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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The comparison of the precision of different dental radiographic methods in mandibular peri-implantary measurements: an in vitro study</title><author><name sortKey="Bilhan, Hakan" sort="Bilhan, Hakan" uniqKey="Bilhan H" first="Hakan" last="Bilhan">Hakan Bilhan</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, Faculty of Dentistry, Okan University,<country>Turkey</country></nlm:aff></affiliation></author><author><name sortKey="Geckili, Onur" sort="Geckili, Onur" uniqKey="Geckili O" first="Onur" last="Geckili">Onur Geckili</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, Faculty of Dentistry, Okan University,<country>Turkey</country></nlm:aff></affiliation></author><author><name sortKey="Arat Bilhan, Selda" sort="Arat Bilhan, Selda" uniqKey="Arat Bilhan S" first="Selda" last="Arat Bilhan">Selda Arat Bilhan</name><affiliation><nlm:aff id="aff2">Department of Prosthodontics, Medipol Mega Hospital and University,<country>Turkey</country></nlm:aff></affiliation></author><author><name sortKey="Aycicek, Fatih" sort="Aycicek, Fatih" uniqKey="Aycicek F" first="Fatih" last="Aycicek">Fatih Aycicek</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, Faculty of Dentistry, Okan University,<country>Turkey</country></nlm:aff></affiliation></author><author><name sortKey="Albayrak, Berkman" sort="Albayrak, Berkman" uniqKey="Albayrak B" first="Berkman" last="Albayrak">Berkman Albayrak</name><affiliation><nlm:aff id="aff3">Undergraduate Student, Faculty of Dentistry, Istanbul University<country>Turkey</country></nlm:aff></affiliation></author><author><name sortKey="Bozbulut, Pelin" sort="Bozbulut, Pelin" uniqKey="Bozbulut P" first="Pelin" last="Bozbulut">Pelin Bozbulut</name><affiliation><nlm:aff id="aff3">Undergraduate Student, Faculty of Dentistry, Istanbul University<country>Turkey</country></nlm:aff></affiliation></author><author><name sortKey="Unalan, Fatma" sort="Unalan, Fatma" uniqKey="Unalan F" first="Fatma" last="Unalan">Fatma Unalan</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, Faculty of Dentistry, Okan University,<country>Turkey</country></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28955519</idno><idno type="pmc">5573457</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573457</idno><idno type="RBID">PMC:5573457</idno><idno type="doi">10.17096/jiufd.55134</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">003211</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">003211</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The comparison of the precision of different dental radiographic methods in mandibular peri-implantary measurements: an in vitro study</title><author><name sortKey="Bilhan, Hakan" sort="Bilhan, Hakan" uniqKey="Bilhan H" first="Hakan" last="Bilhan">Hakan Bilhan</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, Faculty of Dentistry, Okan University,<country>Turkey</country></nlm:aff></affiliation></author><author><name sortKey="Geckili, Onur" sort="Geckili, Onur" uniqKey="Geckili O" first="Onur" last="Geckili">Onur Geckili</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, Faculty of Dentistry, Okan University,<country>Turkey</country></nlm:aff></affiliation></author><author><name sortKey="Arat Bilhan, Selda" sort="Arat Bilhan, Selda" uniqKey="Arat Bilhan S" first="Selda" last="Arat Bilhan">Selda Arat Bilhan</name><affiliation><nlm:aff id="aff2">Department of Prosthodontics, Medipol Mega Hospital and University,<country>Turkey</country></nlm:aff></affiliation></author><author><name sortKey="Aycicek, Fatih" sort="Aycicek, Fatih" uniqKey="Aycicek F" first="Fatih" last="Aycicek">Fatih Aycicek</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, Faculty of Dentistry, Okan University,<country>Turkey</country></nlm:aff></affiliation></author><author><name sortKey="Albayrak, Berkman" sort="Albayrak, Berkman" uniqKey="Albayrak B" first="Berkman" last="Albayrak">Berkman Albayrak</name><affiliation><nlm:aff id="aff3">Undergraduate Student, Faculty of Dentistry, Istanbul University<country>Turkey</country></nlm:aff></affiliation></author><author><name sortKey="Bozbulut, Pelin" sort="Bozbulut, Pelin" uniqKey="Bozbulut P" first="Pelin" last="Bozbulut">Pelin Bozbulut</name><affiliation><nlm:aff id="aff3">Undergraduate Student, Faculty of Dentistry, Istanbul University<country>Turkey</country></nlm:aff></affiliation></author><author><name sortKey="Unalan, Fatma" sort="Unalan, Fatma" uniqKey="Unalan F" first="Fatma" last="Unalan">Fatma Unalan</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, Faculty of Dentistry, Okan University,<country>Turkey</country></nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Istanbul University Faculty of Dentistry</title><idno type="ISSN">2149-2352</idno><idno type="eISSN">2149-4592</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Purpose:</title><p>The objective of this in vitro study was to investigate and compare the precisions of
several radiodiagnostic methods used in dentistry for the measurement of peri-implantary sites.</p></sec><sec><title>Materials and Methods:</title><p>Six dental implants were placed in a human cadaver mandible. Periapical radiographs obtained with the parallel as well as
the bisecting angle technique, digital and conventional panoramic radiographs were used
for implant and peri-implant bone measurements. The measurement results at each implant were statistically analyzed.</p></sec><sec><title>Results:</title><p>The ICC values for the inter-observer reliability were 0.79 for implant diameters and 0.96 for implant lengths.
