Oral Radiology

, Volume 35, Issue 2, pp 177–183 | Cite as

Comparison of cone-beam computed tomography with bitewing radiography for detection of periodontal bone loss and assessment of effects of different voxel resolutions: an in vitro study

  • Hayriye Cetmili
  • Melek TassokerEmail author
  • Sevgi Sener
Original Article



The aim of the study was to compare intraoral radiographs and CBCT images for detection of horizontal periodontal bone loss, and to investigate the diagnostic effect of different voxel resolutions in CBCT imaging.


A total of 240 sites with horizontal bone loss were measured on the buccal, lingual, mesial, and distal surfaces of 60 posterior teeth in four maxillary and six mandibular bones obtained from cadavers (dry skulls). Direct measurements on the dry skulls were accepted as the gold standard values. Measurements on CBCT images at two different voxel resolutions (0.250 and 0.160 mm3) and intraoral bitewing radiographs were compared with one another and with the gold standard values.


The measurements on the CBCT images at two voxel resolutions and bitewing radiographs did not differ significantly (p > 0.05) from the direct measurements on the dry skulls. No significant difference was found between the bitewing radiographs and CBCT images for measurements in the mesial and distal regions (p > 0.05). There was no significant difference between the measurements on the buccal and lingual surfaces at the two different voxel resolutions (p > 0.05).


CBCT scans are recommended for evaluation of buccal and lingual bone loss to avoid intraoral radiographs that exceed routine examination of interproximal alveolar bone loss. Furthermore, instead of basing the voxel size on the required CBCT scans, it is recommended to select the smallest possible field of view to reduce the dose of radiation.


CBCT Voxel Periodontal bone loss Bitewing radiography 




Compliance with ethical standards

Conflict of interest

Hayriye Cetmili, Melek Tassoker, and Sevgi Sener declare that they have no conflict of interest.

Ethical statement

The study protocol was approved by The Ethics Committee in Research of the Necmettin Erbakan University, Faculty of Dentistry (no. 2017/08). 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.


