The accuracy of probing, ultrasound and cone-beam CT scans for determining the buccal bone plate dimensions around oral implants – A systematic review

Abstract

Objective: The objective of this review was to assess the accuracy of available means of determining the BBT (buccal bone thickness) and/or BBL (buccal bone level). This was translated into the following research question: What is the accuracy of the available means of visualizing the BBP (buccal bone plate) to establish the BBT and/or the BBL, when compared to control measurements? As control measurements histomorphometric measurements, direct measurements and cone-beam computed tomography (CBCT) measurements in the absence of metal are accepted. Background Data: Methods: The literary search was performed by searching the databases of MEDLINE, Embase, and Web of Science, up to July 13, 2021. Types of studies included were clinical, in vitro and animal trials, specifically looking into the bone level and/or bone thickness of the buccal bone plate at oral implants. Reference lists were hand searched for relevant articles. Two reviewers performed the data extraction and analysis. Only studies using reliable control measurements to evaluate the accuracy of the tested means of visualizing BBT and/or BBL were included for analysis. The QUADAS-2 tool was used to perform bias analysis on the relevant studies. Extracted data was tabulated to show the differences between test and control measurements for BBT and BBL. For in vitro studies on CBCT measurements of BBT meta-analysis could be performed. Results: A total of 1176 papers were identified in the search. Twenty-two articles were used for data extraction and qualitative analysis. Of these studies nine were animal studies, 9 were in vitro studies and four were human studies. Six animal studies and three human studies provided data on probing. CBCT and sonography as techniques for visualizing the buccal bone plate. Probing at implant sites seems to provide data that correlates with a consistent distance from the BBP. Meta-analysis for probing studies could not be performed due to heterogeneity in the setups of these studies. Eleven studies on CBCT were eligible for inclusion. Of these three were animal studies, the remaining 8 studies were all in vitro studies. Meta-analysis was performed on the accuracy of CBCT for in vitro studies, finding a significant underestimation of the BBT when compared to control measurements by a mean difference of −0.15 mm with 95%CI [−0.26,−0.03]. Three studies were identified on measurement of BBT and/or BBL by sonography. This included one human study and two in vitro studies. The identified studies show a low error when determining the buccal bone level or thickness using sonography. All included studies possess a high risk of bias according to risk of bias analysis, mostly due to selection of the patient. Conclusion: A strong limitation of this systematic review is the inclusion of different studies with heterogeneous designs. Within the limits of this analysis it cannot be concluded that probing is an accurate way of visualizing the BBP. CBCT cannot yet be recommended as a standard diagnostic tool for follow-up of the BBP at oral implants. The application of sonography as a diagnostic tool to visualize the BBP needs further scientific validation.