Statistical significance was not detected between the differences of the measurements of the 2 examiners from the original implant dimensions related to
anatomic locations. For both of the examiner measurements, significantly less difference from the original implant dimensions was detected in the parallel
technique compared to the other techniques (p<0.05).</p></sec><sec><title>Conclusion:</title><p>The present study showed that the most precise peri-implant bone measurements can be
obtained from periapical radiographies by using the parallel technique.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Chaytor, Dv" uniqKey="Chaytor D">DV Chaytor</name></author><author><name sortKey="Zarb, Ga" uniqKey="Zarb G">GA Zarb</name></author><author><name sortKey="Schmitt, A" uniqKey="Schmitt A">A Schmitt</name></author><author><name sortKey="Lewis, Dw" uniqKey="Lewis D">DW Lewis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Monsour, Pa" uniqKey="Monsour P">PA Monsour</name></author><author><name sortKey="Dudhia, R" uniqKey="Dudhia R">R Dudhia</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dula, K" uniqKey="Dula K">K Dula</name></author><author><name sortKey="Mini, R" uniqKey="Mini R">R Mini</name></author><author><name sortKey="Van Der Stelt, Pf" uniqKey="Van Der Stelt P">PF van der Stelt</name></author><author><name sortKey="Buser, D" 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Istanb Univ Fac Dent</journal-id><journal-id journal-id-type="iso-abbrev">J Istanb Univ Fac Dent</journal-id><journal-id journal-id-type="publisher-id">J. Istanbul Univ. Fac. Dent.</journal-id><journal-id journal-id-type="hwp">jiufd</journal-id><journal-id journal-id-type="pmc">jiufd</journal-id><journal-id journal-id-type="publisher-id">IUFD</journal-id><journal-title-group><journal-title>Journal of Istanbul University Faculty of Dentistry</journal-title></journal-title-group><issn pub-type="ppub">2149-2352</issn><issn pub-type="epub">2149-4592</issn><issn-l>2149-2352</issn-l><publisher><publisher-name>Istanbul University Faculty of Dentisty</publisher-name><publisher-loc>Istanbul, Turkey</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28955519</article-id><article-id pub-id-type="pmc">5573457</article-id><article-id pub-id-type="doi">10.17096/jiufd.55134</article-id><article-id pub-id-type="publisher-id">jiufd-49-1-335</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject><subj-group subj-group-type="heading"><subject>Biological Sciences</subject><subj-group subj-group-type="heading"><subject>Dentistry</subject></subj-group></subj-group></subj-group></article-categories><title-group><article-title>The comparison of the precision of different dental radiographic methods in mandibular peri-implantary measurements: an in vitro study</article-title><alt-title alt-title-type="short">Radiographic methods in mandibular measurements</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Bilhan</surname><given-names>Hakan</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Geckili</surname><given-names>Onur</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref rid="cor" ref-type="corresp"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Arat Bilhan</surname><given-names>Selda</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Aycicek</surname><given-names>Fatih</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Albayrak</surname><given-names>Berkman</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Bozbulut</surname><given-names>Pelin</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Unalan</surname><given-names>Fatma</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><aff id="aff1"><label>1</label>Department of Prosthodontics, Faculty of Dentistry, Okan University,<country>Turkey</country></aff><aff id="aff2"><label>2</label>Department of Prosthodontics, Medipol Mega Hospital and University,<country>Turkey</country></aff><aff id="aff3"><label>3</label>Undergraduate Student, Faculty of Dentistry, Istanbul University<country>Turkey</country></aff></contrib-group><author-notes><corresp id="cor"><label>*</label>To whom correspondence should be addressed: Dr. Onur Geckili <institution content-type="edu">Department of Prosthodontics
Faculty of Dentistry Istanbul University </institution> 34093 Capa Istanbul <country>Turkey</country> Phone: +90 212 414 20 20 (ext: 30385)<email> geckili@istanbul.edu.tr</email></corresp></author-notes><pub-date pub-type="collection"><year>2015</year></pub-date><pub-date pub-type="epub"><day>31</day><month>1</month><year>2015</year></pub-date><volume>49</volume><issue>1</issue><fpage>1</fpage><lpage>9</lpage><history><date date-type="received"><day>13</day><month>5</month><year>2014</year></date><date date-type="accepted"><day>13</day><month>11</month><year>2014</year></date></history><permissions><copyright-statement>Copyright © 2015 Journal of Istanbul University Faculty of Dentistry</copyright-statement><copyright-year>2015</copyright-year><copyright-holder>Journal of Istanbul University Faculty of Dentistry</copyright-holder><license license-type="open-access"><license-p>This article is licensed under Creative Commons License Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) license (<ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by-nc-nd/4.0/" xlink:show="new"></ext-link>). Users must give appropriate credit, provide a link to the license, and indicate if changes were made. Users may do so in any reasonable manner, but not in any way that suggests the journal endorses its use. The material cannot be used for commercial purposes. If the user remixes, transforms, or builds upon the material, he/she may not distribute the modified material. No warranties are given. The license may not give the user all of the permissions necessary for his/her intended use. For example, other rights such as publicity, privacy, or moral rights may limit how the material can be used.</license-p></license></permissions><abstract abstract-type="section"><sec><title>Purpose:</title><p>The objective of this in vitro study was to investigate and compare the precisions of
several radiodiagnostic methods used in dentistry for the measurement of peri-implantary sites.</p></sec><sec><title>Materials and Methods:</title><p>Six dental implants were placed in a human cadaver mandible. Periapical radiographs obtained with the parallel as well as
the bisecting angle technique, digital and conventional panoramic radiographs were used
for implant and peri-implant bone measurements. The measurement results at each implant were statistically analyzed.</p></sec><sec><title>Results:</title><p>The ICC values for the inter-observer reliability were 0.79 for implant diameters and 0.96 for implant lengths.
