|Year : 2018 | Volume
| Issue : 2 | Page : 81-85
A comparative study of cone-beam computed tomography and intrasurgical measurements of intrabony periodontal defects
Santosh R Patil1, Ibrahim A Al-Zoubi2, Ravi Gudipaneni3, Kuraym Khalid Kuraym Alenazi4, Nidhi Yadav5
1 Department of Oral Medicine and Radiology, College of Dentistry, Aljouf University, Sakaka, Al-Jouf, Saudi Arabia
2 Department of Preventive Dentistry, College of Dentistry, Aljouf University, Sakaka, Al-Jouf, Saudi Arabia
3 Department of Pedodontics, College of Dentistry, Aljouf University, Sakaka, Al-Jouf, Saudi Arabia
4 Department of Orthodontics, College of Dentistry, Aljouf University, Sakaka, Al-Jouf, Saudi Arabia
5 Department of Oral Medicine and Radiology, Jodhpur Dental College, Jodhpur National University, Jodhpur, Rajasthan, India
|Date of Web Publication||18-Dec-2018|
Santosh R Patil
Department of Oral Medicine and Radiology, College of Dentistry, Aljouf University, Sakaka, Al -Jouf
Source of Support: None, Conflict of Interest: None
Objective: The objective of this study was to analyze the correlation between cone-beam computed tomography (CBCT) measurements and intrasurgical measurements of intrabony periodontal defects.
Materials and Methods: Thirty-two patients with intrabony defects, who underwent periodontal therapy and were advised for surgical therapy, were included in this study. Diagnostic images were obtained by periapical radiographs and CBCT before the surgical procedure. The distance from the cementoenamel junction to the base of the periodontal defect (CEJ–BD), the distance from the crest of bone to the deepest point of the defect, and mesiodistal (M-D) width of the periodontal defect were measured on CBCT and periapical radiographs during the surgical procedure. The faciolingual width of the defect was only measured on CBCT images during the surgical procedure. The linear measurements obtained during the surgical therapy were compared with that obtained by intraoral radiographs and CBCT imaging.
Results: The M-D width of the defect measured during the surgical procedure was similar to that measured on the periapical radiograph. The distance of CEJ to BD and the distance from the crest of bone to the deepest point of the defect measured on the periapical radiographs were less than that of intrasurgical measurements. No significant difference was noted regarding the CBCT measurements of the faciolingual width and M-D width of the defect when compared with the measurements obtained during the surgical procedures. A significant difference was noted in the CBCT measurements from the CEJ to BD and the distance from the crest of bone to the deepest point of the defect when compared with the intrasurgical measurements.
Conclusion: CBCT may lend comparatively discriminative dimensions of the periodontal defect similar to that of intrasurgical measurements.
Keywords: Cone-beam computed tomography, intrabony periodontal defect, intraoral periapical radiographs, linear measurement
|How to cite this article:|
Patil SR, Al-Zoubi IA, Gudipaneni R, Alenazi KK, Yadav N. A comparative study of cone-beam computed tomography and intrasurgical measurements of intrabony periodontal defects. Int J Oral Health Sci 2018;8:81-5
|How to cite this URL:|
Patil SR, Al-Zoubi IA, Gudipaneni R, Alenazi KK, Yadav N. A comparative study of cone-beam computed tomography and intrasurgical measurements of intrabony periodontal defects. Int J Oral Health Sci [serial online] 2018 [cited 2020 Jun 4];8:81-5. Available from: http://www.ijohsjournal.org/text.asp?2018/8/2/81/247797
| Introduction|| |
Radiographic imaging assumes a critical part in diagnosing periodontal diseases as they display the amount and nature of injury caused to the alveolar tissues. Various intra- and extra-oral imaging techniques are accessible to aid the diagnosis and treatment plan for patients with periodontal diseases. Some of the routinely used radiographic views are bitewing, periapical, and panoramic views. One of the limitations of these views is that they only provide a two-dimensional (2D) representation of a three-dimensional (3D) object. Funnel-shaped, lingual defects, buccal plate loss, hemiseptum, intrabony defects, and furcation involvements cannot be evaluated using routine radiographic imaging modalities.,
To overcome the inherent difficulties of intraoral periapical radiograph (IOPA), 3D image analysis employing cone-beam computed tomography (CBCT), a relatively latest imaging method, is advised. When compared with conventional radiographic images, CBCT images reveal minimal distortion and overlapping., CBCT gives the morphologic description of bone defects and measures intrabony defects in sagittal, axial, and coronal planes without magnification and superimposition. The bone volume, quality of hard tissue, interproximal defects, buccolingual (B-L) defects, furcation defects, dehiscence, and fenestrations can be very well depicted by CBCT imaging. Treatment-outcome evaluations, especially to assess healing after grafting, can also be very well assessed using the CBCT. This imaging modality can also be employed for measuring the gingival tissue and the dentogingival unit dimensions.,
Topography and clinical observation is regarded as the precise method in analyzing the number of walls existing or missing and for diagnosing periodontal diseases. At present, radiography is used as a supplementary diagnostic tool for periodontal defects.
