Comparative Evaluation of Cone-Beam Computed Tomography (CBCT) and Panoramic Radiography for Presurgical Implant Planning in the Posterior Mandible: A Retrospective Analysis
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Radiographic evaluation is critical in implant planning in the posterior mandible, where proximity to the inferior alveolar neurovascular bundle necessitates precise assessment of bone quantity, bone quality, and spatial relationships with vital anatomical structures. Panoramic radiography is widely available and cost-effective but suffers from magnification distortion and inability to depict buccolingual dimensions. Cone-beam computed tomography (CBCT) provides three-dimensional (3D) information but at a higher cost and radiation exposure. Objective: This study aims to compare CBCT and panoramic radiography in terms of (i) visualization of the mandibular canal and mental foramen, (ii) visualization of the crest of the alveolar ridge and superior border of the inferior alveolar canal, and (iii) assessment of bone quantity (height and mesiodistal width) and quality (buccolingual width and density in Hounsfield units (HU)) at posterior mandibular implant sites. METHODS: A retrospective cross-sectional analysis was performed on pre-existing radiographic records from a single academic center, comprising CBCT volumes and corresponding panoramic radiographs of the same patients with at least one posterior mandibular edentulous site. Visibility of the mandibular canal at the mental foramen and at 1, 2, and 3 cm posterior to the mental foramen was graded using a four-point scale (1, poor; 4, excellent). Visibility of the superior border of the inferior alveolar canal and crest of the alveolar ridge was similarly graded. Bone height and mesiodistal width were measured on both modalities, whereas buccolingual width and bone density (HU) were obtained only from CBCT. Results: CBCT showed significantly higher grading scores for mandibular canal visualization at all four evaluated locations (at the mental foramen and at 1, 2, and 3 cm posterior) compared with panoramic radiography. Visualization of both the crest of the alveolar ridge and the superior border of the inferior alveolar canal was also significantly better with CBCT. CONCLUSION: CBCT provides superior visualization of the mandibular canal in the posterior mandible, especially 2-3 cm distal to the mental foramen, and uniquely allows assessment of buccolingual bone dimensions and density, making it more suitable than panoramic radiography for presurgical implant planning in anatomically critical posterior mandibular sites. Panoramic radiography remains acceptable for routine cases with adequate vertical bone height away from vital structures, but CBCT should be considered when canal visualization is inadequate or when buccolingual and density information are required.
Source: Cureus
Language: English
Subfield: Oral Surgery
Field: Dentistry
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7214767888