Voxel Size and Field of View Influence on Periodontal Bone Assessment Using Four CBCT Systems: An Experimental Ex Vivo Analysis

OBJECTIVE: This ex vivo study aimed to evaluate the influence of different acquisition protocols, combining voxel size and field of view (FOV), across four cone-beam computed tomography (CBCT) systems, on the accuracy of alveolar bone level measurements for periodontal assessment. MATERIALS AND METHODS: A dry human mandible was used, with standardized radiopaque markers placed on the cementoenamel junction (CEJ) of the buccal-mesial and buccal-distal aspects of teeth 34 and 43. CBCT scans were performed using four systems-Veraview® X800, OP300 Pro®, I-CAT Next Generation®, and Orthophos XG®-applying various combinations of field of view (FOV) and voxel resolution available in each device. Reference measurements were obtained in situ using a digital caliper. CBCT images were exported in DICOM format and analyzed with OnDemand3D software (version 4.6) to obtain paracoronal sections. Linear measurements from the CEJ to the alveolar crest were recorded in triplicate and compared to the gold standard using ANOVA and the Dunnett test (α = 0.05). RESULTS: Protocols with smaller voxel sizes and limited FOVs generally yielded measurements closer to the gold standard. However, some larger-FOV protocols with intermediate voxel sizes also achieved comparable accuracy. Among the systems, the I-CAT showed lower agreement within in situ measurements, while others demonstrated reliable performance depending on the acquisition parameters. CONCLUSIONS: The findings suggest that CBCT protocols with smaller voxel sizes and reduced FOVs can enhance measurement accuracy in periodontal bone assessments. Nevertheless, intermediate protocols may offer a balance between diagnostic quality and radiation exposure, aligning with the ALADA principle. This study reinforces the need for standardized acquisition parameters tailored to periodontal imaging.