Date of Award


Document Type


Degree Name

Master of Dental Science (MDS)



Research Advisor

David R. Cagna, D.M.D., M.S.


Robert L. Brandt, D.D.S, M.S. Jeffrey H. Brooks, D.M.D. Vinay Jain, B.D.S, M.S., M.D.S. Mark Scarbecz, Ph.D.


CBCT, CBCT Guided Dental Implant Surgery, Dental Implant Surgery, Nobel Guide, Stitched Cone Beam Computed Tomography, Stitched CBCT


Background: Recently a "stitched" small field of view (SSFOV) cone beam computed tomography (CBCT) extraoral imaging system (Kodak 9000D, Carestream Health Inc, Kodak Dental Systems, Marne‑la‑Vallee, France) has been released. The benefits of the 3D stitching module of stitched SFOV CBCT may include: broader range of applications, affordability, flexibility, safety optimizing radiation dose and improved workflow. With the reduced effective dose of radiation and cost to both the patient and clinician, this superior imaging modality becomes more accessible to the community, potentially elevating the standard of care. Currently, stitched data sets are restricted to diagnostic data gathering only. To date, no study has addressed the use of stitched SFOV CBCT data sets for import and use in the fabrication of image‑guided CAD/CAM dental implant surgical stents. In comparison to conventional implant surgery, image‑guided surgery provides safe, less‑invasive treatment and superior planning ability and accuracy for the clinician.

Objective: The purpose of this study was to evaluate the dimensional accuracy and reliability of stitched SFOV CBCT reconstructed images for use in the fabrication of surgical dental implant guides.

Methods: Three 1.5 x 1.5 mm gutta percha points were fixated on the inferior border of a human mandible serving as control reference points. An additional ten, 1.5 x 1.5 mm gutta percha points, representing fiduciary markers of a proposed radiographic template, were then scattered on the buccal and lingual cortex at the level of the proposed complete denture flange. The distances between reference points and fiduciary markers were measured with digital calipers by providing an anatomic linear dimension (ALD). The mandible was the scanned, images reconstructed and "stitched" using manufacturer's imaging software (Kodak 9000, Carestream Health Inc, Kodak Dental Systems, Marne‑la‑Vallee, France). The same measurements were accomplished within the CBCT software using the provided measuring tools and statistically evaluated for dimensional stability.

Results: In comparing the control (ALD) to the CBCT measurements, the mean difference between the ALD and SSFOV CBCT was found to be 0.34 mm with a 95% confidence interval of +0.24 to +0.44 and a mean standard deviation of 0.30. No systematic bias between the difference of the observations was evident. Thus, each measurement appeared to be as good as the other. The differences between the control and CBCT were acceptable within the defined parameters of this study.

Conclusions: Considering human error, this difference is considered clinically acceptable but should be accounted for when reading CBCT for diagnostic and or planning purposes. Proven accuracy of stitched SFOV CBCT data sets may allow image‑guided implant surgical stents to be fabricated from such data sets.