Efficacy of customized crown-level position jig in measuring peri-implant crestal bone level on periapical radiographs: An in vitro study

Background/purpose: Accuracy of using implant length on periapical radiographs as calibration reference for measurements has not been verified. This study aimed to verify the measurements of peri-implant crestal bone level (piCBL) on periapical radiographs taken by the paralleling technique and using the implant length for calibration; and to propose a customized crownlevel position (CLP) jig to improve the measurement accuracy of piCBL. Materials and methods: A typodont installed an implant and a screw-retained crown at maxillary central incisor was used. To simulate piCBL, a metal post was placed near the implant at the same height of implant platform. The CLP jig was designed and 3-dimensionally printed out to allow implant projected orthogonally on periapical film. Thirty periapical radiographs were taken using paralleling technique with and without the jig by three examiners. The implant axis and implant length on radiographs were acquired by image segmentation. The discrepancy of piCBL determination (ΔD) from these measurements were compared and further analyzed when using the implant length for calibration. Results: The piCBL measurement errors were smaller when the jig was used for all examiners (P < 0.001). The inter-rater differences were insignificant. After calibration, ΔD with and without jig were 0.09 (0.07–0.11) and 0.43 (0.38–0.49) mm, respectively. Conclusion: Conventional long-cone paralleling technique using true implant length for calibration demonstrated imprecise piCBL measurement on periapical radiographs. Transferring the implant axis to the CLP jig allowed orthogonal projection of radiography which provided reliable measurements of piCBL with an accuracy of less than 0.1 mm.