Influence of projection angles upon position of cementoenamel junction on radiographs

The CEJ on radiographs is often used as a reference point in the assessment of alveolar bone loss. The aim of the present study was to test the stability of the radiographic CEJ ("RCEJ") in relation to the alveolar crest under varying angulations of the central X-ray beam. In an experimental model four types of extracted teeth were radiographed at 0 degree and 20 degrees vertical angulation and at 15 horizontal angulations varying from a 17.5 degrees mesial view to a 17.5 degrees distal view. The buccal alveolar bone margin was simulated by a steel needle. RCEJ-"crest" distances were read at a X 10 magnification. Changing the vertical angulation from 0 degree to 20 degrees reduced the RCEJ-"crest" distances for all tooth types (range of average reduction 2.2-4.1 mm). Horizontal angulations without concomitant vertical angulation had a significant effect but were without clinical significance. Horizontal angulations in combination with a 20 degrees vertical angulation had a considerable influence; in a mesial view, mesial RCEJ-"crest" distances decreased and distal ones increased, and vice versa in a distal view. The deviations from the true CEJ-crest distance demonstrated may be of clinical significance, and a critical attitude to alveolar bone loss measures on radiographs using the RCEJ as reference point is recommended.