Are dental magnetic resonance imaging and ultrasonography techniques reliable alternatives for treatment planning dental implants? A systematic review and meta-analysis.

BACKGROUND: The rising global demand for dental implant highlights the necessity for precise imaging techniques that minimise patient risk of radiation exposure. While the cone -beam Computed Tomography (CBCT) remains the gold standard, its ionizing radiation exposure raises safety concerns. This systematic review and meta-analysis aim to evaluate the accuracy of non-ionizing alternatives, Magnetic Resonance Imaging (MRI) and Ultrasonography (US), in dental implantology. METHODS: Databases (MEDLINE, Scopus, Cochrane) were searched for studies (2014-2024) using predefined PICO criteria. Risk of bias was assessed via QUADAS-2. Meta-analysis employed fixed/random-effects models to synthesize quantitative data on geometric deviations and soft-tissue accuracy. RESULTS: Twelve studies were included in this study. While MRI generally exhibited greater deviation in implant tip placement at 0.3 mm (95% CI -0.08, 0.68), its overall accuracy remained comparable to CBCT. MRI showed a higher mean deviation at the implant entry level of 0.38 mm (95% CI 0.04, 0.71) and for implant angulation with a mean difference of 0.81 degree (95% CI -0.50, 2.12), indicating less precision under specific conditions. Conversely, Ultrasonography demonstrated superior performance in soft tissue accuracy with a smaller deviation compared to CBCT, at just 0.04 mm (95% CI -0.04, 0.13). CONCLUSION: MRI and ultrasonography offer reliable non-ionizing alternatives for dental implant planning, with MRI matching CBCT in hard-tissue accuracy and ultrasonography excelling in soft tissue assessment. Further standardisation of protocols is needed to address variability in clinical workflows. CLINICAL TRIAL NUMBER: The Clinical Trial Number is not applicable in this systematic review. This study was prospectively registered on the International Prospective Register of Systematic Reviews (PROSPERO) online with the identification number CRD42024610741.