Evaluation of the interference of metallic dental artifacts with virtual implant planning on CBCT

Introduction: The quality of cone-beam computed tomography (CBCT) images can be affected by patient factors, including metal artifacts, which may compromise diagnosis and surgical planning. Objective: To evaluate the interference of metal restoration artifacts with superimposed DICOM and STL files using automatic segmentation in CBCT planning software and compare it with image acquisition. Methods: Subjects were divided into three groups: group 0 (zero to two restorations), group 1 (three to five restorations), and group 2 (six or more restorations). DICOM files were superimposed on STL files using four fixed anatomical positions in 3D arches for standardization. Statistical analysis included Shapiro-Wilk normality, Levene, Kruskal-Wallis, Dunn's post-tests, and Mann-Whitney U Test, with a 5% significance level. Results: The mean deviation was 0.489 mm (SD ±1.353 mm). The number of restorations significantly influenced deviations in the horizontal/anterior position (p=0.009). Group 1 differed significantly from group 2, while group 0 showed no significant differences from either. Comparing occlusion and non-occlusion, Vertical/Posterior (VP) and Vertical/Anterior (VA) positions showed significant differences, with higher means for group 1. Conclusion: Metal artifacts did not affect vertical analyses in CBCT planning but caused discrepancies in horizontal DICOM-STL segmentation adjustments.