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2026
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| Online Access: | https://doi.org/10.5281/zenodo.19822247 |
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| author | Anas Abdul Khader |
| author_facet | Anas Abdul Khader |
| contents | <p class="MsoNormal"><strong><span>Background: </span></strong><span>Cone beam computed tomography (CBCT) is the gold standard for implant treatment planning, however variability in the interpretation may result in reduced diagnostic consistency and affect treatment outcomes. </span></p> <p class="MsoNormal"><strong><span>Aim: </span></strong><span>To measure the diagnostic agreement for interpretation of CBCT scans for dental implant planning and determine the impact of operator experience on diagnostic agreement.</span></p> <p class="MsoNormal"><strong><span>Materials and methods: </span></strong><span>In this retrospective observational study 100 anonymous CBCT scans of patients needing implant treatment planning were assessed by two groups of operators: Group A: clinicians with >=10 years of experience and Group B: clinicians with <=5 years of experience. The operators assessed bone height, width, Hounsfield unit (HU) values, bone density (Misch D1-D4) and implant feasibility including recommended surgical modification. The reliability of operator agreement was assessed using the intraclass correlation coefficient (ICC), Cohen's kappa, t-test and Bland-Altman analysis.</span></p> <p class="MsoNormal"><strong><span>Results:</span></strong><span> There was an excellent agreement amongst operators for linear measurements (ICC = height = 0.996, width = 0.989). Density measurements showed an excellent correlation (ICC = 0.984), but a statistically significant systematic difference (mean difference = 16.31 HU, p = 0.001) was observed, with higher values in experienced operators. Bone density determination showed substantial agreement (κ = 0.793; weighted κ = 0.830), with all 12 disagreements occurring between consecutive categories, most commonly at the D2/D3 interface (58.3%). The assessment of implant feasibility was found to be clinically relevant. Group A rated 90% of the sites feasible compared to 80% by Group B (k = 0.668). The 10 dissenting feasibility assessments (feasibility vs. non-feasibility) were all recommended by the experienced clinicians. Most disagreements (6/14) were in the Posterior Maxilla due to sinus-related complexities. </span></p> <p class="MsoNormal"><strong><span>Conclusions: </span></strong><span>CBCT linear measurements showed excellent interoperator agreement, independently of the clinical experience, however, bone density assessment and its feasibility for dental implant placement were based on operator's experience. Experienced operators showed larger armamentarium, thus more positive feasibility. Guidelines for how to interpret and dedicated training in more advanced surgical options may reduce the variability due to experience and increase the consistency of planning.</span></p> |
| format | Recurso digital |
| id | zenodo_https___doi_org_10_5281_zenodo_19822247 |
| institution | Zenodo |
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| publishDate | 2026 |
| publisher | Zenodo |
| record_format | zenodo |
| spellingShingle | Interoperator Variations in Interpretation of Cone Beam Computed Tomography for Dental Implant Treatment Planning: A Retrospective Observational Study Anas Abdul Khader Cone beam computed tomography; dental implants; interoperator agreement; treatment planning; bone density; Hounsfield units; clinical experience; intraclass correlation coefficient <p class="MsoNormal"><strong><span>Background: </span></strong><span>Cone beam computed tomography (CBCT) is the gold standard for implant treatment planning, however variability in the interpretation may result in reduced diagnostic consistency and affect treatment outcomes. </span></p> <p class="MsoNormal"><strong><span>Aim: </span></strong><span>To measure the diagnostic agreement for interpretation of CBCT scans for dental implant planning and determine the impact of operator experience on diagnostic agreement.</span></p> <p class="MsoNormal"><strong><span>Materials and methods: </span></strong><span>In this retrospective observational study 100 anonymous CBCT scans of patients needing implant treatment planning were assessed by two groups of operators: Group A: clinicians with >=10 years of experience and Group B: clinicians with <=5 years of experience. The operators assessed bone height, width, Hounsfield unit (HU) values, bone density (Misch D1-D4) and implant feasibility including recommended surgical modification. The reliability of operator agreement was assessed using the intraclass correlation coefficient (ICC), Cohen's kappa, t-test and Bland-Altman analysis.</span></p> <p class="MsoNormal"><strong><span>Results:</span></strong><span> There was an excellent agreement amongst operators for linear measurements (ICC = height = 0.996, width = 0.989). Density measurements showed an excellent correlation (ICC = 0.984), but a statistically significant systematic difference (mean difference = 16.31 HU, p = 0.001) was observed, with higher values in experienced operators. Bone density determination showed substantial agreement (κ = 0.793; weighted κ = 0.830), with all 12 disagreements occurring between consecutive categories, most commonly at the D2/D3 interface (58.3%). The assessment of implant feasibility was found to be clinically relevant. Group A rated 90% of the sites feasible compared to 80% by Group B (k = 0.668). The 10 dissenting feasibility assessments (feasibility vs. non-feasibility) were all recommended by the experienced clinicians. Most disagreements (6/14) were in the Posterior Maxilla due to sinus-related complexities. </span></p> <p class="MsoNormal"><strong><span>Conclusions: </span></strong><span>CBCT linear measurements showed excellent interoperator agreement, independently of the clinical experience, however, bone density assessment and its feasibility for dental implant placement were based on operator's experience. Experienced operators showed larger armamentarium, thus more positive feasibility. Guidelines for how to interpret and dedicated training in more advanced surgical options may reduce the variability due to experience and increase the consistency of planning.</span></p> |
| title | Interoperator Variations in Interpretation of Cone Beam Computed Tomography for Dental Implant Treatment Planning: A Retrospective Observational Study |
| topic | Cone beam computed tomography; dental implants; interoperator agreement; treatment planning; bone density; Hounsfield units; clinical experience; intraclass correlation coefficient |
| url | https://doi.org/10.5281/zenodo.19822247 |