  1. 1.
    Gedik R, Marakoglu I, Demirer S. Assessment of alveolar bone levels from bitewing, periapical and panoramic radiographs in periodontitis patients. West Indian Med J. 2008;57:410–3.Google Scholar
  2. 2.
    Corbet EF, Ho DKL, Lai SML. Radiographs in periodontal disease diagnosis and management. Aust Dent J. 2009;54(Suppl 1):S27–43.CrossRefGoogle Scholar
  3. 3.
    Mol A, Balasundaram A. In vitro cone beam computed tomography imaging of periodontal bone. Dentomaxillofac Radiol. 2008;37:319–24.CrossRefGoogle Scholar
  4. 4.
    Scarfe WC, Azevedo B, Pinheiro LR, Priaminiarti M, Sales MAO. The emerging role of maxillofacial radiology in the diagnosis and management of patients with complex periodontitis. Periodontol 2000. 2017;74:116–39.CrossRefGoogle Scholar
  5. 5.
    Kim TS, Obst C, Zehaczek S, Geenen C. Detection of bone loss with different X-ray techniques in periodontal patients. J Periodontol. 2008;79:1141–9.CrossRefGoogle Scholar
  6. 6.
    Brägger U. Radiographic parameters: biological significance and clinical use. Periodontol 2000. 2005;39:73–90.CrossRefGoogle Scholar
  7. 7.
    Miracle AC, Mukherji KS. Conebeam CT of the head and neck, part 2: clinical applications. AJNR Am J Neuroradiol. 2009;30:1285–92.CrossRefGoogle Scholar
  8. 8.
    Naitoh M, Yamada S, Noguchi T, Ariji E, Nagao J, Mori K, et al. Three-dimensional display with quantitative analysis in alveolar bone resorption using cone-beam computerized tomography for dental use: a preliminary study. Int J Periodontics Restorative Dent. 2006;26:607–12.Google Scholar
  9. 9.
    Acar B, Kamburoğlu K. Use of cone beam computed tomography in periodontology. World J Radiol. 2014;6:139–47.CrossRefGoogle Scholar
  10. 10.
    Misch KA, Yi ES, Sarment DP. Accuracy of cone beam computed tomography for periodontal defect measurements. J Periodontol. 2006;77:1261–6.CrossRefGoogle Scholar
  11. 11.
    White SC, Pharoah MJ. Oral radiology: principles and interpretation. 7th ed. St. Louis: Elsevier; 2014.Google Scholar
  12. 12.
    Bragatto FP, Iwaki Filho L, Kasuya AV, Chicarelli M, Queiroz A, Takeshita WM, et al. Accuracy in the diagnosis of vertical root fractures, external root resorptions and root perforations using cone-beam computed tomography with different voxel sizes of acquisition. J Conserv Dent. 2016;19:573–7.CrossRefGoogle Scholar
  13. 13.
    Nikneshan S, Valizadeh S, Javanmard A, Alibakhshi L. Effect of voxel size on detection of external root resorption defects using cone beam computed tomography. Iran J Radiol. 2016;13:e34985.Google Scholar
  14. 14.
    Neves FS, de Freitas DQ, Campos PSF, de Almeida SM, Haiter-Neto F. In vitro comparison of cone beam computed tomography with different voxel sizes for detection of simulated external root resorption. J Oral Sci. 2012;54:219–25.CrossRefGoogle Scholar
  15. 15.
    Dalili Z, Taramsari M, Mousavi Mehr SZ, Salamat F. Diagnostic value of two modes of cone-beam computed tomography in evaluation of simulated external root resorption: an in vitro study. Imaging Sci Dent. 2012;42:19–24.CrossRefGoogle Scholar
  16. 16.
    Liedke GS, da Silveira HE, da Silveira HL, Dutra V, de Figueiredo JA. Influence of voxel size in the diagnostic ability of cone beam tomography to evaluate simulated external root resorption. J Endod. 2009;35:233–5.CrossRefGoogle Scholar
  17. 17.
    Uzun I, Gunduz K, Celenk P, Avsever H, Orhan K, Canitezer G, et al. Comparing the effect of different voxel resolutions for assessment of vertical root fracture of permanent teeth. Iran J Radiol. 2015;12:e18290.CrossRefGoogle Scholar
  18. 18.
    Junqueira RB, Verner FS, Campos CN, Devito KL, do Carmo AMR. Detection of vertical root fractures in the presence of intracanal metallic post: a comparison between periapical radiography and cone-beam computed tomography. J Endod. 2013;39:1620–4.CrossRefGoogle Scholar
  19. 19.
    Sakhdari S, Talaeipour AR, Talaeipour M, Pazhutan M, Tehrani SH, Kharazifard MJ. Diagnostic accuracy of CBCT with different voxel sizes and intraoral digital radiography for detection of periapical bone lesions: an ex-vivo study. J Dent (Tehran). 2016;13:77–84.Google Scholar