Surgical entry, on the other hand, provides more precise outcomes for the finding of different bone deformities in periodontal ailments. However, due to the invasive nature of this technique and conceivable postoperative complications, the dental surgeons and the patients attempt to stay away from this technique. Consequently, clinical evaluation along with radiographic imaging assumes an imperative part in precise analysis and relevant treatment planning. With this background, the present study is carried out to compare the CBCT measurements of periodontal intrabony defects with intrasurgical measurements.,
| Materials and Methods|| |
In this study, 32 patients (18 males and 14 females) with an age range of 18–56 years (mean: 40 years), with generalized aggressive periodontitis or advanced chronic periodontitis, were enrolled. Patients aged <18 years, with untreated cervical caries, restorations at the cementoenamel junction (CEJ) obscuring the evaluation of CEJ, and any metallic crowns or restorations near the vicinity of alveolar crest (AC) were excluded from this study.
Considering the above-mentioned criteria, a total of 36 intrabony defects were incorporated, 8 in the anterior teeth, 10 in the premolar teeth, and 18 in the molar teeth. Of these, 8 were two-wall defects, 11 were three-wall defects, and 16 were combined defects, and there was only a single case of one-walled defect.
Clinical examination was performed by experienced periodontists. Pocket depth, gingival recession, clinical attachment level, and the distance from the bottom of the intrabony defect to the CEJ were measured. IOPA and CBCT were performed before the surgical procedures. During the surgical therapy, measurements of intrabony defects were noted.
IOPA was performed with the Scanora® (Soredex, Helsinki, Finland) using the long-cone paralleling technique with a bite registration positioning device. The exposure setting was 70 kVp with 12–25 mA. CBCT was performed using Cranex™ (SOREDEX, Tuusula, Finland), with tube current, 6 mA; tube voltage, 65 kV; exposure time, 20 s at 50 Hz; inherent filtration, 1.8 mm Al; and total filtration, 2.7 mm Al. An experienced maxillofacial radiologist interpreted the images, and each measurement was repeated twice by the same operator after 15 days. The intraclass correlation coefficient (ICC) was used to evaluate the interexaminer reliability for the linear measurement by CBCT and IOPAs.
Linear measurements were recorded on the radiographic image acquired as follows: the distance from the cementoenamel junction to the base of the periodontal defect (CEJ–BD) was considered as a point at which the periodontal ligament space is no longer uniform. The distance from cementonamel junction to the AC (CEJ–AC) was measured by considering AC to be the most cervical position on the proximal surface of the root, where the periodontal ligament begins to be of equal width and the infrabony component was measured by subtracting the CEJ–AC from CEJ–BD.
After administering the initial periodontal treatment, periodontal surgeries were carried out. Surgery and intrasurgical measurements were performed under local anesthesia by an experienced periodontist. During the surgery, after thorough debridement, all direct surgical measurements were made with a probe (HU-Friedy),
All the intrasurgical measurements and radiographs have been carried out as per the standard protocol. A probe was inserted along the root surface parallel to the long axis of the tooth with its top positioned at the most apical point of the defect. The distance CEJ–BD was thus documented as bone loss. Similarly, a probe was inserted along the root surface and a probe was placed perpendicular to the tooth axis, at the crest level of the alveolar bone. The distance from the junction of the two probes to the BD was recorded as the depth of the defect. The horizontal distance from the root to the mesial or distal edge of the bone defect at crest level was measured by placing a probe horizontal to the root surface. The horizontal distance from the mesial or distal edge of the bone defect at crest level to the root surface was recorded as mesiodistal (M-D) width of the periodontal defect. B-L width measured as the horizontal distance from the inner side of the buccal edge to the inner portion of the lingual edge of the bone defect at the bone crest level was recorded if both the walls were at the same level. When the walls were at different levels, then one probe was placed along the long axis of the tooth and another probe was placed horizontally on the relatively higher bone wall crest level, and the distance from the intersection point of the two probes to the higher bone crest was measured.
