A novel methodology for characterizing implant recipient bone sites using free software for clinicians

Accurate analysis of the bone bed is essential for surgical planning in implant dentistry and for understanding the relationship between bone parameters and primary implant stability. However, characterization of the bone bed after implant placement still presents methodological limitations, particularly in retrospective studies. This study presents a novel methodology of image superimposition between two cone-beam computed tomography (CBCT) acquisitions that retrospectively enables localization of the exact tomographic slice corresponding to the three-dimensional position of the placed implant, thus allowing detailed characterization of the bone bed. Pre- and postoperative CBCT scans of patients who received implants in the interforaminal region of the mandible were used. The Blue Sky Plan software was employed for segmentation of the mandible and implants, as well as for image superimposition based on stable anatomical landmarks. This methodology enabled direct measurements of bone thickness, implant position relative to the cortical plates, and evaluation of the buccal cortical bone. All measurements on CBCT images were performed by a single calibrated examiner, in duplicate, with a one-month interval between assessments. The intraclass correlation coefficient (ICC) was applied, and values equal to or greater than 0.80 were considered acceptable. The proposed superimposition method demonstrated high accuracy and reproducibility, allowing objective assessment of the bone bed even after implant placement. This methodology is free, accessible, and applicable to diverse clinical and research contexts, as well as adaptable to different areas of oral and maxillofacial surgery. The technique represents an innovative tool for retrospective analyses in implant dentistry, with potential to improve methodological quality and optimize digital planning protocols.