 Oct;32(5):e162-8.
25. Shiratori LN, Marotti J, Yamanouchi J, Chilvarquer I, Contin I, Tortamano-Neto P. Measurement of buccal bone volume of dental implants by means of cone-beam computed tomography. Clin Oral Implants Res. 2012 Jul;23(7):797-804.
26. Timock AM, Cook V, McDonald T, Leo MC, Crowe J, Benninger BL, et al. Accuracy and reliability of buccal bone height and thickness measurements from cone-beam computed tomography imaging. Am J Orthod Dentofacial Orthop. 2011 Nov;140(5):734-44.
27. Dings JP, Verhamme L, Merkx MA, Xi T, Meijer GJ, Maal TJ. Reliability and accuracy of cone beam computed tomography versus conventional multidetector computed tomography for image-guided craniofacial implant planning: An in vitro study. Int J Oral Maxillofac Implants. 2019 May/June;34(3):665–672.
28. Liang X, Jacobs R, Hassan B, Li L, Pauwels R, Corpas L, et al. A comparative evaluation of Cone Beam Computed Tomography (CBCT) and Multi-Slice CT (MSCT) Part I. On subjective image quality. Eur J Radiol. 2010 Aug;75(2):265-9.
29. Gomes LR, Gomes MR, Gonçalves JR, Ruellas AC, Wolford LM, Paniagua B, et al. Cone beam computed tomography-based models versus multislice spiral computed tomography-based models for assessing condylar morphology. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jan;121(1):96-105.
30. Aytugar E, Özeren C, Lacin N, Veli I, Çene E. Cone-beam computed tomographic evaluation of accessory mental foramen in a Turkish population. Anat Sci Int. 2019 Jun;94(3):257-265.
31. Krishnan U, Monsour P, Thaha K, Lalloo R, Moule A. A Limited Field Cone-beam Computed Tomography-based Evaluation of the Mental Foramen, Accessory Mental Foramina, Anterior Loop, Lateral Lingual Foramen, and Lateral Lingual Canal. J Endod. 2018 Jun;44(6):946-951.
32. Holberg C, Steinhäuser S, Geis P, Rudzki-Janson I. Cone-beam computed tomography in orthodontics: benefits and limitations. J Orofac Orthop. 2005 Nov;66(6):434-44. English, German.
33. Mukhia N, Birur NP, Shubhasini AR, Shubha G, Keerthi G. Dimensional measurement accuracy of 3-dimensional models from cone beam computed tomography using different voxel sizes. Oral Surg Oral Med Oral Pathol Oral Radiol. 2021 Sep;132(3):361-369.
34. Periago DR, Scarfe WC, Moshiri M, Scheetz JP, Silveira AM, Farman AG. Linear accuracy and reliability of cone beam CT derived 3-dimensional images constructed using an orthodontic volumetric rendering program. Angle Orthod. 2008 May;78(3):387-95.
35. Katsumata A, Hirukawa A, Okumura S, Naitoh M, Fujishita M, Ariji E, et al. Relationship between density variability and imaging volume size in cone-beam computerized tomographic scanning of the maxillofacial region: an in vitro study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Mar;107(3):420-5.
36. Nguyen KT, Pachêco-Pereira C, Kaipatur NR, Cheung J, Major PW, Le LH. Comparison of ultrasound imaging and cone-beam computed tomography for examination of the alveolar bone level: A systematic review. PLoS One. 2018 Oct 3;13(10):e0200596.
37. Schubert O, Schweiger J, Stimmelmayr M, Nold E, Güth JF. Digital implant planning and guided implant surgery - workflow and reliability. Br Dent J. 2019 Jan 25;226(2):101-108.
38. Talaei Pour AR, Mehralizadeh S, Mesgarzadeh A. Comparison between conventional tomography & radiovisiography methods for assessment of presurgical dental implants. Journal of Dental Medicine. 2005 Mar 10;18(1):68-73.
2. Heimes D, Schiegnitz E, Kuchen R, Kämmerer PW, Al-Nawas B. Buccal Bone Thickness in Anterior and Posterior Teeth-A Systematic Review. Healthcare (Basel). 2021 Nov 30;9(12):1663.
3. Testori T, Weinstein T, Scutellà F, Wang HL, Zucchelli G. Implant placement in the esthetic area: criteria for positioning single and multiple implants. Periodontol 2000. 2018 Jun;77(1):176-196.
4. Meng HW, Chien EY, Chien HH. Immediate Implant Placement and Provisionalization in the Esthetic Zone: A 6.5-Year Follow-Up and Literature Review. Case Rep Dent. 2021 Sep 15;2021:4290193.
5. Rokn AR, Hashemi K, Akbari S, Kharazifard MJ, Barikani H, Panjnoosh M. Accuracy of Linear Measurements Using Cone Beam Computed Tomography in Comparison with Clinical Measurements. J Dent (Tehran). 2016 Sep;13(5):333-339.