For the analysis, the Statistical Package for Social Sciences for Windows, version 20.0 (SPSS Inc., Chicago, Illinois, USA) was used. A paired t-test was applied to assess the difference among CBCT measurements and intrasurgical measurements and between the periapical radiographic measurements and intrasurgical measurements. The statistical significance was set at 5% level of significance (P < 0.05).
| Results|| |
[Table 1] summarizes the clinical values of all intrabony defects before the surgical therapy. All lesions consisted of deep pockets and severe bone loss.
[Table 2] shows the ICC values for interexaminer agreement for CBCT measurements and periapical radiograph measurements. The ICC for each parameter measured on CBCT was >98%, and the ICC for each parameter measured on the periapical radiographs was <94%.
The intrasurgical panoramic and CBCT measurements of intrabony defects are shown in [Table 3]. The M-D width of the defect measured on the periapical radiographs was similar to that measured in surgery (P > 0.05). However, CEJ–BD and the distance from the crest of bone to the deepest point of the defect measured on the periapical radiographs were less than those measured during the surgery, and the differences were statistically significant. No significant difference was noted regarding the CBCT measurements of the faciolingual and M-D widths of the defect when compared with the measurements obtained during the surgical procedures (P > 0.05). A statistically significant difference was noted in the CBCT measurements from the CEJ to BD and the distance from the crest of bone to the deepest point of the defect when compared with the intrasurgical measurements (P < 0.05) [Table 3].
|Table 3: Differences between intrasurgical and periapical measurements and cone-beam computed tomography measurements|
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| Discussion|| |
Conventional radiographic imaging modalities are still widely utilized as a part of dental practice despite their known restrictions. IOPAs are routinely prone for angulation errors, leading to dimensional variation of the resultant image. CBCT imaging is introduced to overcome these shortcomings and to provide a most precise image matching the exact clinical image without superimposition in all three dimensions.,
Studies in the literature employing CBCT for comparing with 2D radiographical imaging modality for assessing the periodontal defects were carried out in vitro on artificially created osseous defects on human mandibles of dry skulls. Due to the existence of unambiguous and clear-cut border of prepared defects and exceptional geometrical positioning of dry skulls, enhanced fidelity was countenanced in the sensitivity of their revelation. Be that as it may, they cannot reenact the strikingly unique in vivo conditions which are required for the analytic legitimacy of periodontal bony deformities. The restriction was overcome in this study by in vivo assessment of the osseous defects.
Periodontal intrabony defect is one of the prevalent clinical periodontal conditions clinically comprising 3D complexes. On conventional radiographic images, only the height and the M-D width of a periodontal defect can be measured, but the measurement of faciolingual dimensions could not be carried out. However, precise information about the faciolingual dimension of the periodontal defect will aid the dental surgeons for predicting the prognosis and making an accurate treatment plan.
Previously, CBCT measurements for the B-L width of the defect are reported, but the CBCT measurements were not compared with those of intrasurgical measurements. Only one study compared the CBCT measurements with intrasurgical measurements for the B-L width of the intrabony defect. The authors in their study explained the detailed procedures for measuring the B-L width of the defect, and in the present study, the same procedures were followed. The result of the present study demonstrated that the faciolingual width of the defect measured on CBCT was similar to that measured in the surgery; this observation was similar to that noticed by Li et al.
In the present study, the M-D dimension was estimated and compared between intrasurgical, periapical, and CBCT values. Even though the mean values of M-D dimension were slightly more when measured on intraoral radiographs and CBCT, the differences among the three values were not statistically significant. Our observation was similar to that of Li et al., who found similar intrasurgical and CBCT measurements. The authors suggested that M-D dimensions of the periodontal defect measured on CBCT can exactly imitate the substantial exigency of the M-D dimension of the defect. Except Li et al., no authors correlated the CBCT measurements for the M-D dimensions of the periodontal defect with intrasurgical dimensions in the past. Misch et al. measured the M-D dimension of the artificial intrabony defects on the mandible of dry skull by placing accessory gutta-percha cones in the vertically created grooves at each line angle and they observed a non-significant difference in the linear measurements for the defects by CBCT or radiography.
In the present study, the measurements obtained from the CBCT revealed underestimation regarding the measurements of CEJ–BD dimension, the distance from crest of the bone to the deepest point of the defect, and the depth of the defect, in comparison with surgical measurements. Grimard et al. noted that CBCT measurements for CEJ–BD revealed underestimations in comparison with the surgical measurements, which was similar to the results of the present study. Pahwa et al., Tonetti et al., Eickholz and Hausmann, and Zybutz et al. also noted underestimation of recordings from radiographs.
