COMPARISON BETWEEN THE INTRAORAL RADIOGRAPHS AND THE CONE BEAM COMPUTED TOMOGRAPHY (CBCT) FOR PERIODONTAL ASSESSMENT

Abstract

Background: The radiograph is an important source of information for periodontal diagnosis and treatment. The two-dimensional nature of the intraoral radiograph often obscures the periodontal bone loss. Cone beam computed tomography (CBCT) provides three-dimensional images that overcome the limitation of the intraoral radiograph. The aim of this study was to compare the use of intraoral radiographs and CBCT images for periodontal assessment Methods: The study included 25 subjects who had moderate to advanced periodontitis and had at least 2 infrabony defects of ≥3 mm deep. All subjects received full mouth clinical examination, intraoral and CBCT radiographs. Three examiners performed the periodontal assessment including periodontal diagnosis, prognosis, infrabony defect classification and treatment decision, based on the clinical and radiographic data. The periodontal assessment by the intraoral radiograph and the CBCT was compared. The inter-examiner agreement on periodontal assessment was evaluated. Results: The concordance between the intraoral radiograph and the CBCT for periodontal diagnosis, prognosis, infrabony defect classification, and infrabony defect treatment were 79.3%, 69.5%, 44.7% and 64.2%, respectively. Assessment by the intraoral radiograph was likely to underestimate periodontal diagnosis, prognosis, and the number of infrabony defect wall. The inter-examiner agreement (Fleiss’kappa) of the CBCT group was very high (0.87-0.94) and was higher than that of the intraoral radiograph (0.59-0.88) for all types of assessment. The percent complete agreement among examiners was 63.4-88.4% for the intraoral radiograph and was 87.8-94.0% for the CBCT. The agreement was significantly higher among the CBCT group than the intraoral radiograph group for all types of assessment. Conclusions: The assessment by the intraoral radiograph and the CBCT was significantly different. The periodontal assessment by intraoral radiographs was likely to underestimate the periodontal diagnosis, prognosis, and infrabony defect classification. The assessments by the CBCT provided more consistent results among examiners than those by the intraoral radiograph.