Evaluation of Artifacts Generated by Titanium, Zirconium, and Titanium–Zirconium Alloy Dental Implants on MRI, CT, and CBCT Images: A Phantom Study

Abstract

Objective: The aim of this study was to assess artifacts generated by zirconium, titanium, and titanium–zirconium alloy implants on magnetic resonance imaging(MRI), computed tomography(CT), and cone beam computed tomography(CBCT) and to correlate the findings to the dose–area product and exposure factors on CT and CBCT. Study Design: Three phantoms were built by embedding zirconium, titanium, and titanium–zirconium implants in ultrasound gel. MRI, CT, and CBCT images were acquired by using multiple sequences and settings. For MRI, “artifact” was described as the length of signal void beyond the limits of the implant. For CT and CBCT, “artifact” was calculated by subtracting the gray level of the darkest pixel from the level of the lightest pixel. Results: On MRI, zirconium implants had minor distortion artifacts, whereas titanium and titanium–zirconium implants created extensive artifacts (P < .05). On CT and CBCT, artifacts were less prominent with titanium and titanium–zirconium implants compared with zirconium (P < .05). Titanium grade 5 implants with 0.3 and 0.4 mm 3 voxels produced the least severe artifacts. Conclusions: MRI images were less affected by artifacts from zirconium implants, whereas CT and CBCT images showed less severe artifacts from titanium and titanium–zirconium alloy implants. CT generated greater artifacts compared with CBCT. Larger CBCT voxel sizes reduced the dose–area product and the severity of artifacts. © 2019 Elsevier Inc.