Detection of periodontal bone loss using digital intraoral and cone beam computed tomography images:: an in vitro assessment of bony and/or infrabony defects

Objectives: To explore the diagnostic values of digital intraoral radiography and cone beam CT (CBCT) in the determination of periodontal bone loss, infrabony craters and furcation involvements. Methods: Accuracy assessment of the imaging modalities was conducted through bone level measurements, infrabony crater and furcation involvement classifications. For CBCT, images were obtained at 120 kV and 23.87 mAs, and observations were made on a 5.2 mm panoramic reconstruction view and on 0.4 mm thick cross-sectional slices. Intraoral radiographs of a size 2 charge-coupled device (CCD) sensor were obtained using the paralleling technique, at 60 kV (DC) and 0.28 mAs exposure. 71 human cadaver and dry skull bony defects were measured and evaluated by 3 observers. Comparison was made with the gold standard. Results: The mean error (gold standard deviation) of bone level measurements was 0.56 mm for intraoral radiography and 0.47 mm for the CBCT panoramic 5.2 mm reconstruction view. There were no significant differences (P = 0.165) between the two methods. However, on 0.4 mm thick cross-sections, the mean error was 0.29 mm and the Wilcoxon signed-rank test indicated a significant difference when compared with the CCD (P = 0.006). The detection of crater and furcation involvements failed in 29% and 44% for the CCD, respectively, in contrast to 100% detectability for both defects with CBCT. Conclusions: CBCT on the panoramic 5.2 mm reconstruction view allowed comparable measurements of periodontal bone levels and defects as with intraoral radiography. CBCT with 0.4 mm thick cross-sections demonstrated values closer to the gold standard, indicating more accurate assessment of periodontal bone loss. Further research is needed to explore these results in vivo and to determine the use of CBCT in periodontal diagnosis.