Statistical significance was not detected between the differences of the measurements of the 2 examiners from the original implant dimensions related to
anatomic locations. For both of the examiner measurements, significantly less difference from the original implant dimensions was detected in the parallel
technique compared to the other techniques (p<0.05).</p></sec><sec><title>Conclusion:</title><p>The present study showed that the most precise peri-implant bone measurements can be
obtained from periapical radiographies by using the parallel technique.</p></sec></abstract><kwd-group><kwd>Panoramic radiography</kwd><kwd>dental implantation</kwd><kwd>parallel technique</kwd><kwd>bisecting technique</kwd><kwd>periapical radiography</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="s1"><title>Introduction</title><p>The measurement of the marginal alveolar bone
level changes over time using radiographs has been
reported to be an important parameter in the evaluation
of dental implant success (<xref rid="r1" ref-type="bibr">1</xref>). Thus, radiography plays
an important role in clinical routine practice and in
research projects evaluating dental implants. It is
difficult to determine small changes in bone height
clinically, therefore radiography is an important help
for detailed measurements. Marginal bone loss can
be defined as the distance between the alveolar crest
and the cement-enamel border or the border line
of rough and polished surfaces in dental implants.
Several intra- or extra-oral radiographic methods are
used in dentistry. Intra- and extra-oral radiographs
can be acquired conventionally as well as digitally.
Periapical radiographies acquired by using bisecting
angle or parallel techniques are often used in implant
dentistry (<xref rid="r2" ref-type="bibr">2</xref>, <xref rid="r3" ref-type="bibr">3</xref>, <xref rid="r4" ref-type="bibr">4</xref>). Panoramic radiographs are widely
used for evaluation of the condition of the bone around
implants supporting mandibular overdentures (<xref rid="r5" ref-type="bibr">5</xref>, <xref rid="r6" ref-type="bibr">6</xref>, <xref rid="r7" ref-type="bibr">7</xref>, <xref rid="r8" ref-type="bibr">8</xref>, <xref rid="r9" ref-type="bibr">9</xref>, <xref rid="r10" ref-type="bibr">10</xref>).
Panoramic radiograph includes both the jaws and
the teeth and is a simple examination process (<xref rid="r11" ref-type="bibr">11</xref>),
offering ease of operation and a shorter working time.
It should be kept in mind that, especially in patients
with severe alveolar resorption, the use of intraoral
films may be difficult. On the other hand, there are
several studies pointing out the disadvantages of
panoramic radiographies in diagnostic imaging
performed for detailed evaluation and quantification.
Panoramic radiographs have been reported to be
unsuitable because of the magnification, distortion,
relative unsharpness and superimposition of the
cervical spine (<xref rid="r12" ref-type="bibr">12</xref>, <xref rid="r13" ref-type="bibr">13</xref>). Many authors only accept the
results of measurements obtained from standardized
intraoral radiographs. The aim of this in vitro study
was to investigate the precision of peri-implantary
measurements on different 2-dimensional radiographic
methods and help clinicians to decide which technique
to use for radiographic measurements.</p></sec><sec sec-type="materials|methods" id="s2"><title>Materials and Methods</title><p>The mandible of a formalin fixed human cadaver
(<xref ref-type="fig" rid="fig1">Figure 1</xref>) was used for the exposure with different
radiographic methods. After removal of the mandible
from the cadaver, six implant recipient sites with a
safe distance to each other (<xref ref-type="fig" rid="fig2">Figure 2</xref>) were prepared
following the standard drilling protocol recommended
by the manufacturer (Straumann Dental Implants; Institut Straumann AG, Basel, Switzerland). Care was
taken to spread the implants to all possible alveolar
sites of the mandible. Six implants were inserted until
the roughened surfaces were completely covered by
the bone.</p><fig id="fig1" orientation="portrait" position="float"><label>Figure 1.</label><caption><p>The mandible obtained from a formalin fixed human cadaver</p></caption><graphic xlink:href="jiufd-049-001-a-e001"></graphic></fig><fig id="fig2" orientation="portrait" position="float"><label>Figure 2.</label><caption><p>Six implants were placed with a safe distance to each other.</p></caption><graphic xlink:href="jiufd-049-001-a-e002"></graphic></fig><sec id="s2a"><title>Radiographic Evaluation and Bone Level Assessment</title><p>After placement of the implants, following
methods were used to obtain radiographies:</p><p>1. Conventional panoramic radiography
(Planmeca, Proline XC, Helsinki, Finland) (<xref ref-type="fig" rid="fig3">Figure 3</xref>).</p><p>2. Digital panoramic radiography (Morita
Veraview IC5, J. Morita MFG. Corp., Kyoto, Japan).</p><p>3. Bisecting angle (Kodak Ultraspeed Dental Film,
Eastman Kodak, Rochester, NY) with a Siemens
Heliodent MD model X1744 (Sirona Dental Systems,
GmbH D-64625, Bensheim, Germany).</p><p>4. Parallel technique (Kodak Ultraspeed Dental
Film, Eastman Kodak, Rochester, NY) with a Siemens
Heliodent MD model X1744 (Sirona Dental Systems,
GmbH D-64625, Bensheim, Germany) X-ray machine
set to 70 kV and 7 mA.</p><p>All the measurements were performed
independently by two examiners blinded to the study
protocol. Measurements were obtained from images
of conventional radiographs which were scanned,
digitized (Epson 1680 Pro, Seiko Epson Corporation,
Nagano, Japan) and analyzed at 5x magnification
using a software program (CorelDraw 11.0; Corel
Corp and Coral Ltd, Ottawa, Canada). The implant
diameters at the widest region and implant lengths,
as specified by the manufacturer, were used as
reference points, which were 4.8 mm and 10 mm
respectively. To account for variability, implant
diameters and lengths were measured and compared
to the documented original dimensions, and ratios
were calculated to adjust for distortion. A distortion
coefficient was determined for each site and imaging
technique. Inter-observer reliability was assessed via
comparison of the measurements of two different
examiners.</p><fig id="fig3" orientation="portrait" position="float"><label>Figure 3.</label><caption><p>Conventional panoramic radiography of the mounted mandible.</p></caption><graphic xlink:href="jiufd-049-001-a-e003"></graphic></fig></sec><sec id="s2b"><title>Statistical Analysis</title><p>Statistical Package for Social Sciences (SPSS)
statistical software (ver. 15.0 for Windows; SPSS,
Inc., Chicago, IL, USA) was used in this study.
