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

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.