Magnitude of cone beam CT image artifacts related to zirconium and titanium implants: impact on image quality

Objectives: To evaluate the magnitude of artifacts related to titanium and zirconium implants at different distances and angulations and their impact on cone beam CT(CBCT) image quality. Methods: CBCT images were obtained before and after the insertion of titanium and zirconium implants in a mandible on different CBCT units: Picasso Trio, ProMax 3D and 3D Accuitomo 80. Artifact was assessed by measuring the standard deviation (SD) of gray values and contrast-to-noise ratio (CNR) of 11 regions of interest (ROIs) at different distances (1.5 cm, 2.5 cm and 3.5 cm) and angulations (65 degrees, 90 degrees, 115 degrees and 140 degrees) from implant region. Results: For titanium images, SD values did not differ from those of images without implant in all ROIs; however, some effect occurred in Picasso images as higher values were observed in ROIs closer to the implant (p < 0.05). Zirconium images showed higher SD values than the others in some ROIs for Picasso and ProMax (p < 0.05). In ProMax, the difference was observed even in the farthest ROIs from the implant. CNR values were not influenced by the ROI in Picasso, but presented lower values in ROIs closer to the zirconium implant for ProMax and Accuitomo. Conclusions: The quantity and magnitude of artifacts in CBCT are influenced by the type of implant and CBCT unit. Although they are more pronounced in regions closer to the implant and located at 90 degrees in relation to the mandibular long axis, they can reach as far as 3.5 cm from the artifact-generator object.