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Review
. 2025 Aug;130(8):1193-1206.
doi: 10.1007/s11547-025-02052-5. Epub 2025 Jul 16.

A systematic review and meta-analysis on the concept of bone quality in dento-maxillofacial Cone Beam Computed Tomography

Fabio Mistretta  1 , Andrea Magnini  2 , Lorenzo Cinci  2 , Patrizio Zanobini  3 , Maria Pisano  2 , Eleonora Barcali  4 , Leonardo Bocchi  4 , Cosimo Nardi  5
Affiliations
Review

A systematic review and meta-analysis on the concept of bone quality in dento-maxillofacial Cone Beam Computed Tomography

Fabio Mistretta et al. Radiol Med. 2025 Aug.

Abstract

Objectives: Bone quality is currently considered a set of intrinsic characteristics of the bone, among which macro- and microarchitecture of the trabecular bone tissue stands out. The investigation of bone quality is crucial in maxillofacial area and especially in dental implant planning. Nevertheless, there is currently no consensus about what bone quality really represents. The aim of this study was to investigate the role of CBCT in assessing bone quality of mandibular and maxillary bones.

Methods: This systematic review included fourteen articles selected via PubMed, Embase, and Web of Science databases, with the following features: samples of maxillary or mandibular bones from living individuals or corpses; CBCT as diagnostic investigation tool; a reference standard in assessing bone quality. Ten studies using µCT as reference standard were included in the meta-analysis.

Results: CBCT voxel size was from 80 to 400 µm. Only half of the studies evaluated a considerable number of morphometric parameters as described by the Society for Bone and Mineral Research. Meta-analysis was only possible for the 3D Accuitomo 170 CBCT scanner with a voxel size of 80 µm. Trabecular separation (Tb.Sp) and Degree of Anisotropy (DA) microstructural parameters showed moderate to low heterogeneity among studies without significative differences between CBCT and μCT.

Conclusions: High-resolution CBCT with a voxel size down to 80 μm should be considered a suitable tool for the assessment of bone microarchitecture. Tb.Sp and DA showed similar values between CBCT and μCT and they could thus be considered as reliable tools for the assessment of bone quality with CBCT. Nevertheless, the high heterogeneity in several bone microstructural parameters and the lack of standardization both in imaging protocols and in image analysis software made CBCT not adequate to be currently deemed the gold standard technique for the assessment of jawbones quality.

Keywords: Bone density; Bone quality; Cone Beam Computed Tomography; Implants; Jaws; μCT.

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Conflict of interest statement

Declarations. Conflict of interest: The authors have not disclosed any competing interests. Ethical Statement: Ethical standards This article does not contain any studies with human participants or animals performed by any of the authors.

References

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