Kolmogorov-Smirnov test was used to test normality
of the distribution. Since the data did not meet the
requirements for normal distribution, non-parametric
Kruskal Wallis test was used for multiple comparisons.
When signigicant differences are detected among
study variables, Mann Whitney U test was employed
for pairwise comparisons. Wilcoxon sign-test was
performed to compare the examiners. Inter-observer
reliability was calculated by the intra-class correlation coefficient (ICC). The results were assessed at 95%
confidence interval, and p values less than 0.05 are
considered significant.</p></sec></sec><sec sec-type="results" id="s3"><title>Results</title><p>No statistically significant difference was detected
between the differences of the overall measurements
of the 2 examiners from the original implant lengths
and implant diameters (p>0.05; <xref ref-type="table" rid="table1">Table 1</xref>). The ICC
values for the inter-observer reliability were 0.79
for implant diameter and 0.96 for implant lengths
These findings were qualified as excellent agreements
according to the recommendations of Schuck (<xref rid="r14" ref-type="bibr">14</xref>).
The measurements of 2 examiners for in all techniques
are presented in <xref ref-type="table" rid="table2">Table 2</xref>.</p><p>No statistical difference was detected between
the different measurements of the 2 examiners from
the original implant dimensions related to anatomic
locations (p>0.05; <xref ref-type="table" rid="table3">Table 3</xref>).</p><p>The measurements of both examiners revealed
a significant difference from the original implant
dimensions (p<0.05; <xref ref-type="table" rid="table4">Table 4</xref>). The difference from the
original implant dimensions measured by the bisecting
angle technique were found significantly lower than
the analog and digital panoramic techniques (p<0.05;<xref ref-type="table" rid="table4">Table 4</xref>). No significance was detected between the
differences from the original implant dimensions
found in analog and digital panoramic techniques
(p>0.05;<xref ref-type="table" rid="table4">Table 4</xref>).</p><table-wrap id="table1" orientation="portrait" position="float"><label>Table 1.</label><caption><p>The differences of all of the measurements of the 2 examiners from the original implant dimensions
(SD: standard deviation).</p></caption><table frame="hsides" rules="groups" style="border-collapse:collapse; border-bottom: 3px solid; border-top: 3px solid" cellpadding="10px"><tbody><tr><th rowspan="1" colspan="1"></th><th rowspan="1" colspan="1"></th><th rowspan="1" colspan="1">Mean±SD</th><th rowspan="1" colspan="1">p</th></tr><tr><td rowspan="1" colspan="1">Implant Diameter</td><td rowspan="1" colspan="1">Examiner 1</td><td rowspan="1" colspan="1">0.89±0.72</td><td rowspan="1" colspan="1">0.719</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Examiner 2</td><td rowspan="1" colspan="1">0.83±0.68</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1">Implant length</td><td rowspan="1" colspan="1">Examiner 1</td><td rowspan="1" colspan="1">1.82±1.46</td><td rowspan="1" colspan="1">0.586</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Examiner 2</td><td rowspan="1" colspan="1">1.85±1.46</td><td rowspan="1" colspan="1"></td></tr></tbody></table><table-wrap-foot><fn id="foot1"><p>Wilcoxon sign test</p></fn></table-wrap-foot></table-wrap><table-wrap id="table2" orientation="portrait" position="float"><label>Table 2.</label><caption><p>The differences of the measurements of the 2 examiners from the original implant dimensions using the bisecting, parallel
and analog and digital panoramic techniques.</p></caption><table frame="hsides" rules="groups" style="border-collapse:collapse; border-bottom: 3px solid; border-top: 3px solid" cellpadding="10px"><tbody><tr><th rowspan="1" colspan="1">Technique</th><th rowspan="1" colspan="1"></th><th rowspan="1" colspan="1"></th><th rowspan="1" colspan="1">Mean±SD</th><th rowspan="1" colspan="1">p</th></tr><tr><td rowspan="1" colspan="1">Bisecting Technique</td><td rowspan="1" colspan="1">Implant Diameter</td><td rowspan="1" colspan="1">Examiner 1</td><td rowspan="1" colspan="1">0.58±0.46</td><td rowspan="1" colspan="1">0,173</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Examiner 2</td><td rowspan="1" colspan="1">0.65±0.40</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Implant length</td><td rowspan="1" colspan="1">Examiner 1</td><td rowspan="1" colspan="1">1.19±1.93</td><td rowspan="1" colspan="1">0,249</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Examiner 2</td><td rowspan="1" colspan="1">1.31±1.82</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1">Parallel Technique</td><td rowspan="1" colspan="1">Implant Diameter</td><td rowspan="1" colspan="1">Examiner 1</td><td rowspan="1" colspan="1">0.05±0.04</td><td rowspan="1" colspan="1">0,6</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Examiner 2</td><td rowspan="1" colspan="1">0.10±0.15</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Implant length</td><td rowspan="1" colspan="1">Examiner 1</td><td rowspan="1" colspan="1">0.13±0.11</td><td