International Journal of Prosthodontics & Restorative Dentistry
Volume 11 | Issue 4 | Year 2021

How Accurate are Intraoral Radiographs for Measuring Peri-implant Crestal Bone Loss?

Pravinkumar G Patil

Department of Prosthodontics, Division of Restorative Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia

Corresponding Author: Pravinkumar G Patil, Department of Prosthodontics, Division of Restorative Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia, Phone: +601135022042, e-mail: pravinandsmita@yahoo.co.in

How to cite this article: Patil PG. How Accurate are Intraoral Radiographs for Measuring Peri-implant Crestal Bone Loss? Int J Prosthodont Restor Dent 2021;11(4):158.

Source of support: Nil

Conflict of interest: None

The search term “dental implant crestal bone loss” in the PubMed MEDLINE database has shown over 1100 articles in the last 30 years. The evaluation of crestal bone loss to assess implant success rate with radiographs and/or computerized tomography scans has been well described.1-4 The standardized intraoral periapical (PA) radiographs have been popularly used.1,2 Conventionally, the level of the first screw thread or the shoulder of the implant to the top of the alveolar crest is typically measured to assess crestal bone changes.1-4 The intraoral film must be in the same precise position, angulation, and distance during each time-point of recall appointments to maintain uniformity in crestal bone level changes.3 To maintain the X-ray film in the position, the researchers have used various film holders or paralleling devices to ensure the same film position during each recall time-point.3,4 However, it is a challenging task to maintain the same precise position with or without film holding devices due to time-dependent and patient-related intraoral changes. Moreover, a completely edentulous arch is an additional challenge while taking the PA radiograph, as the X-ray film is difficult to place and stabilize. In such situations, it is advised to place the X-ray film with the complete denture in place, if available. Alternately, some clinicians have used orthopantomographs in edentulous patients.3 In the PA radiographs, the distance measured between two points is sometimes so small that accurate measurement is difficult.5 Patil and Nimbalkar-Patil5 described the measurement of the crestal bone level from the tip of the implant and calculated the effective changes by normalizing the values using actual implant length and radiographic implant length.5 This technique minimizes the measurement errors and is successfully used in clinical research6 and can be recommended in addition to use of the paralleling device or the film holder technique. Walton and Layton7 evaluated intra- and inter-examiner agreement of radiographic crestal bone level assessment around implants related to radiograph brightness, discrimination level (accuracy), participant demographics, or implant characteristics using 100 normal radiographs. They concluded that the agreement within and between examiners when assessing the crestal bone loss was poor. Disagreement occurred around 25% of the time, potentially affecting consistent disease assessments, and observed that the changes below 1 mm are likely due to human, not biological variations.7 The use of Cone Beam Computerized Tomography and novel Photoacoustic Ultrasound Imaging techniques have been described in the literature however not very popular yet.2,8

Peri-implant health parameters could be influenced by other confounding factors such as implant system, implant surface treatment, loading protocols, method of bone level measurement, intraoperator, and interoperator agreement reporting the results of the study.


1. Gholami H, Mericske-Stern R, Kessler-Liechti G, et al. Radiographic bone level changes of implant-supported restorations in edentulous and partially dentate patients: 5-year results. Int J Oral Maxillofac Implants 2014;29(4):898–904. DOI: 10.11607/jomi.3042

2. Naveau A, Shinmyouzu K, Moore C, et al . Etiology and measurement of peri-implant Crestal Bone Loss (CBL). J Clin Med 2019;8(2):166. DOI: 10.3390/jcm8020166

3. Patil P, Seow LL, Kweh TJ, et al . Unsplinted attachment systems and peri-implant outcomes in two-implant-retained mandibular overdentures: a systematic review of randomized controlled trials. J Contemp Dent Pract 2021;22(11):1346–1354. DOI: 10.5005/jp-journals-10024-3228

4. Akça K, Çavuşoğlu Y, Sağirkaya E, et al. Early-loaded one-stage implants retaining mandibular overdentures by two different mechanisms: 5-year results. Int J Oral Maxillofac Implants 2013;28:824-830. DOI: 10.11607/jomi.2994

5. Patil PG, Nimbalkar-Patil S. A radiographic measurement technique for crest bone changes related to dental implants. J Prosthet Dent 2015;113(4):350–351. DOI: 10.1016/j.prosdent.2014.11.002

6. Patil PG, Seow LL. Crestal bone-level changes and patient satisfaction with mandibular overdentures retained by one or two implants with immediate loading protocols: a randomized controlled clinical study. J Prosthet Dent 2020;123(5):710–716. DOI: 10.1016/j.prosdent.2019.07.015

7. Walton TR, Layton DM. Intra- and inter-examiner agreement when assessing radiographic implant bone levels: differences related to brightness, accuracy, participant demographics and implant characteristics. Clin Oral Implants Res 2018;29(7):756–771. DOI: 10.1111/clr.13290

8. Bohner LOL, Mukai E, Oderich E, et al . Comparative analysis of imaging techniques for diagnostic accuracy of peri-implant bone defects: a meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2017;124(4):432.e5–440.e5. DOI: 10.1016/j.oooo.2017.06.119

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