JICDRO is a UGC approved journal (Journal no. 63927)

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Year : 2016  |  Volume : 8  |  Issue : 2  |  Page : 142-144

Revolutionizing radiographic diagnostic accuracy in periodontics


Department of Periodontology, Babu Banarasi Das College of Dental Sciences, Lucknow, Uttar Pradesh, India

Date of Web Publication15-Jul-2016

Correspondence Address:
Dr. Brijesh Sharma
Department of Periodontology, Babu Banarasi Das College of Dental Sciences, Babu Banarasi Das University, Lucknow - 227 105, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-0754.173790

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   Abstract 

Effective diagnostic accuracy has in some way been the missing link between periodontal diagnosis and treatment. Most of the clinicians rely on the conventional two-dimensional (2D) radiographs. But being a 2D image, it has its own limitations. 2D images at times can give an incomplete picture about the severity or type of disease and can further affect the treatment plan. Cone beam computed tomography (CBCT) has a better potential for detecting periodontal bone defects with accuracy. The purpose here is to describe how CBCT imaging is beneficial in accurate diagnosis and will lead to a precise treatment plan.

Keywords: Bone loss, cone beam computed tomography (CBCT), vertical defects


How to cite this article:
Sharma B, Govila V, Verma S, Meenawat A. Revolutionizing radiographic diagnostic accuracy in periodontics. J Int Clin Dent Res Organ 2016;8:142-4

How to cite this URL:
Sharma B, Govila V, Verma S, Meenawat A. Revolutionizing radiographic diagnostic accuracy in periodontics. J Int Clin Dent Res Organ [serial online] 2016 [cited 2019 Jul 23];8:142-4. Available from: http://www.jicdro.org/text.asp?2016/8/2/142/173790


   Introduction Top


The success of periodontal therapy depends on the accurate diagnosis of the morphology of periodontal bone destruction. Effective diagnostic accuracy has in some way been the missing link between periodontal diagnosis and treatment. Advanced periodontal disease requires clinical as well as radiographic examination for precise diagnosis and treatment. Most of the clinicians rely on the conventional two-dimensional (2D) radiographs that prove to be useful in routine diagnosis. But being a 2D image, it has its own limitations, such as the superimposition of anatomical structures, distortion of the image, and 2D view of the anatomy of bone. This at times can give an incomplete picture about the severity or type of disease and can further affect the treatment plan.

Two-dimensional imaging

No doubt the technique of 2D radiography (intraoral or panoramic) is simple, inexpensive, and a technique that the practitioners are most familiar and comfortable with. The majority of the dental surgeons found it to be quite useful in their clinical practice. However, intraoral and extraoral procedures, used separately or in combination, undergo the similar inherent drawback of all planar 2D projections that lead us to the misdiagnosis of the current situation sometimes. Periapical radiographs have a magnification error of an average distortion of 14%.[1] Therefore, in the field of periodontology, precision in diagnosing a periodontal disease where an imperfect picture cannot complete an accurate diagnosis, a 2D picture of a three-dimensional (3D) bone anatomy raises questions every time.

Cone beam computed tomography

Cone beam computed tomography (CBCT) is a relatively new imaging modality, introduced in the late 1990s, that has the clear advantage of being of a relatively low-cost and of being of a relatively low dose when compared to computed tomography (CT).[2] Only two dimensions of the supporting alveolar bone are discernible on an intraoral periapical radiograph (IOPA), whereas CBCT, in addition, allows assessment in all three dimensions. Compared to periodontal probing and 2D intraoral radiography, 3D CBCT scanning was found to be more effective in assessing periodontal structures. CBCT has better potential for detecting periodontal bone defects in all planes, for diagnosing furcations, craters, and in measuring periodontal defects. In 2000, Eickholz et al. found CBCT to be very accurate, when he examined the accuracy of linear measurements on radiographs of interproximal bone loss in infrabony defects utilizing the gold standard of surgical measurements.[3] The CBCT devices currently available are capable of providing panoramic and cephalometric images along with 3D images, producing high quality images of specific regions of interest.

How CBCT ameliorates the treatment outcome

CBCT is a revolutionized diagnostic tool, that is, a 3D approach to data acquisition and image reconstruction of an anatomical structure. It can be useful in different ways.

Regenerative therapy

For performing a guided tissue regeneration/guided bone regeneration (GTR/GBR); proper outline of the periodontal defect gives an idea about how many walls are remaining and how steep or shallow the defect is. IOPA is not able to provide a detailed picture of how many walls are left or about the pattern of bone loss. In order to enhance the outcome, CBCT can be used to effectively diagnose the defect.

Furcation involvement

Without getting a clear picture of a furcation defect, especially in maxillary molars, planning a treatment is always doubtful. CBCT images reveal a high accuracy to assess the loss of periodontal tissue and to classify the degree of furcation involvement in maxillary molars.[4] We cannot depict the grade of furcation by assessing a 2D radiograph. At times, the detection of furcation on an IOPA gets difficult and can lead to misjudged diagnosis [Figure 1].
Figure 1: (a) 2D conventional IOPA radiograph shows shallow horizontal bone loss in 26 region (b) CBCT showing infrabony combine defect with furcation involvement of the same region

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Accuracy in measurement

Correlations between CBCT and direct surgical measurements were higher than those between radiovisiography (RVG) and surgical measurements. It has proved to be efficient in planning the outcome of regenerative therapy as well.[5]

Diagnosing craters and fenestration

CBCT has proved to be highly resourceful for detecting periodontal bone defects in all dimensions for diagnosing craters and fenestration in measuring periodontal defects when compared to conventional radiography.

Implantology

Sometimes panoramic radiographs and IOPA give an ambiguous picture due to superimposition of anatomical structure in maxillary area and overestimate the distance between mandibular canal and alveolar crest [Figure 2]. CBCT has proved to be efficient in planning the outcome of implant dentistry, as it can interpret the maxillofacial structure in all possible planes.[5]
Figure 2: (a) in the OPG, the distance from alveolar crest to mental foramen was measured to be 16 mm (b) Measurement was reduced to 11.1 mm on CBCT

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   Conclusion Top


CBCT is currently an advanced emerging technique; that has several advantages over conventional 2D radiography and it has the potential to gather accurate diagnostic and quantitative information about periodontal bone condition along with very less radiation dose when compared to CT. Bony defects, craters, and furcation involvements seem to be better seen on CBCT. As the cost and radiation dosage of CBCT is substantially higher than that of other routine dental imaging techniques, appropriate patient selection criteria must be adopted. No doubt it is very useful in diagnosing a periodontal disease; however, we do not require CBCT for every case. Decision pertaining to the use of CBCT in the field of periodontology should be taken after careful consideration of its advantages, limitations, and risks.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Sonick M, Abrahams J, Faiella R. A comparison of the accuracy of periapical, panoramic, and computerized tomographic radiographs in locating the mandibular canal. Int J Oral Maxillofac Implants 1994;9:455-60.  Back to cited text no. 1
    
2.
Mozzo P, Procacci C, Tacconi A, Martini PT, Andreis IA. A new volumetric CT machine for dental imaging based on the cone-beam technique: Preliminary results. Eur Radiol 1998;8:1558-64.  Back to cited text no. 2
    
3.
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.  Back to cited text no. 3
    
4.
Walter C, Weiger R, Zitzmann NU. Accuracy of three-dimensional imaging in assessing maxillary molar furcation involvement. J Clin Periodontol 2010;37:436-41.  Back to cited text no. 4
    
5.
Ganz SD. Conventional CT and cone beam CT for improved dental diagnostics and implant Planning. Dent Implantol Update 2005;16:89-95.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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