Abstract
OBJECTIVES: To create a new phantom design to evaluate the real impact of artefacts caused by titanium on bone structures in cone beam CT images considering different positions and quantity of metals in the dental arch, with and without metal artefact reduction (MAR). METHODS: A three cylindrical polymethyl methacrylate (PMMA) plate phantom was designed containing eight perforations arranged to simulate the lower dental arch in the intermediate plate. Three titanium cylinders were positioned in different locations and quantities to test different clinical conditions and to quantify the impact of the metal artefact around five bone cylinders. Scans were carried out in seven different protocols (Control, A-F) in two cone beam CT devices (OP300 Maxio and Picasso Trio). Eight regions of interest around each cortical and trabecular bone were used to measure the grey value standard deviation corresponding the artefact expression in the Image J software. Both the artefact expression and the MAR effect were assessed using the Wilcoxon, Friedman (Dunn) and Kruskal-Wallis tests (significance level of 5%). RESULTS: For both devices, MAR was statistically efficient only for the protocols E, and F. Protocol F (three metals on the adjacent area of the analysis region) showed higher artefact expression when compared to the others. CONCLUSION: In conclusion, the new phantom design allowed the quantification of the metal artefact expression caused by titanium. The metal artefact expression is higher when more metal objects are positioned in the adjacent bone structures. MAR may not be effective to reduce artefact expression on the adjacencies of those objects for the devices studied.