6. Jaju PP, Jaju SP. Clinical utility of dental cone-beam computed tomography: current perspectives. Clin Cosmet Investig Dent. 2014 Apr 2;6:29-43.
7. Özalp Ö, Tezerişener HA, Kocabalkan B, Büyükkaplan UŞ, Özarslan MM, Şimşek Kaya G, et al. Comparing the precision of panoramic radiography and cone-beam computed tomography in avoiding anatomical structures critical to dental implant surgery: A retrospective study. Imaging Sci Dent. 2018 Dec;48(4):269-275.
8. Fokas G, Vaughn VM, Scarfe WC, Bornstein MM. Accuracy of linear measurements on CBCT images related to presurgical implant treatment planning: A systematic review. Clin Oral Implants Res. 2018 Oct;29 Suppl 16:393-415.
9. Ghoncheh Z, Panjnoush M, Kaviani H, Kharazifard MJ, Zahirnia F. Knowledge and Attitude of Iranian Dentists towards Cone-Beam Computed Tomography. Front Dent. 2019 Sep-Oct;16(5):379-385.
10. Ganguly R, Ruprecht A, Vincent S, Hellstein J, Timmons S, Qian F. Accuracy of linear measurement in the Galileos cone beam computed tomography under simulated clinical conditions. Dentomaxillofac Radiol. 2011 Jul;40(5):299-305.
11. Halperin-Sternfeld M, Machtei EE, Horwitz J. Diagnostic accuracy of cone beam computed tomography for dimensional linear measurements in the mandible. Int J Oral Maxillofac Implants. 2014 May-Jun;29(3):593-9.
12. Tanaka Y, Dutra V, Lin WS, Levon J, Hamada Y. Evaluation of the accuracy of buccal bone thickness measurement from cone beam computed tomography compared with histologic analysis. J Prosthet Dent. 2023 Jul;130(1):68-73.
13. Behnia H, Motamedian SR, Kiani MT, Morad G, Khojasteh A. Accuracy and reliability of cone beam computed tomographic measurements of the bone labial and palatal to the maxillary anterior teeth. Int J Oral Maxillofac Implants. 2015 Nov-Dec;30(6):1249-55.
14. Prakash N, Karjodkar FR, Sansare K, Sonawane HV, Bansal N, Arwade R. Visibility of lamina dura and periodontal space on periapical radiographs and its comparison with cone beam computed tomography. Contemp Clin Dent. 2015 Jan-Mar;6(1):21-5.
15. Freire-Maia B, Machado VD, Valerio CS, Custódio AL, Manzi FR, Junqueira JL. Evaluation of the accuracy of linear measurements on multi-slice and cone beam computed tomography scans to detect the mandibular canal during bilateral sagittal split osteotomy of the mandible. Int J Oral Maxillofac Surg. 2017 Mar;46(3):296-302.
16. Charyeva O, Altynbekov K, Zhartybaev R, Sabdanaliev A. Long-term dental implant success and survival--a clinical study after an observation period up to 6 years. Swed Dent J. 2012;36(1):1-6
17. Ritter L, Elger MC, Rothamel D, Fienitz T, Zinser M, Schwarz F, et al. Accuracy of peri-implant bone evaluation using cone beam CT, digital intra-oral radiographs and histology. Dentomaxillofac Radiol. 2014;43(6):20130088.
18. Walter C, Schmidt JC, Rinne CA, Mendes S, Dula K, Sculean A. Cone beam computed tomography (CBCT) for diagnosis and treatment planning in periodontology: systematic review update. Clin Oral Investig. 2020 Sep;24(9):2943-2958.
19. El-din SA. Accuracy and Reliability of CBCT Scan in Obtaining Digital 3D Model from Dental Plaster Model for Orthodontic Space Analysis: Diagnostic Accuracy Study. Acta Scientific Dental Sciences. 2020;4:01-4.
20. Song D, Shujaat S, de Faria Vasconcelos K, Huang Y, Politis C, Lambrichts I, et al. Diagnostic accuracy of CBCT versus intraoral imaging for assessment of peri-implant bone defects. BMC Med Imaging. 2021 Feb 10;21(1):23.
21. Tyndall DA, Price JB, Tetradis S, Ganz SD, Hildebolt C, Scarfe WC; American Academy of Oral and Maxillofacial Radiology. Position statement of the American Academy of Oral and Maxillofacial Radiology on selection criteria for the use of radiology in dental implantology with emphasis on cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Jun;113(6):817-26.
22. Weiss R 2nd, Read-Fuller A. Cone Beam Computed Tomography in Oral and Maxillofacial Surgery: An Evidence-Based Review. Dent J (Basel). 2019 May 2;7(2):52.
