Comparison between panoramic and intra-oral radiographs for the assessment of alveolar bone levels in a periodontal maintenance population.

BACKGROUND Information about the agreement between intra-oral (I-O) and panoramic (OPG) radiographs is limited. AIMS : (1) To assess the agreement between I-Os and OPGs for direct measurements of the distance between the cemento-enamel junction (CEJ) and the alveolar bone level (BL) as well as the proportional values in relation to the root length (CEJ-BL/root length), and (2) to explore the symmetry between the left- and right-side measurements. MATERIAL AND METHODS I-Os and OPGs were studied in 292 periodontal maintenance subjects (mean age 55.5 years, SD+/-12.6) with on average 22.4 teeth (SD+/-4.1 range: 6-28). The images were measured using a PC software program. Site-based I-O and OPG values for CEJ-BL as well as CEJ-BL/root length were compared. OPG values of CEJ-BL/root length values between the left and right sides were also studied. RESULTS A total of 11,395 linear distances (CEJ-BL plus CEJ-apex) from the I-Os and 21,462 linear distances from the OPGs were measured. The intra-class correlation coefficients (ICCs) between sets of readings of CEJ-BL varied between 0.80 and 0.89 (p<0.001), with the best agreement for tooth 22 (ICC: 0.89; 95% CI: 0.83-0.92). The ICCs for CEJ-BL/root length varied between 0.54 and 0.92. Mean differences between I-O and OPG values were in the 0.00-0.04 mm range for the CEJ-BL/root length comparisons. The maxillary anterior sextant demonstrated a 1.4 x enlargement by OPG for the CEJ-BL/root length comparisons. No distortions were observed for mandibular sextants. Left- and right-side symmetry of periodontal bone loss was demonstrated. ICC varied between 0.79 (95.00% CI: 0.71-0.84, p<0.01) and 0.53 (95.00% CI: 0.36-0.65, p< 0.01). CONCLUSIONS I-O and OPG radiograph readings are in great agreement. Alveolar bone loss appeared to have a symmetrical distribution pattern. Hence for periodontal assessments, OPG radiographic readings may, at least in part, substitute for full-mouth periapical radiographic evaluation.

[1]  M. Rohlin,et al.  Measurements of tooth length in panoramic radiographs. 2: Observer performance. , 1992, Dento maxillo facial radiology.

[2]  H. Björn,et al.  Radiographic determination of periodontal bone destruction in epidemiological research. , 1966, Odontologisk revy.

[3]  A. Forsythe,et al.  Patient-selection criteria for panoramic radiography. , 1984, Oral surgery, oral medicine, and oral pathology.

[4]  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.

[5]  H. Falk,et al.  A retrospective radiographic outcome assessment study of intra-bony defects treated by osseous surgery or by bone graft procedures. , 2000, Journal of clinical periodontology.

[6]  H. Gröndahl,et al.  Agreement between panoramic and intra-oral radiography in the assessment of marginal bone height. , 1991, Dento maxillo facial radiology.

[7]  E Hausmann,et al.  Effect of x-ray beam vertical angulation on radiographic alveolar crest level measurement. , 1989, Journal of periodontal research.

[8]  W. T. McFall.  Tooth loss in 100 treated patients with periodontal disease. A long-term study. , 1982, Journal of periodontology.

[9]  F. Krummenauer,et al.  Precision and accuracy of measurements in digital panoramic radiography. , 2000, Dento maxillo facial radiology.

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

[11]  M. Rohlin,et al.  Marginal bone in periodontal disease: an evaluation of image quality in panoramic and intra-oral radiography. , 1989, Dento maxillo facial radiology.

[12]  E. Vañó,et al.  Reference doses in dental radiodiagnostic facilities. , 2001, The British journal of radiology.

[13]  J. Williams,et al.  Measurement of dose in panoramic dental radiology. , 2000, The British journal of radiology.

[14]  L Hollender,et al.  A radiographic method for assessing changes in alveolar bone height following periodontal therapy. , 1975, Journal of clinical periodontology.

[15]  A. Mombelli,et al.  On the symmetry of periodontal disease. , 2001, Journal of clinical periodontology.

[16]  J. Rise,et al.  Reliability of plaque and periodontal measurements estimated by the internal consistency method. , 1984, Acta odontologica Scandinavica.

[17]  G. R. Persson,et al.  Comparisons of clinical and radiographic measurements of inter-proximal vertical defects before and 1 year after surgical treatments. , 2000, Journal of clinical periodontology.

[18]  N. Lang,et al.  Effect of interleukin-1 gene polymorphisms on gingival inflammation assessed by bleeding on probing in a periodontal maintenance population. , 2000, Journal of periodontal research.

[19]  J. Egelberg,et al.  Healing after treatment of periodontal intraosseous defects. I. Comparative study of clinical methods. , 1981, Journal of clinical periodontology.

[20]  P. Hirschmann,et al.  Survey of radiographic practices for periodontal disease in UK and Irish dental teaching hospitals. , 2000, Dento maxillo facial radiology.

[21]  M. Kantor,et al.  Efficacy of Panoramic Radiography in Dental Diagnosis and Treatment Planning , 1989, Journal of dental research.

[22]  J. D. De Boever,et al.  Comparison of intra-oral long-cone paralleling radiographic surveys and orthopantomographs with special reference to the bone height. , 1982, Journal of oral rehabilitation.

[23]  A. P. Barrett,et al.  A critical evaluation of panoramic radiography as a screening procedure in dental practice. , 1984, Oral surgery, oral medicine, and oral pathology.

[24]  N. Lang,et al.  Short-term effects of initial periodontal therapy (hygienic phase). , 1991, Journal of clinical periodontology.

[25]  H G Gröndahl,et al.  Digital subtraction radiography for diagnosis of periodontal bone lesions with simulated high-speed systems. , 1983, Oral surgery, oral medicine, and oral pathology.

[26]  N. Lang,et al.  Evaluation of tetracycline fiber therapy with digital image analysis. , 1998, Journal of clinical periodontology.

[27]  Ray Williams,et al.  Periodontal regeneration of human infrabony defects. III. Diagnostic strategies to detect bone gain. , 1993, Journal of periodontology.

[28]  N. Lang,et al.  Effect of chlorhexidine (0.12%) rinses on periodontal tissue healing after tooth extraction. (I). Clinical parameters. , 1994, Journal of clinical periodontology.