rowspan="1" colspan="1">0,753</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Examiner 2</td><td rowspan="1" colspan="1">0.19±0.30</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1">Analog panoramic technique</td><td rowspan="1" colspan="1">Implant Diameter</td><td rowspan="1" colspan="1">Examiner 1</td><td rowspan="1" colspan="1">1.67±0.29</td><td rowspan="1" colspan="1">0,917</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Examiner 2</td><td rowspan="1" colspan="1">1.68±0.33</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Implant length</td><td rowspan="1" colspan="1">Examiner 1</td><td rowspan="1" colspan="1">3.40±0.60</td><td rowspan="1" colspan="1">0,6</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Examiner 2</td><td rowspan="1" colspan="1">3.44±0.68</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1">Digital panoramic technique</td><td rowspan="1" colspan="1">Implant Diameter</td><td rowspan="1" colspan="1">Examiner 1</td><td rowspan="1" colspan="1">1.42±0.78</td><td rowspan="1" colspan="1">0,6</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Examiner 2</td><td rowspan="1" colspan="1">1.10±0.77</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Implant length</td><td rowspan="1" colspan="1">Examiner 1</td><td rowspan="1" colspan="1">2.90±1.58</td><td rowspan="1" colspan="1">0,917</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Examiner 2</td><td rowspan="1" colspan="1">3.01±1.39</td><td rowspan="1" colspan="1"></td></tr></tbody></table><table-wrap-foot><fn id="foot2"><p>Wilcoxon sign test</p></fn></table-wrap-foot></table-wrap><table-wrap id="table3" orientation="portrait" position="float"><label>Table 3.</label><caption><p>The differences of the measurements of the 2 examiners from the original implant dimensions related to anatomic locations
(FDI 2-digit tooth numbering system was used to describe anatomic location, SD: standard deviation).</p></caption><table frame="hsides" rules="groups" style="border-collapse:collapse; border-bottom: 3px solid; border-top: 3px solid" cellpadding="10px"><tbody><tr><th rowspan="1" colspan="1"></th><th colspan="2" rowspan="1">Examiner 1</th><th colspan="2" rowspan="1">Examiner 2</th><th rowspan="1" colspan="1"></th></tr><tr><td rowspan="1" colspan="1">Anatomic Location</td><td rowspan="1" colspan="1">Implant Diameter</td><td rowspan="1" colspan="1">Implant length</td><td rowspan="1" colspan="1">Implant Diameter</td><td rowspan="1" colspan="1">Implant length</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Mean±SD</td><td rowspan="1" colspan="1">Mean±SD</td><td rowspan="1" colspan="1">Mean±SD</td><td rowspan="1" colspan="1">Mean±SD</td></tr><tr><td rowspan="1" colspan="1">Tooth no: 31</td><td rowspan="1" colspan="1">0.81±0.63 (0.68)</td><td rowspan="1" colspan="1">1.65±1.29 (1.40)</td><td rowspan="1" colspan="1">0.77±0.72 (0.71)</td><td rowspan="1" colspan="1">1.57±1.48 (1.44)</td></tr><tr><td rowspan="1" colspan="1">Tooth no: 33</td><td rowspan="1" colspan="1">1.07±0.87 (0.78)</td><td rowspan="1" colspan="1">2.22±1.73 (1.60)</td><td rowspan="1" colspan="1">1.12±0.94 (0.78)</td><td rowspan="1" colspan="1">2.38±2.04 (1.61)</td></tr><tr><td rowspan="1" colspan="1">Tooth no: 36</td><td rowspan="1" colspan="1">0.41±0.54 (0.05)</td><td rowspan="1" colspan="1">0.85±1.10 (0.11)</td><td rowspan="1" colspan="1">0.51±0.50 (0.47)</td><td rowspan="1" colspan="1">1.04±1.02 (0.97)</td></tr><tr><td rowspan="1" colspan="1">Tooth no: 41</td><td rowspan="1" colspan="1">1.08±0.74 (0.98)</td><td rowspan="1" colspan="1">2.20±1.51 (2.01)</td><td rowspan="1" colspan="1">1.06±0.69 (1.10)</td><td rowspan="1" colspan="1">2.17±1.42 (2.22)</td></tr><tr><td rowspan="1" colspan="1">Tooth no: 43</td><td rowspan="1" colspan="1">1.20±0.83 (1.24)</td><td rowspan="1" colspan="1">2.46±1.69 (2.54)</td><td rowspan="1" colspan="1">0.76±0.71 (0.88)</td><td rowspan="1" colspan="1">2.38±1.54 (2.11)</td></tr><tr><td rowspan="1" colspan="1">Tooth no: 46</td><td rowspan="1" colspan="1">0.76±0.72 (0.53)</td><td rowspan="1" colspan="1">1.56±1.47 (1.09)</td><td rowspan="1" colspan="1">0.78±0.65 (0.38)</td><td rowspan="1" colspan="1">1.60±1.33 (0.78)</td></tr><tr><td rowspan="1" colspan="1">p</td><td rowspan="1" colspan="1">0,521</td><td rowspan="1" colspan="1">0,481</td><td rowspan="1" colspan="1">0,856</td><td rowspan="1" colspan="1">0,716</td></tr></tbody></table><table-wrap-foot><fn id="foot3"><p>Kruskal Wallis Test</p></fn></table-wrap-foot></table-wrap><table-wrap id="table4" orientation="portrait" position="float"><label>Table 4.</label><caption><p>The differences of the measurements of the 2 examiners from the original implant dimensions related to anatomic locations