The reason for this is hypothecated as there is a vacillating range of demineralization in the base of the bone lesion which is detected on the periapical radiographs and CBCT may be waived off during the surgical debridement.
Although the dimensions from the crestal bone to the deepest point of defect on the intraoral radiographs were not exactly the same as the measurements obtained during the surgery, the difference was statistically nonsignificant.
The ICC measured on CBCT was high when compared with that of intraoral radiographs; this observation was similar to that of Pahwa et al., who reported a higher ICC of computed tomography scan than radiovisiography in the assessment of defect depth. Fuhrmann et al. likewise observed the correlation coefficient of CT scan to be in a better agreement with jaw specimen findings than the dental radiographs.
| Conclusion|| |
Currently, CBCT studies regarding the quantitative linear measurement of periodontal intrabony defects are rare. In this study, the correlation between CBCT measurements and intrasurgical measurements was analyzed. The results of this study revealed that CBCT may cater comparatively authentic M-D measurements of the periodontal defect and on the contrary conceded the precise values of the faciolingual dimensions which cannot be obtained by periapical radiographs. CBCT did not prove advantageous for obtaining the measurements from the crest of bone to the deepest point of the defect when compared to periapical radiographs.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
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.
] [Full text]
Kamburoglu K, Eres G, Akgün C, Yeta EN, Gülen O, Karacaoglu 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.
Takeshita WM, Vessoni Iwaki LC, 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.
] [Full text]
Anter E, Zayet MK, El-Dessouky SH. Accuracy and precision of cone beam computed tomography in periodontal defects measurement (systematic review). J Indian Soc Periodontol 2016;20:235-43.
] [Full text]
Cimbaljevic MM, Spin-Neto RR, Miletic VJ, Jankovic SM, Aleksic ZM, Nikolic-Jakoba NS. Clinical and CBCT-based diagnosis of furcation involvement in patients with severe periodontitis. Quintessence Int 2015;46:863-70.
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;45:20150265.
Newman M, Takei H, Carranza A. Clinical Periodontology. 9th
ed., Vol. 4, 8, 14. Philadelphia, USA: W.B. Saunders Co.; 2006. p. 70-1, 126, 36, 208, 10, 561-75.
Walter C, Schmidt JC, Dula K, Sculean A. Cone beam computed tomography (CBCT) for diagnosis and treatment planning in periodontology: A systematic review. Quintessence Int 2016;47:25-37.
Banodkar AB, Gaikwad RP, Gunjikar TU, Lobo TA. Evaluation of accuracy of cone beam computed tomography for measurement of periodontal defects: A clinical study. J Indian Soc Periodontol 2015;19:285-9.
] [Full text]
Li F, Jia PY, Ouyang XY. Comparison of measurements on cone beam computed tomography for periodontal intrabony defect with intra-surgical measurements. Chin J Dent Res 2015;18:171-6.
Mengel R, Candir M, Shiratori K, Flores-de-Jacoby L. Digital volume tomography in the diagnosis of periodontal defects: An in vitro
study on native pig and human mandibles. J Periodontol 2005;76:665-73.
Pahwa P, Lamba AK, Grewal H, Faraz F, Tandon S, Yadav N. Evaluation of two-dimensional and three-dimensional radiography with direct surgical assessment of periodontal osseous defects: A clinical study. Indian J Dent Res 2014;25:783-7.
] [Full text]
de Faria Vasconcelos K, Evangelista KM, Rodrigues CD, Estrela C, de Sousa TO, Silva MA. Detection of periodontal bone loss using cone beam CT and intraoral radiography. Dentomaxillofac Radiol 2012;41:64-9.
Misch KA, Yi ES, Sarment DP. Accuracy of cone beam computed tomography for periodontal defect measurements. J Periodontol 2006;77:1261-6.
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.
Tonetti MS, Pini Prato G, Williams RC, Cortellini P. Periodontal regeneration of human infrabony defects. III. Diagnostic strategies to detect bone gain. J Periodontol 1993;64:269-77.
Eickholz P, Hausmann E. Accuracy of radiographic assessment of interproximal bone loss in intrabony defects using linear measurements. Eur J Oral Sci 2000;108:70-3.
Zybutz M, Rapoport D, Laurell L, Persson GR. Comparisons of clinical and radiographic measurements of inter-proximal vertical defects before and 1 year after surgical treatments. J Clin Periodontol 2000;27:179-86.
Fuhrmann RA, Bücker A, Diedrich PR. Assessment of alveolar bone loss with high resolution computed tomography. J Periodontal Res 1995;30:258-63.
[Table 1], [Table 2], [Table 3]