Impact of Cone Beam Computed Tomography Dose in Pre-Surgical Implant Analysis

Nabil EL Sahili1, *, Ibrahim Nasseh2, Antoine Berberi3, Sandra David-Tchouda3, 4, Sophie Thoret5, Thomas Fortin6, 7
1 School of Dentistry, Lebanese University, Beirut, Lebanon
2 Department of Oral & Maxillofacial Radiology, School of Dentistry, Lebanese University, Beirut, Lebanon
3 Medico-Economic Evaluation Unit, University Hospital of Grenoble, Grenoble, France
4 ThEMAS TIMC UMR CNRS 5525, Grenoble Joseph Fourier University, France
5 Investigation Clinical Center of Grenoble, INSERM, Paris, France
6 Department of Oral Surgery, Dental University of Lyon, University Claude Bernard, Lyon 1, France
7 UJF-Grenoble 1 / CNRS / TIMC-IMAG UMR 5525, Grenoble, F-38041, France

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Creative Commons License
© 2018 EL Sahili et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at The School of Dentistry, Lebanese University, Beirut, Lebanon, Tel: 009613614894; E-mails:,



Cone-Beam Computed Tomography (CBCT) produces vital information required for the accurate and prudent placement of dental implants. Lack of standardization between CBCT machines may result in unsafe patient exposure to harmful radiation; higher doses are not necessarily associated with improved image quality.


The study aimed to assess the influence of low- and high-dose milliamperage settings on CBCT images for objective and subjective implant planning.


Two dry skulls (4 hemi-maxillary segments of the maxilla and 4 hemi-maxillary segments of the mandible) were scanned under low (2 mA) and high (6.3 mA) dosage settings using a CBCT (Carestream CS 9300). Cross-sectional slices of both image qualities were evaluated by five expert clinicians, for image quality for implant planning and objective bone measurements.


There were no significant differences in bone measurements taken on high or low dose images (p > 0.05). In qualitative image assessments, assessment and image quality for almost all observers were independent of each other. For planning posterior mandibular implant placement, increased dosage improved concordance and kappa values between low and high dose images.


Reduction in milliamperage did not affect diagnostic image quality for objective bone measurements and produced sufficient intra-rater reliability for qualitative assessment; therefore dose reduction can be achieved without compromising diagnostic decision- making.

Keywords: Cone-beam computed tomography, Implant-placement planning, Image quality, Radiation dose alteration, Posterior mandibular implant, Hemi Maxillary segments (HM).