(FDI 2-digit tooth numbering system was used to describe anatomic location, SD: standard deviation).</p></caption><table frame="hsides" rules="groups" style="border-collapse:collapse; border-bottom: 3px solid; border-top: 3px solid" cellpadding="10px"><tbody><tr><th rowspan="1" colspan="1"></th><th colspan="2" rowspan="1">Examiner 1</th><th colspan="2" rowspan="1">Examiner 2</th></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Implant Diameter</td><td rowspan="1" colspan="1">Implant length</td><td rowspan="1" colspan="1">Implant Diameter</td><td rowspan="1" colspan="1">Implant length</td></tr><tr><td rowspan="1" colspan="1">Techniques</td><td rowspan="1" colspan="1">Mean±SD</td><td rowspan="1" colspan="1">Mean±SD</td><td rowspan="1" colspan="1">Mean±SD</td><td rowspan="1" colspan="1">Mean±SD</td></tr><tr><td rowspan="1" colspan="1">Bisecting Technique</td><td rowspan="1" colspan="1">0.58±0.46 (0.62)</td><td rowspan="1" colspan="1">1.19±1.93 (1.27)</td><td rowspan="1" colspan="1">0.65±0.40 (0.67)</td><td rowspan="1" colspan="1">1.31±0.82 (1.36)</td></tr><tr><td rowspan="1" colspan="1">Parallel Technique</td><td rowspan="1" colspan="1">0.05±0.04 (0.04)</td><td rowspan="1" colspan="1">0.13±0.11 (0.12)</td><td rowspan="1" colspan="1">0.10±0.15 (0.02)</td><td rowspan="1" colspan="1">0.19±0.30 (0.06)</td></tr><tr><td rowspan="1" colspan="1">Analog panoramic technique</td><td rowspan="1" colspan="1">1.66±0.29 (1.7)</td><td rowspan="1" colspan="1">3.40±0.60 (3.48)</td><td rowspan="1" colspan="1">1.68±0.33 (1.79)</td><td rowspan="1" colspan="1">3.44±0.68 (3.67)</td></tr><tr><td rowspan="1" colspan="1">Digital panoramic technique</td><td rowspan="1" colspan="1">1.42±0.77 (1.61)</td><td rowspan="1" colspan="1">2.90±1.58 (3.28)</td><td rowspan="1" colspan="1">1.10±0.77 (1.20)</td><td rowspan="1" colspan="1">3.01±1.39 (2.96)</td></tr><tr><td rowspan="1" colspan="1">p</td><td rowspan="1" colspan="1">0.001**</td><td rowspan="1" colspan="1">0.001**</td><td rowspan="1" colspan="1">0.001**</td><td rowspan="1" colspan="1">0.001**</td></tr><tr><td rowspan="1" colspan="1">Kruskal Wallis ** p<0.01</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><th rowspan="1" colspan="1"></th><th colspan="2" rowspan="1">Examiner 1</th><th colspan="2" rowspan="1">Examiner 2</th></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Implant Diameter</td><td rowspan="1" colspan="1">Implant length</td><td rowspan="1" colspan="1">Implant Diameter</td><td rowspan="1" colspan="1">Implant length</td></tr><tr><td rowspan="1" colspan="1">Techniques</td><td rowspan="1" colspan="1">p</td><td rowspan="1" colspan="1">p</td><td rowspan="1" colspan="1">p</td><td rowspan="1" colspan="1">p</td></tr><tr><td rowspan="1" colspan="1">Bisecting/Parallel techniques</td><td rowspan="1" colspan="1">0.037*</td><td rowspan="1" colspan="1">0.037*</td><td rowspan="1" colspan="1">0.019*</td><td rowspan="1" colspan="1">0.025*</td></tr><tr><td rowspan="1" colspan="1">Bisecting/Analog panoramic techniques</td><td rowspan="1" colspan="1">0.006**</td><td rowspan="1" colspan="1">0.006**</td><td rowspan="1" colspan="1">0.004**</td><td rowspan="1" colspan="1">0.004**</td></tr><tr><td rowspan="1" colspan="1">Bisecting/Digital panoramic techniques</td><td rowspan="1" colspan="1">0.050*</td><td rowspan="1" colspan="1">0.050*</td><td rowspan="1" colspan="1">0,262</td><td rowspan="1" colspan="1">0.037*</td></tr><tr><td rowspan="1" colspan="1">Parallel /Analog panoramic techniques</td><td rowspan="1" colspan="1">0.004**</td><td rowspan="1" colspan="1">0.004**</td><td rowspan="1" colspan="1">0.004**</td><td rowspan="1" colspan="1">0.004**</td></tr><tr><td rowspan="1" colspan="1">Parallel /Digital panoramic techniques</td><td rowspan="1" colspan="1">0.011*</td><td rowspan="1" colspan="1">0.016*</td><td rowspan="1" colspan="1">0.016*</td><td rowspan="1" colspan="1">0.004**</td></tr><tr><td rowspan="1" colspan="1">Analog/Digital panoramic techniques</td><td rowspan="1" colspan="1">0,631</td><td rowspan="1" colspan="1">0,631</td><td rowspan="1" colspan="1">0,15</td><td rowspan="1" colspan="1">0,631</td></tr><tr><td rowspan="1" colspan="1">Mann Whitney U Test * p<0.05, ** p<0.01</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr></tbody></table></table-wrap></sec><sec sec-type="discussion" id="s4"><title>Discussion</title><p>The purpose of this study was to investigate
the precision of various radiographic methods in
evaluating bone around dental implants. Intraoral
and panoramic radiographies were used to compare
the precision of measurements in this study. It is
noteworthy that the results are reproducible, the ICC
values showing excellent inter-observer agreement for
overall measurements of two examiners according to
the recommendations of Schuck (<xref rid="r14" ref-type="bibr">14</xref>).</p><p>The peri-implant bone can be analyzed with
the aid of vectoral software programs and various
measurements on digital or digitized radiographies or
by hand tracing of digital radiographic printouts. Two
recent articles showed that in computerized tracing of
direct digital radiographs compared with hand tracing
of digital radiographic printouts, differences were
minimal and clinically acceptable (<xref rid="r15" ref-type="bibr">15</xref>, <xref rid="r16" ref-type="bibr">16</xref>).</p><p>The digital method which was used in the present study is one of the most often used programs for
this purpose. Although a 2000% magnification
is recommended, our experience showed that in
magnification levels over 500% the image can lose
