Detection of bone loss with different X-ray techniques in periodontal patients

Intraoral radiographs can aid in formulating a more accurate diagnosis of periodontal disease. However, it must be considered whether a comparable amount of information can be obtained with modern panoramic radiographs. The aim of this study was to determine to what degree the diagnosable amount of bone loss in patients with aggressive periodontitis or severe chronic periodontitis depends on the type of x-ray technique used.

A total of 110 subjects (63 females) were included in this study. The inclusion criteria were the diagnosis of aggressive periodontitis (N = 49) or severe chronic periodontitis (N = 61). In all patients, panoramic radiographs (panoramic) and intraoral films of all regions (eight to 10 single exposures) were available. Analysis of the panoramic and intraoral films was carried out with a computer-assisted technique for linear measurement. The amount of bone loss in reference to the alveolar crest (AC) and bottom of the bony defect (BD) was determined as a percentage of total root length.

Depending on the examined tooth and reference point, 47.01% to 81.89% of all subjects showed differences between intraoral and panoramic measurements that were < or =10% of the total root length. For cemento-enamel junction-AC measurements, differences between intraoral and panoramic measurements that were >10% of the total root length were found predominantly in the upper molar and premolar regions. In the mandible, differences between intraoral and panoramic measurements that were >10% of the total root length were observed for BD and AC at the mesial contour of the central incisor.

A preorientation with respect to the expected bone loss is possible using panoramic radiographs. Additional intraoral films might be helpful where rapid changes of bone level are expected (e.g., aggressive periodontitis).