Abstract
Objectives
Cone-beam computed tomography (CBCT) has been widely used in many fields of dentistry. However, little is known about the accuracy of CBCT for evaluation of periodontal status. The objective of this study was to compare and correlate periodontal assessments among CBCT, clinical attachment loss (CAL) measurement, and periapical (PA)/bitewing (BW) radiography.
Methods
Eighty patients (28 males, 52 females; age range, 19–84 years) from the University of Texas School of Dentistry at Houston were evaluated retrospectively. Measurements were taken on the central incisors, canines, and first molars of the right maxilla and left mandible. CAL was extracted from periodontal charts. The radiographic distance from the cementum–enamel junction (CEJ) to the alveolar crest was measured for tooth mesial and distal sites on PA/BW and CBCT images using MiPacs software and Anatomage Invivo software, respectively. One-way ANOVA and Pearson analysis were performed for statistical analyses.
Results
The CEJ–crest distances for CBCT, PA/BW, and CAL were 2.56 ± 0.12, 2.04 ± 0.12, and 2.08 ± 0.17 mm (mean ± SD), respectively. CBCT exhibited larger values than the other two methods (p < 0.05). There were highly significant positive correlations among CBCT, PA/BW, and CAL measurements at all examined sites (p < 0.001). The Pearson correlation coefficient was higher for CBCT with CAL relative to PA/BW with CAL, but the difference was not significant (r = 0.64 and r = 0.55, respectively, p > 0.05).
Conclusions
This study validates the suitability of CBCT for periodontal assessment. Further studies are necessary to optimize the measurement methodology with CBCT.
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References
Loe H, Anerud A, Boysen H, Morrison E. Natural history of periodontal disease in man. Rapid, moderate and no loss of attachment in Sri Lankan laborers 14–46 years of age. J Clin Periodontol. 1986;13:431–45.
Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. Lancet. 2005;366:1809–20.
Eke PI, Dye BA, Wei L, Slade GD, Thornton-Evans GO, Borgnakke WS, et al. Update on prevalence of periodontitis in adults in the United States: NHANES 2009 to 2012. J Periodontol. 2015;86:611–22.
Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJ. CDC Periodontal Disease Surveillance workgroup: James Beck GDRP: prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res. 2012;91:914–20.
Beck JD, Eke P, Heiss G, Madianos P, Couper D, Lin D, et al. Periodontal disease and coronary heart disease: a reappraisal of the exposure. Circulation. 2005;112:19–24.
Offenbacher S. Maternal periodontal infections, prematurity, and growth restriction. Clin Obstet Gynecol. 2004;47:808–21.
Scannapieco FA. Periodontal inflammation: from gingivitis to systemic disease? Compend Contin Educ Dent. 2004;25:16–25.
Highfield J. Diagnosis and classification of periodontal disease. Aust Dent J. 2009;54:S11–26.
Holtfreter B, Alte D, Schwahn C, Desvarieux M, Kocher T. Effects of different manual periodontal probes on periodontal measurements. J Clin Periodontol. 2012;39:1032–41.
Bulthuis HM, Barendregt DS, Timmerman MF, Loos BG, van der Velden U. Probe penetration in relation to the connective tissue attachment level: influence of tine shape and probing force. J Clin Periodontol. 1998;25:417–23.
van der Velden U. Probing force and the relationship of the probe tip to the periodontal tissues. J Clin Periodontol. 1979;6:106–14.
Clerehugh V, Abdeia R, Hull PS. The effect of subgingival calculus on the validity of clinical probing measurements. J Dent. 1996;24:329–33.
Corraini P, Baelum V, Lopez R. Reliability of direct and indirect clinical attachment level measurements. J Clin Periodontol. 2013;40:896–905.
Fowler C, Garrett S, Crigger M, Egelberg J. Histologic probe position in treated and untreated human periodontal tissues. J Clin Periodontol. 1982;9:373–85.
Magnusson I, Listgarten MA. Histological evaluation of probing depth following periodontal treatment. J Clin Periodontol. 1980;7:26–31.
Hill EG, Slate EH, Wiegand RE, Grossi SG, Salinas CF. Study design for calibration of clinical examiners measuring periodontal parameters. J Periodontol. 2006;77:1129–41.
Michalowicz BS, Hodges JS, Pihlstrom BL. Is change in probing depth a reliable predictor of change in clinical attachment loss? J Am Dent Assoc. 2013;144:171–8.
Corbet EF, Ho DK, Lai SM. Radiographs in periodontal disease diagnosis and management. Aust Dent J. 2009;54:S27–43.
Hausmann E, Allen K, Clerehugh V. What alveolar crest level on a bite-wing radiograph represents bone loss? J Periodontol. 1991;62:570–2.
Jeffcoat MK. Current concepts in periodontal disease testing. J Am Dent Assoc. 1994;125:1071–8.
Reddy MS. Radiographic methods in the evaluation of periodontal therapy. J Periodontol. 1992;63:1078–84.
Bragger U. Radiographic parameters: biological significance and clinical use. Periodontology. 2000;2005(39):73–90.
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.
Mol A. Imaging methods in periodontology. Periodontology. 2000;2004(34):34–48.
Aljehani YA. Diagnostic applications of cone-beam CT for periodontal diseases. Int J Dent. 2014;. doi:10.1155/2014/865079.
Mol A, Balasundaram A. In vitro cone beam computed tomography imaging of periodontal bone. Dentomaxillofac Radiol. 2008;37:319–24.
