Single-tooth implant placement in the esthetic zone is a highly reliable treatment option for replacing a failing tooth [1-4]. Yet, research interest has shifted from implant survival towards optimal preservation of soft and hard tissues [5-7]. Especially in the esthetic region, buccal bone and its preservation is one of the key factors in esthetic outcome [8].

Computerized tomography (CT) scans and cone beam CTs (CBCTs) are commonly used for presurgical planning and to predict bone density and potential stability of dental implants [9]. Next to this, CTs and CBCTs also allow for measuring bone at dental implants during follow-up [10,11]. The quality and accuracy of a three-dimensional (3D) model derived from a (CB)CT is dependent on scanner-related factors such as type of scanner, field of view (FoV), artifacts, and voxel size [12]. In addition, patient-related factors such as patient position and metal artifacts [13] and operator-related factors such as the segmentation process or interpretation of the (CB)CT are of influence [14]. It has been reported that buccal bone thickness at implant sites can be measured with CBCT, but background scattering and problems with standardization of the measurements are frequently encountered [15]. In view of the aforementioned factors, there is need for a reliable, reproducible method to facilitate measurements. The use of 3D image diagnostic and treatment planning software programs in combination with software programs for tracking and registration of the exact position of existing dental implants in radiographs can be of help [16].

The aim of the current study was to develop a reproducible method based on 3D image diagnostic and treatment planning software programs for buccal bone measurements at implants on CBCTs.