23. Sheerah H, Othman B, Jaafar A, Alsharif A. Alveolar bone plate measurements of maxillary anterior teeth: A retrospective Cone Beam Computed Tomography study, AlMadianh, Saudi Arabia. Saudi Dent J. 2019 Oct;31(4):437-444.
24. Feijo CV, Lucena JG, Kurita LM, Pereira SL. Evaluation of cone beam computed tomography in the detection of horizontal periodontal bone defects: an in vivo study. Int J Periodontics Restorative Dent. 2012 Oct;32(5):e162-8.
25. Shiratori LN, Marotti J, Yamanouchi J, Chilvarquer I, Contin I, Tortamano-Neto P. Measurement of buccal bone volume of dental implants by means of cone-beam computed tomography. Clin Oral Implants Res. 2012 Jul;23(7):797-804.
26. Timock AM, Cook V, McDonald T, Leo MC, Crowe J, Benninger BL, et al. Accuracy and reliability of buccal bone height and thickness measurements from cone-beam computed tomography imaging. Am J Orthod Dentofacial Orthop. 2011 Nov;140(5):734-44.
27. Dings JP, Verhamme L, Merkx MA, Xi T, Meijer GJ, Maal TJ. Reliability and accuracy of cone beam computed tomography versus conventional multidetector computed tomography for image-guided craniofacial implant planning: An in vitro study. Int J Oral Maxillofac Implants. 2019 May/June;34(3):665–672.
28. Liang X, Jacobs R, Hassan B, Li L, Pauwels R, Corpas L, et al. A comparative evaluation of Cone Beam Computed Tomography (CBCT) and Multi-Slice CT (MSCT) Part I. On subjective image quality. Eur J Radiol. 2010 Aug;75(2):265-9.
29. Gomes LR, Gomes MR, Gonçalves JR, Ruellas AC, Wolford LM, Paniagua B, et al. Cone beam computed tomography-based models versus multislice spiral computed tomography-based models for assessing condylar morphology. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jan;121(1):96-105.
30. Aytugar E, Özeren C, Lacin N, Veli I, Çene E. Cone-beam computed tomographic evaluation of accessory mental foramen in a Turkish population. Anat Sci Int. 2019 Jun;94(3):257-265.
31. Krishnan U, Monsour P, Thaha K, Lalloo R, Moule A. A Limited Field Cone-beam Computed Tomography-based Evaluation of the Mental Foramen, Accessory Mental Foramina, Anterior Loop, Lateral Lingual Foramen, and Lateral Lingual Canal. J Endod. 2018 Jun;44(6):946-951.
32. Holberg C, Steinhäuser S, Geis P, Rudzki-Janson I. Cone-beam computed tomography in orthodontics: benefits and limitations. J Orofac Orthop. 2005 Nov;66(6):434-44. English, German.
33. Mukhia N, Birur NP, Shubhasini AR, Shubha G, Keerthi G. Dimensional measurement accuracy of 3-dimensional models from cone beam computed tomography using different voxel sizes. Oral Surg Oral Med Oral Pathol Oral Radiol. 2021 Sep;132(3):361-369.
34. Periago DR, Scarfe WC, Moshiri M, Scheetz JP, Silveira AM, Farman AG. Linear accuracy and reliability of cone beam CT derived 3-dimensional images constructed using an orthodontic volumetric rendering program. Angle Orthod. 2008 May;78(3):387-95.
35. Katsumata A, Hirukawa A, Okumura S, Naitoh M, Fujishita M, Ariji E, et al. Relationship between density variability and imaging volume size in cone-beam computerized tomographic scanning of the maxillofacial region: an in vitro study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Mar;107(3):420-5.
36. Nguyen KT, Pachêco-Pereira C, Kaipatur NR, Cheung J, Major PW, Le LH. Comparison of ultrasound imaging and cone-beam computed tomography for examination of the alveolar bone level: A systematic review. PLoS One. 2018 Oct 3;13(10):e0200596.
37. Schubert O, Schweiger J, Stimmelmayr M, Nold E, Güth JF. Digital implant planning and guided implant surgery - workflow and reliability. Br Dent J. 2019 Jan 25;226(2):101-108.
38. Talaei Pour AR, Mehralizadeh S, Mesgarzadeh A. Comparison between conventional tomography & radiovisiography methods for assessment of presurgical dental implants. Journal of Dental Medicine. 2005 Mar 10;18(1):68-73.
| Issue | Vol 23 (Continuously Published Article-Based) | |
| Section | Original Article | |
| Keywords | ||
| Cone-Beam Computed Tomography Dental Implants Dimensional Measurement Accuracy Tooth Cervix | ||
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How to Cite
1.
Goodarzipour D, Ghahramani S, Kiani N, Madani Z. Accuracy of Crestal Buccal Bone Height Measurements in the Anterior Maxilla Using Cone-Beam Computed Tomography. Front Dent. 2026;23.
