Evaluation of The Relationship Between Radiation Doses And Image Quality of CBCT Images Obtained In Different Voxels For Implant Planning

Year 2026, Volume: 53 Issue: 1, 6 - 10, 25.03.2026

Cengiz Evli , Abdullah Aktaş , Gözde Haksayar , Hakan Eren

https://doi.org/10.52037/eads.2026.0002

https://izlik.org/JA94WD98ZT

Abstract

Objective: To investigate the effect of different imaging modes and voxel sizes on linear measurement accuracy and organ radiation doses in cone-beam computed tomography (CBCT) for dental implant planning.

Materials and Methods: Four dry skull specimens (2 maxillae, 2 mandibles) with gutta-percha reference markers at specific anatomical sites were scanned. Soft-tissue simulation was performed using three layers of wax (mean thickness: 4.5 mm). CBCT scans were performed using a Newtom 7G device in three modes: low-dose, regular-dose, and best-quality. Initial measurements between reference points were recorded using a digital caliper. Subsequently, an experienced oral radiologist performed measurements on CBCT images reconstructed at different voxel sizes. Organ doses were calculated using PCXMC 2.0 Rotation software based on dose-area product values.

Results: High agreement was observed between caliper measurements and all CBCT protocols (p<0.05). However, significant differences in organ doses were noted across imaging modes. Effective dose values ranged from 17.4 µSv to 135.7 µSv for mandibular scans and from 24.0 µSv to 181.9 µSv for maxillary scans according to ICRP 103, representing an approximately 8-fold increase from low-dose to high-dose protocols.

Conclusion: Low dose CBCT protocols provided sufficient accuracy for implant planning while substantially reducing radiation exposure. Given the stochastic nature of radiation effects, low-dose imaging is recommended when linear measurements are the primary diagnostic requirement.

Keywords: CBCT, Monte Carlo Simulation, PCXMC 2.0 Rotation Simulation Program, Implant surgery, Radiation dose

Keywords

CBCT , Monte Carlo Simulation , PCXMC 2.0 , Rotation Simulation Program , Implant Surgery , Radiation Dose

Ethical Statement

The study was approved by the Non-Interventional Clinical Research Ethics Committee of Ankara University (Protocol: İ11-701-21, Date: 23.11.2021).

Supporting Institution

None

Thanks

None

References

• Hazout S, Oehler C, Zwahlen DR, Taussky D. Historical view of the effects of radiation on cancer cells. Oncol Rev. 2025;19:1527742. doi:10.3389/or.2025.1527742.
• Hamada N. Noncancer Effects of Ionizing Radiation Exposure on the Eye, the Circulatory System and beyond: Developments made since the 2011 ICRP Statement on Tissue Reactions. Radiat Res. 2023;200(2):188–216. doi:10.1667/rade-23-00030.1.
• Wrixon AD. New ICRP recommendations. J Radiol Prot. 2008;28(2):161–8. doi:10.1088/0952-4746/28/2/r02.
• Scarfe WC, Levin MD, Gane D, Farman AG. Use of cone beam computed tomography in endodontics. Int J Dent. 2009;2009(1):634567. doi:10.1155/2009/634567.
• Adibi S, Zhang W, Servos T, O'Neill PN. Cone beam computed tomography in dentistry: what dental educators and learners should know. J Dent Educ. 2012;76(11):1437–1442.
• Fokas G, Vaughn VM, Scarfe WC, Bornstein MM. Accuracy of linear measurements on CBCT images related to presurgical implant treatment planning: A systematic review. Clin Oral Implants Res. 2018;29 Suppl 16:393–415. doi:10.1111/clr.13142.
• Kehrwald R, de Castro HS, Salmeron S, Matheus RA, Santaella GM, Queiroz PM. Influence of voxel size on CBCT images for dental implants planning. European Journal of Dentistry. 2022;16(02):381–385. doi:10.1055/s-0041-1736388.
• Tapiovaara M, Siiskonen T. PCXMC, A Monte Carlo program for calculating patient doses in medical x-ray examinations. STUK; 2008.
• Yeh JK, Chen CH. Estimated radiation risk of cancer from dental cone-beam computed tomography imaging in orthodontics patients. BMC oral health. 2018;18:1–8. doi:10.1186/s12903-018-0592-5.
• Thummerer A, Schmidt L, Hofmaier J, Corradini S, Belka C, Landry G, et al. Deep learning based super-resolution for CBCT dose reduction in radiotherapy. Med Phys. 2025;52(3):1629–1642. doi:10.1002/mp.17557.
• Jacobs R, Salmon B, Codari M, Hassan B, Bornstein MM. Cone beam computed tomography in implant dentistry: recommendations for clinical use. BMC oral health. 2018;18:1–16. doi:10.1186/s12903-018-0523-5.
• Carneiro ALE, Reis INR, Bitencourt FV, Salgado D, Costa C, Spin-Neto R. Accuracy of linear measurements for implant planning based on low-dose cone beam CT protocols: a systematic review and meta-analysis. Dentomaxillofac Radiol. 2024;53(4):207–221. doi:10.1093/dmfr/twae007.
• Kaaber L, Matzen LH, Schropp L, Spin-Neto R. Low-dose CBCT protocols in implant dentistry: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2024;138(3):427–439. doi:10.1016/j.oooo.2024.03.013.
• Kaaber L, Matzen LH, Spin-Neto R, Schropp L. Low-dose, standard, and high-resolution cone beam computed tomography for alveolar bone measurements related to implant planning: An ex vivo study in human specimens. Clin Oral Implants Res. 2024;35(11):1394–1405. doi:10.1111/clr.14326.
• White S, Pharoah M. Oral Radyoloji: İlkeler Ve Yorumlama. Baskı. Ankara: Palme Yayınevi; 2018.
• Böse MWH, Buchholz J, Beuer F, Pieralli S, Bumann A. Evaluation of Ultra-Low-Dose CBCT Protocols to Investigate Vestibular Bone Defects in the Context of Immediate Implant Planning: An Ex Vivo Study on Cadaver Skulls. J Clin Med. 2025;14(12). doi:10.3390/jcm14124196.
• Kottou S, Zapros A, Stefanopoulou N, Krompas N, Tsapaki V. CONE BEAM CT IN DENTAL IMPLANT PLANNING: HOW CLOSE ARE PATIENT DOSIMETRY RESULTS WITH DATA FROM PHANTOM STUDIES FOUND IN LITERATURE? Radiat Prot Dosimetry. 2019;187(3):321–326. doi:10.1093/rpd/ncz169.
• La Torre G, Bongiovanni A, Shaholli D, Manai MV, De Giorgi A, Iera D, et al. Low-dose ionizing radiation and cancer risk, thyroid alteration in health professionals: A retrospective cohort study. Arch Environ Occup Health. 2025;80(7-8):187–200. doi:10.1080/19338244.2025.2533774.
• Pita A, Thacker S, Sobue T, Gandhi V, Tadinada A. Newly Developed Low Dose 180-degree CBCT Protocol Reduces Radiation Dose Without Compromising Diagnostic Value. Int J Oral Maxillofac Implants. 2023;38(6):1161–1167. doi:10.11607/jomi.10364.
• Bryant PA. The role of public engagement in the journey to ALARA. Radiat Prot Dosimetry. 2023;199(8-9):705–709. doi:10.1093/rpd/ncad123.