its clarity and the precision of the measurements is
lost. For this reason a 500% magnification was used in
the present study during measurements. When using
radiography techniques, it is essential to use minimal ionizing radiation doses to obtain images that have
acceptable diagnostic quality.Standard methods such
as panoramic radiographies or intraoral projections
are mostly sufficient, although geometric distortions
or magnification in the images may occur depending
on the distance of the film to the object as well as
position and factors related to the patient.</p><p>Although it had been stated that radiographs
cannot always provide diagnostic information, even
when a computer-aided analysis system is used
(<xref rid="r17" ref-type="bibr">17</xref>), radiography plays an important role in clinical
routine practice and in research projects evaluating
dental implants (<xref rid="r18" ref-type="bibr">18</xref>, <xref rid="r19" ref-type="bibr">19</xref>) The bone loss documented
in two-dimensional radiodiagnostic methods is
the reduction of the bone levels at the mesial and
distal aspects of the implants, ignoring the so-called
saucerization of the crestal bone around the neck of
the implants since only 2-dimensional imaging is
used.</p><p>To be able to obtain data, especially about the
vestibular crestal bone changes, a 3-dimensional
imaging technique such as the Cone Beam
Computerized Tomography (CBCT) is reported to
be necessary (<xref rid="r20" ref-type="bibr">20</xref>) and it is considered as the golden
standard (<xref rid="r2" ref-type="bibr">2</xref>). During radiographic evaluation of
a radiolucent zone bordering a metal implant, it
should also be reminded that the influence of the
Mach-band effect will most probably alter the
outcome (<xref rid="r21" ref-type="bibr">21</xref>).</p><p>Panoramic radiographs are widely used for
evaluation of the bone condition around implants
(<xref rid="r5" ref-type="bibr">5</xref>, <xref rid="r6" ref-type="bibr">6</xref>, <xref rid="r7" ref-type="bibr">7</xref>, <xref rid="r8" ref-type="bibr">8</xref>,
<xref rid="r9" ref-type="bibr">9</xref>, <xref rid="r10" ref-type="bibr">10</xref>). Although there are numerous studies pointing
out the disadvantages of panoramic radiographies in
diagnostic imaging (<xref rid="r12" ref-type="bibr">12</xref>, <xref rid="r13" ref-type="bibr">13</xref>) and many authorities only
accept the results of measurements obtained from
standardized intraoral radiographs, it is known that a
panoramic radiograph includes both of the jaws and
the teeth and is a simple examination method (<xref rid="r22" ref-type="bibr">22</xref>).
Given that the radiographs were of a high quality,
Akesson (<xref rid="r23" ref-type="bibr">23</xref>) had concluded that for the assessment of
the marginal bone level around teeth the radiographic
examination of choice should be the panoramic
radiograph, which is in accordance with a study by
Persson et al. (<xref rid="r24" ref-type="bibr">24</xref>) A study by Kullman et al. (<xref rid="r25" ref-type="bibr">25</xref>) also
showed that panoramic radiographs are as reliable as
conventional intra-oral films when used to assess the
point of bone attachment to implant threads. It was
concluded in a recent study that vertical measurements
had acceptable accuracy and reproducibility when
a software-based calibrated measurement tool was
used, confirming that digital panoramic radiography
can be reliably utilized to determine the pre-operative
implant length in premolar and molar mandibular
segments (<xref rid="r26" ref-type="bibr">26</xref>). As stated in a recent study, there are
only a few studies reporting on the measurement
accuracy and on the distortion or magnification of
digital panoramic radiography (<xref rid="r27" ref-type="bibr">27</xref>, <xref rid="r28" ref-type="bibr">28</xref>, <xref rid="r29" ref-type="bibr">29</xref>, <xref rid="r30" ref-type="bibr">30</xref>) and none
that describes the impact of measurement accuracy
on the pre-operative bone height evaluation prior
to especially implant placement in the posterior
mandible. Although most panoramic machines also
might give varied and unreliable magnification, they
are easier to obtain (<xref rid="r4" ref-type="bibr">4</xref>), since the panoramic exposure
offers ease of operation and shorter working time. In
spite of a higher resolution of the images, the most
important disadvantage of intraoral radiographies
might be that intraoral film-holders can be painful
especially for edentulous patients with severe ridge
resorption (<xref rid="r31" ref-type="bibr">31</xref>, <xref rid="r32" ref-type="bibr">32</xref>). For highly atrophic mandibles
with unfavorable imaging conditions, rotational panoramic radiographs can be a useful alternative to
intraoral small-format radiographs for evaluating periimplant
bone loss (<xref rid="r32" ref-type="bibr">32</xref>). On conventional panoramic
radiographs, dental implants of known length are
reported to be easily measured with a sliding caliper
to determine the unit’s magnification factor (<xref rid="r33" ref-type="bibr">33</xref>).