  20. 20.
    Cook VC, Timock AM, Crowe JJ, Wang M, Covell DA Jr. Accuracy of alveolar bone measurements from cone beam computed tomography acquired using varying settings. Orthod Craniofac Res. 2015;18(Suppl 1):127–36.CrossRefGoogle Scholar
  21. 21.
    Kamburoğlu K, Ereş G, Akgün C, Yeta EN, Gülen O, Karacaoĝlu F. Effect of voxel size on accuracy of cone beam computed tomography-aided assessment of periodontal furcation involvement. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;120:644–50.CrossRefGoogle Scholar
  22. 22.
    Kolsuz ME, Bagis N, Orhan K, Avsever H, Demiralp K. Comparison of the influence of FOV sizes and different voxel resolutions for the assessment of periodontal defects. Dentomaxillofac Radiol. 2015;44:20150070.CrossRefGoogle Scholar
  23. 23.
    Scaf G, Morihisa O, Loffredo LCM. Comparison between inverted and unprocessed digitized radiographic imaging in periodontal bone loss measurements. J Appl Oral Sci. 2007;15:492–4.CrossRefGoogle Scholar
  24. 24.
    Newman M, Takei H, Klokkevold P, Carranza F. Carranza’s clinical periodontology. 12th ed. St Louis: Elsevier Saunders; 2011.Google Scholar
  25. 25.
    Mohan R, Singh A, Gundappa M. Three-dimensional imaging in periodontal diagnosis—utilization of cone beam computed tomography. J Indian Soc Periodontol. 2011;15:11–7.CrossRefGoogle Scholar
  26. 26.
    du Bois AH, Kardachi B, Bartold PM. Is there a role for the use of volumetric cone beam computed tomography in periodontics? Aust Dent J. 2012;57(Suppl 1):103–8.CrossRefGoogle Scholar
  27. 27.
    Almeida VC, Pinheiro LR, Salineiro FCS, Mendes MF, Neto JBC, Cavalcanti MGP, et al. Performance of cone beam computed tomography and conventional intraoral radiographs in detecting interproximal alveolar bone lesions: a study in pig mandibles. BMC Oral Health. 2017;17:100.CrossRefGoogle Scholar
  28. 28.
    Harorlı A. Oral and maxillofacial radiology [Ağız, Diş ve ÇeneRadyolojisi]. 1st ed. Istanbul: Nobel Tıp Kitabevi; 2014 (in Turkish).Google Scholar
  29. 29.
    Skundberg PA. Radiologic science for technologists: physics, biology and protection. Radiology. 1998;207:310.CrossRefGoogle Scholar
  30. 30.
    de-Azevedo-Vaz SL, Vasconcelos Kde F, Neves FS, Melo SLS, Campos PSF, Haiter-Neto F. Detection of periimplant fenestration and dehiscence with the use of two scan modes and the smallest voxel sizes of a cone-beam computed tomography device. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115:121–7.CrossRefGoogle Scholar
  31. 31.
    Tanimoto H, Arai Y. The effect of voxel size on image reconstruction in cone-beam computed tomography. Oral Radiol. 2009;25:149–53.CrossRefGoogle Scholar
  32. 32.
    Sun Z, Smith T, Kortam S, Kim DG, Tee BC, Fields H. Effect of bone thickness on alveolar bone-height measurements from cone-beam computed tomography images. Am J Orthod Dentofac Orthop. 2011;139:e117–e127.CrossRefGoogle Scholar
  33. 33.
    Kamburoğlu K, Murat S, Kolsuz E, Kurt H, Yüksel S, Paksoy C. Comparative assessment of subjective image quality of cross-sectional cone-beam computed tomography scans. J Oral Sci. 2011;53:501–8.CrossRefGoogle Scholar
  34. 34.
    Liang X, Jacobs R, Hassan B, Li L, Pauwels R, Corpas L, et al. A comparative evaluation of cone beam computed tomography (CBCT) and multi-slice CT (MSCT) Part I. On subjective image quality. Eur J Radiol. 2010;75:265–9.CrossRefGoogle Scholar
  35. 35.
    Moshfeghi M, Tavakoli MA, Hosseini ET, Hosseini AT, Hosseini IT. Analysis of linear measurement accuracy obtained by cone beam computed tomography (CBCT-NewTom VG). Dent Res J (Isfahan). 2012;9(Suppl 1):S57–S62.Google Scholar
  36. 36.
    Leung CC, Palomo L, Griffith R, Hans MG. Accuracy and reliability of cone-beam computed tomography for measuring alveolar bone height and detecting bony dehiscences and fenestrations. Am J Orthod Dentofac Orthop. 2010;137(4 Suppl):S109–19.CrossRefGoogle Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Department of Oral and Maxillofacial Radiology, Faculty of DentistryNecmettin Erbakan UniversityKonyaTurkey

Personalised recommendations