Usefulness of subtraction radiography in the evaluation of periodontal therapy

Subtraction radiography, a sensitive and accurate technique for identifying alveolar crestal change from standardized pairs of radiographs, is useful in monitoring periodontal therapy. One half of the radiographs were found to be appropriate for subtraction analysis using present technology for taking standardized radiographs. The criterion for usability was identical interpretation of subtraction images made in duplicate from a pair of radiographs. A set of radiographs was analyzed by subtraction radiography as well as by measurement of alveolar bone-crest height. Subtraction radiography was found to be more sensitive in detecting change. Whereas 53% pairs of radiographs showed a change on subtraction radiography, only 14% showed a change in crest height. Comparison of change by subtraction radiography and probing attachment level showed an overall correlation. Since these two measures assess different aspects of the periodontium, perfect correlation was not expected.