Variations in the degree of magnification in the
horizontal and vertical planes may result in image
distortion, showing a certain degree of vertical
magnification due to projection geometry, are expected
for conventional film-based panoramic radiography,
as well as direct digital panoramic devices (<xref rid="r12" ref-type="bibr">12</xref>, <xref rid="r34" ref-type="bibr">34</xref>, <xref rid="r35" ref-type="bibr">35</xref>, <xref rid="r36" ref-type="bibr">36</xref>). Due to varying magnification, reference objects
with known dimensions are necessary to determine
the exact magnification in a particular area (<xref rid="r27" ref-type="bibr">27</xref>, <xref rid="r33" ref-type="bibr">33</xref>, <xref rid="r36" ref-type="bibr">36</xref>). Nevertheless, the results of the present study
point out the importance of variable distortions in the
vertical dimension in measurements on panoramic
radiographies. This could be important in implant
planning, especially in determination of the implant
length, since the planned length can be misleading
and implants with undesired dimensions may be used
which can lead to injury of anatomic structures such
as the mandibular canal or the mental foramen.</p><p>According to the results of a recent study (<xref rid="r37" ref-type="bibr">37</xref>), the
diagnostic performance of conventional and digital
panoramic images was reported to be equal for the
localization of mental and mandibular foramens. The
vertical radiographic measurements were considered
generally reliable and had correlated with direct
measurements in mandible for conventional and
digital panoramic radiography. In the present study
the measurements in mandible for conventional and
digital panoramic radiography were in correlation
as well. Although there are numerous studies
showing a sympathy for panoramic radiographies,
the results of the present study statistically supported
the superiority of the accuracy of measurements on
intraoral radiographies and the most superior obtained
with the parallel technique.</p><p>The comparison of both intraoral techniques has
revealed that the parallel method gives much better
images suitable for making precise measurements
(<xref ref-type="fig" rid="fig4">Figure 4</xref>). The main problem with the bisecting
angle method was that the placement of the film
obviously was inexact in all exposures and the images
failed to show the implant threads sharply (<xref ref-type="fig" rid="fig5">Figure 5</xref>).
Additionally, the bone level at the implant shoulder
was not consistent due to exposure geometry. In an
experimental study, the errors (<xref rid="r38" ref-type="bibr">38</xref>) in radiographic
assessment of marginal bone height around osseointegrated implants had been analyzed and it was
demonstrated that very small deviations of the X-ray
beam from the perpendicular with respect to the long
axis of the implant will compromise the accuracy of
bone height measurements. It was pointed out that for
taking periapical radiographs the use of the bisecting
angle technique should be discouraged because of
the inherent distortion of the resultant image. It
was explained that the bisecting angle technique
relies on a geometric trick to produce the image,
but only a portion of the structures being imaged are
dimensionally accurate. The long cone paralleling
technique for taking periapical radiographs seems to
be the technique of choice since it has advantages like
reduced skin dose, reduced magnification, showing
the true relationship between the bone height and
adjacent teeth and the absence of superimposition of
the zygoma over the upper molar region. It should be
noted that to obtain optimum results from the long
cone paralleling technique, the film-focal distance
should be approximately 30 cm, as we have used in
the present study.</p><fig id="fig4" orientation="portrait" position="float"><label>Figure 4.</label><caption><p>The radiographs taken with the parallel technique
give much better images which are suitable for making precise
measurements.</p></caption><graphic xlink:href="jiufd-049-001-a-e004"></graphic></fig><p>Digitizing radiographs were reported to be able
to facilitate the quantification of bone changes (<xref rid="r39" ref-type="bibr">39</xref>).
In a study that had been conducted for the detection
of bone loss with different x-ray techniques, it had
been reported that a pre-orientation with respect to
the expected bone loss is possible using panoramic
radiographs (<xref rid="r32" ref-type="bibr">32</xref>, <xref rid="r40" ref-type="bibr">40</xref>).Additional intraoral films have
reported to be useful where rapid changes of bone
levels are expected (<xref rid="r40" ref-type="bibr">40</xref>). In the present study, we
have used analogue radiographs.</p><fig id="fig5" orientation="portrait" position="float"><label>Figure 5.</label><caption><p>Due to the difficulty of placement of the film in the correct
angle images will often fail to show the implant threads sharply.</p></caption><graphic xlink:href="jiufd-049-001-a-e005"></graphic></fig><p>The daily routine forces us to use more practical
methods such as the panoramic radiographies. As
an argument it could be stated that the intra-oral
radiographic technique can fail to depict the apical
portion of the implant. However, this will not be a
limitation because in cases where peri-implant bone
level changes are evaluated, the region of interest
is visualized. If accurate measurements on the
radiographies are intended, the parallel technique
seems to be the most reliable method to obtain high
resolution images to be used for peri-implant bone
measurements. Since panoramic and periapical
radiographies do not provide three-dimensional
information on bone quantity and anatomic
structures, CBCT methods are recommended for the
measurement of bone resorption around implants
(<xref rid="r20" ref-type="bibr">20</xref>) and the current literature also inclined towards
CBCT analysis (<xref rid="r40" ref-type="bibr">40</xref>). This may be regarded as the
major limitation of this study and further studies
investigating the precision of CBCT methods in the
same manner should be conducted.</p></sec><sec sec-type="conclusion" id="s5"><title>Conclusion</title><p>Within the limitations of this in vitro study, it
can be concluded that the most suitable radiographic
method for precise mandibular peri-implant bone
measurements is achieving the intraoral periapical
radiography taken with the parallel technique. This
technique is reproducible and provides a good
inter-observer reliability.</p></sec></body><back><fn-group><fn fn-type="financial-disclosure"><p><bold>Source of funding:</bold> None declared.</p></fn><fn fn-type="COI-statement"><p><bold>Conflict of interest:</bold> None declared.</p></fn></fn-group><ref-list><ref id="r1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chaytor</surname><given-names>DV</given-names></name><name><surname>Zarb</surname><given-names>GA</given-names></name><name><surname>Schmitt</surname><given-names>A</given-names></name><name><surname>Lewis</surname><given-names>DW</given-names></name></person-group><article-title>The longitudinal effectiveness of osseointegrated dental implants. 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