Pinsky HM, Dyda S, Pinsky RW, Misch KA, Sarment DP. Accuracy of three-dimensional measurements using cone-beam CT. Dentomaxillofac Radiol. 2006;35:410–6.
Raichur PS, Setty SB, Thakur SL, Naikmasur VG. Comparison of radiovisiography and digital volume tomography to direct surgical measurements in the detection of infrabony defects. J Clin Exp Dent. 2012;4:e43–7.
Dutta A, Smith-Jack F, Saunders WP. Prevalence of periradicular periodontitis in a Scottish subpopulation found on CBCT images. Int Endod J. 2014;47:854–63.
Guerrero ME, Jacobs R, Loubele M, Schutyser F, Suetens P, van Steenberghe D. State-of-the-art on cone beam CT imaging for preoperative planning of implant placement. Clin Oral Investig. 2006;10:1–7.
Honda K, Arai Y, Kashima M, Takano Y, Sawada K, Ejima K, et al. Evaluation of the usefulness of the limited cone-beam CT (3DX) in the assessment of the thickness of the roof of the glenoid fossa of the temporomandibular joint. Dentomaxillofac Radiol. 2004;33:391–5.
Liu DG, Zhang WL, Zhang ZY, Wu YT, Ma XC. Localization of impacted maxillary canines and observation of adjacent incisor resorption with cone-beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105:91–8.
Nakajima K, Yamaguchi T, Maki K. Surgical orthodontic treatment for a patient with advanced periodontal disease: evaluation with electromyography and 3-dimensional cone-beam computed tomography. Am J Orthod Dentofac Orthop. 2009;136:450–9.
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;57:103–8.
Misch KA, Yi ES, Sarment DP. Accuracy of cone beam computed tomography for periodontal defect measurements. J Periodontol. 2006;77:1261–6.
Vandenberghe B, Jacobs R, Yang J. Diagnostic validity (or acuity) of 2D CCD versus 3D CBCT-images for assessing periodontal breakdown. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104:395–401.
Grimard BA, Hoidal MJ, Mills MP, Mellonig JT, Nummikoski PV, Mealey BL. Comparison of clinical, periapical radiograph, and cone-beam volume tomography measurement techniques for assessing bone level changes following regenerative periodontal therapy. J Periodontol. 2009;80:48–55.
Vandenberghe B, Jacobs R, Yang J. Detection of periodontal bone loss using digital intraoral and cone beam computed tomography images: an in vitro assessment of bony and/or infrabony defects. Dentomaxillofac Radiol. 2008;37:252–60.
de Vasconcelos Faria K, Evangelista KM, Rodrigues CD, Estrela C, de Sousa TO, et al. Detection of periodontal bone loss using cone beam CT and intraoral radiography. Dentomaxillofac Radiol. 2012;41:64–9.
Fuhrmann RA, Bucker A, Diedrich PR. Assessment of alveolar bone loss with high resolution computed tomography. J Periodontal Res. 1995;30:258–63.
Takeshita WM, Iwaki LCV, Da Silva MC, Tonin RH. Evaluation of diagnostic accuracy of conventional and digital periapical radiography, panoramic radiography, and cone-beam computed tomography in the assessment of alveolar bone loss. Contemp Clin Dent. 2014;5:318–23.
Anter E, Zayet MK, El-Dessouky SH. Accuracy and precision of cone beam computed tomography in periodontal defects measurement (systematic review). J Indian Soc Period. 2016;20:235–43.
Feijo CV, Lucena JG, Kurita LM, Pereira SL. Evaluation of cone beam computed tomography in the detection of horizontal periodontal bone defects: an in vivo study. Int J Periodontics Restor Dent. 2012;32:e162–8.
Ising N, Kim KB, Araujo E, Buschang P. Evaluation of dehiscences using cone beam computed tomography. Angle Orthod. 2012;82:122–30.
Guo YJ, Ge ZP, Ma RH, Hou JX, Li G. A six-site method for the evaluation of periodontal bone loss in cone-beam CT images. Dentomaxillofac Radiol. 2016;. doi:10.1259/dmfr.20150265.
Ferrare N, Leite AF, Caracas HC, de Azevedo RB, de Melo NS, de Souza Figueiredo PT. Cone-beam computed tomography and microtomography for alveolar bone measurements. Surg Radiol Anat. 2013;35:495–502.
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:S109–19.
White SC, Pharoah MJ. Oral radiology principles and interpretation. 7th ed. St. Louis: Elsevier; 2014.
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Wenjian Zhang, Shazia Rajani, and Bing-Yan Wang declare that they have no conflict of interest.
Human rights statement
All procedures followed were in accordance with the ethical standards of the responsible national and institutional committees on human experimentation and with the Helsinki Declaration of 1964 and later versions. The Institutional Review Board (IRB) of the University of Texas Health Science Center at Houston approval was granted prior to the start of the study (HSC-DB-16-0398).
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The study was a retrospective chart review, and the requirement for informed consent was waived under IRB approval.
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Zhang, W., Rajani, S. & Wang, BY. Comparison of periodontal evaluation by cone-beam computed tomography, and clinical and intraoral radiographic examinations. Oral Radiol 34, 208–218 (2018). https://doi.org/10.1007/s11282-017-0298-4
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DOI: https://doi.org/10.1007/s11282-017-0298-4