Oral Radiology

, Volume 35, Issue 2, pp 152–158 | Cite as

Reproducibility of CBCT image analysis: a clinical study on intrapersonal and interpersonal errors in bone structure determination

  • Sigmar SchnutenhausEmail author
  • Michael Graf
  • Isabel Doering
  • Ralph G. Luthardt
  • Heike Rudolph
Original Article



For correct implant planning based on cone-beam computed tomography (CBCT), the bone contour must be accurately determined. Identification of the contour is difficult in bones with incomplete mineralization. In this clinical study, we investigated the intrapersonal and interpersonal reproducibilities of manual bone contour determination on CBCT images using a semi-automated computerized process.


The bone surface level in the area of the socket in 20 patients who had undergone tooth extraction from the upper jaw at 10 ± 1 weeks previously was determined on CBCT images. Two investigators with different levels of experience determined the bone structure initially (T0) and repeated the procedure after 3 months (T1). The bone structure marked on CBCT images was converted into a surface data set. The resulting data sets were superimposed on one another. In the analyses, the shortest distances between the datasets were identified and measured. The average deviations were statistically evaluated.


The intrapersonal evaluation resulted in an average deviation of 0.18 mm across both investigators. The interpersonal analysis comparing the two investigators resulted in average deviations of 0.15 mm at T0 and 0.26 mm at T1. Significant differences were not found.


The low intrapersonal deviation indicates that the procedure has satisfactory reproducibility. All deviations were within the range of the selected resolution of the CBCT device. Application of a semi-automated procedure to detect the bone border in areas with incomplete mineralization is a predictable process.

Trial registration

The study was registered in the German Clinical Trials Register and the International Clinical Trials Registry Platform of the WHO: DRKS00004769, date of registration: 28 February 2013; and DRKS00005978, date of registration: 09 November 2015.


CBCT Observer error Bone surface determination Accuracy Guided implantology 



The study was funded by Resorba Medical GmbH (Nürnberg, Germany) and the Oral Reconstruction Foundation (Basel, Switzerland) (Grant No. CF 41305).

Compliance with ethical standards

Conflict of interest

Sigmar Schnutenhaus, Michael Graf, Isabel Doering, Ralph G. Luthardt, and Heike Rudolph declare no conflicts of interest.

Ethical approval

The Ethical Committee of the Medical Faculty of Ulm University approved the current study design (processing number: 337/12 and 41/14). The trial was registered at the German Clinical Trial Registry and the International Clinical Trials Registry Platform of the WHO, with assigned numbers DRKS00004769 and DRKS00005978.

Human right statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

Informed consent

Informed consent was obtained from all patients for being included in the study.


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Copyright information

© Japanese Society for Oral and Maxillofacial Radiology and Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.HilzingenGermany
  2. 2.Department of Prosthetic Dentistry, Center of DentistryUlm UniversityUlmGermany
  3. 3.ScheideggGermany

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