Quantitative digital subtraction radiography for the determination of small changes in bone thickness: an in vitro study.

OBJECTIVE The objective of this study was to determine the ability of quantitative digital subtraction radiography to detect small changes in bone thickness adjacent to tooth roots. STUDY DESIGN A series of cortical or cancellous bone slices with a 50 microm-stepwise increasing thickness were attached to 4 porcine mandible sections covering buccal and interproximal "defect" regions. Standardized radiographs were quantitatively evaluated for radiographic density changes with the use of digital subtraction radiography. Furthermore, all radiographs were conventionally evaluated by 10 clinicians. The Wilcoxon signed-rank test and the Mann-Whitney U test were used for statistical analysis (alpha = 0.05). RESULTS A high linear correlation was found between the actual thickness of bone slices and radiographic density changes (cortical bone: r2 = 0.89 to 0.99; cancellous bone r2 = 0.61 to 0.86, p < or = 0.001). A certain increase in bone thickness caused a 3 times higher increase in radiographic density for cortical bone than for cancellous bone (p < or = 0.05). The detection limits of digital subtraction radiography were 200 microm for cortical and 500 microm for cancellous bone, whereas the detection limits of conventional radiography were 600 microm and 2850 microm, respectively. CONCLUSIONS This in vitro study demonstrated a very high correlation between the objective, quantitative assessment of subtle changes in alveolar bone by digital subtraction radiography and the true changes in bone thickness.

[1]  G. Pini-Prato,et al.  Periodontal regeneration of human intrabony defects. IV. Determinants of healing response. , 1993, Journal of periodontology.

[2]  H G Gröndahl,et al.  A digital subtraction technique for dental radiography. , 1983, Oral surgery, oral medicine, and oral pathology.

[3]  I. Brägger.  Radiographic diagnosis of periodontal disease progression. , 1996, Current opinion in periodontology.

[4]  D. F. Mitchell,et al.  A roentgenographic study of experimental bone destruction. , 1962, Oral surgery, oral medicine, and oral pathology.

[5]  U Brägger,et al.  Computer-assisted densitometric image analysis in periodontal radiography. A methodological study. , 1988, Journal of clinical periodontology.

[6]  K. Hiller,et al.  Periodontal regeneration of intrabony defects with resorbable and non-resorbable membranes: 30-month results. , 1997, Journal of clinical periodontology.

[7]  D. Benn.  Limitations of the digital image subtraction technique in assessing alveolar bone crest changes due to misalignment errors during image capture. , 1990, Dento maxillo facial radiology.

[8]  R. L. Webber,et al.  A robust digital method for film contrast correction in subtraction radiography. , 1986, Journal of periodontal research.

[9]  P. Janssen,et al.  Problems around the in vitro and in vivo application of quantitative digital subtraction radiography. , 1989, Journal of clinical periodontology.

[10]  R L Webber,et al.  X-ray image subtraction as a basis for assessment of periodontal changes. , 1982, Journal of periodontal research.

[11]  M S Reddy,et al.  Extraoral control of geometry for digital subtraction radiography. , 1987, Journal of periodontal research.

[12]  J. D. Suomi,et al.  A comparative study of radiographs and pocket measurements in periodontal disease evaluation. , 1968, Journal of periodontology.

[13]  H G Gröndahl,et al.  Influence of variations in projection geometry on the detectability of periodontal bone lesions. A comparison between subtraction radiography and conventional radiographic technique. , 1984, Journal of clinical periodontology.

[14]  R. L. Webber,et al.  Calibration errors in digital subtraction radiography. , 1990, Journal of periodontal research.

[15]  J van Aken,et al.  The detection of in vitro produced periodontal bone lesions by conventional radiography and photographic subtraction radiography using observers and quantitative digital subtraction radiography. , 1989, Journal of clinical periodontology.

[16]  E Hausmann,et al.  Analytical methodology in quantitative digital subtraction radiography: analyses of the aluminum reference wedge. , 1996, Journal of periodontology.

[17]  T. Southard,et al.  Detection of simulated osteoporosis in dog alveolar bone with the use of digital subtraction. , 1994, Oral surgery, oral medicine, and oral pathology.

[18]  Accuracy in detecting bone lesions in vitro with conventional and subtracted direct digital imaging. , 1995, Dento maxillo facial radiology.

[19]  A Wenzel,et al.  Sources of noise in digital subtraction radiography. , 1991, Oral surgery, oral medicine, and oral pathology.

