Low-Dose Cone-Beam Computed Tomography in Implant Dentistry: A Clinical Validation of Diagnostic Sufficiency

Abstract Aim To validate the diagnostic sufficiency of a low-dose cone-beam computed tomography (CBCT) protocol for dental implant assessment by comparing it to a standard-dose protocol in a clinical setting. The study evaluated linear measurement accuracy, subjective clarity of anatomical landmarks, and the impact on bone microarchitecture assessment. Materials and Methods This retrospective study analyzed pre-operative (standard-dose) and post-operative (low-dose) CBCT scans from 37 patients (37 standard-dose and 37 low-dose scans for both maxillary and mandibular sites). The low-dose protocol achieved a 76.7% dose reduction by decreasing tube current and exposure time. The diagnostic utility was assessed: 1) subjective clarity scoring of the mandibular canal and maxillary sinus floor; 2) objective linear measurements of key anatomical dimensions; and 3) quantitative analysis of bone microstructural parameters (Tb.N, Tb.Sp, Tb.Th, BV/TV). Reliability assessment was also performed for clarity scoring and quantitative measurements. Statistical comparisons were performed using Chi-square and paired-samples t-tests. Results No statistically significant differences were found between the low-dose and standard-dose protocols in the subjective clarity of anatomical structures (P 0.05) or in the accuracy of linear measurements (P 0.05). However, all four bone microstructural parameters showed statistically significant differences between the two protocols in both the maxilla and mandible (P 0.05 for all). Intra- and inter-examiner assessments demonstrated substantial to good consistency across all qualitative (weighted Kappa 0.611) and quantitative (ICC 0.702) parameters. Conclusion This study provides clinical evidence that for the specific CBCT unit tested, the optimized low-dose CBCT protocol reduces patient radiation exposure by over 76.7% for dental implant assessment without compromising the diagnostic accuracy required for linear measurements and visualization of key anatomical landmarks. Therefore, for the tested model, the low-dose protocol is sufficient for pre-operative CBCT scanning in implant dentistry. This offers a clinically validated method for enhancing patient safety in this specific context, effectively applying the ALADAIP principle.