[20]  S R Matteson,et al.  Advanced imaging methods. , 1996, Critical reviews in oral biology and medicine : an official publication of the American Association of Oral Biologists.

[21]  T. Southard,et al.  Detection of simulated osteoporosis in human anterior maxillary alveolar bone with digital subtraction. , 1994, Oral surgery, oral medicine, and oral pathology.

[22]  L. Ortman,et al.  Relationship between alveolar bone measured by 125I absorptiometry with analysis of standardized radiographs: 2. Bjorn technique. , 1982, Journal of periodontology.

[23]  W. H. Hiatt,et al.  Repair following mucoperiosteal flap surgery with full gingival retention. , 1968, Journal of periodontology.

[24]  K Allen,et al.  Relationship of texture measurements to the prediction of correct evaluations in subtraction radiography. , 1992, Journal of periodontal research.

[25]  N P Lang,et al.  Digital image processing. II. In vitro quantitative evaluation of soft and hard peri-implant tissue changes. , 1994, Clinical oral implants research.

[26]  C. Lindh,et al.  Trabecular bone volume and bone mineral density in the mandible. , 1997, Dento maxillo facial radiology.

[27]  H. Gröndahl,et al.  Detectability of artificial marginal bone lesions as a function of lesion depth. A comparison between subtraction radiography and conventional radiographic technique. , 1988, Journal of clinical periodontology.

[28]  N P Lang,et al.  Digital image processing. I. Evaluation of gray level correction methods in vitro. , 1994, Clinical oral implants research.

[29]  K. Kornman.  Nature of periodontal diseases: assessment and diagnosis. , 1987, Journal of periodontal research.

[30]  K. Hiller,et al.  GTR therapy of intrabony defects using 2 different bioresorbable membranes: 12-month results. , 1998, Journal of clinical periodontology.

[31]  M. Ohki,et al.  Quantitative evaluation of proximal bone lesions using digital subtraction radiography. , 1988, Dento maxillo facial radiology.

[32]  K. Hiller,et al.  Quantitative digital subtraction radiography for assessment of bone density changes following periodontal guided tissue regeneration. , 1996, Dento maxillo facial radiology.

[33]  P. Janssen,et al.  Quantitative measurement of periodontal bone changes by digital subtraction. , 1986, Journal of periodontal research.

[34]  Influence of variations in projection geometry and lesion size on detection of computer-simulated crestal alveolar bone lesions by subtraction radiography. , 1991, Journal of periodontal research.

[35]  M. E. Tumbleson.  Swine in biomedical research , 1986 .

[36]  J van Aken,et al.  The effect of in-vivo-occurring errors in the reproducibility of radiographs on the use of the subtraction technique. , 1989, Journal of clinical periodontology.

[37]  E Hausmann,et al.  Subtraction radiography and computer assisted densitometric analyses of standardized radiographs. A comparison study with 125I absorptiometry. , 1985, Journal of periodontal research.

[38]  J. Wennström,et al.  Radiographic detectability of bone loss in the bifurcation of mandibular molars: an experimental study. , 1994, Dento maxillo facial radiology.

[39]  A Wenzel.  Effect of manual compared with reference point superimposition on image quality in digital subtraction radiography. , 1989, Dento maxillo facial radiology.

[40]  E Hausmann,et al.  Usefulness of Subtraction Radiography in the Evaluation of Periodontal Therapy. , 1985, Journal of periodontology.

[41]  P. Waite,et al.  Use of digital radiography to demonstrate the potential of naproxen as an adjunct in the treatment of rapidly progressive periodontitis. , 1991, Journal of periodontal research.

[42]  N. Lang,et al.  Radiographs in periodonties , 1977 .

[43]  D. Benn,et al.  A computer-assisted method for making linear radiographic measurements using stored regions of interest. , 1992, Journal of clinical periodontology.

[44]  M S Reddy,et al.  Quantitative digital subtraction radiography for the assessment of peri-implant bone change. , 1992, Clinical oral implants research.

[45]  M. Rohlin,et al.  Comparison of panoramic and intraoral radiography and pocket probing for the measurement of the marginal bone level. , 1992, Journal of clinical periodontology.

[46]  A Tzukert,et al.  The effects of beam hardening on digital subtraction radiography. , 1989, Journal of periodontal research.

[47]  S. Lynch.  Methods for Evaluation of Regenerative Procedures. , 1992, Journal of periodontology.

[48]  U. Ruttimann,et al.  Volumetry of localized bone lesions by subtraction radiography. , 1987, Journal of periodontal research.