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Consensus-based radiographic threshold for identifying vertical periodontal bone loss: an international observer
Omar A Al-Karadsheh1, Siraj Zabadi2, Mohammad H Hatamleh3
1Department of Oral and Maxillofacial Surgery, Oral Medicine, and Periodontology, School of Dentistry, The University of Jordan, Amman, Jordan. O.karadsheh@ju.edu.jo.
Scientific Reports
|July 1, 2026
Summary
Defining vertical bone loss on dental radiographs is subjective. This study established a consensus threshold around 35 degrees for classifying vertical bone loss, improving diagnostic accuracy for periodontitis.
Area of Science:
- Dentistry
- Periodontology
- Radiology
Background:
- Radiographic assessment of periodontal bone loss is crucial for diagnosing and staging periodontitis.
- Current methods for distinguishing horizontal from vertical bone loss rely on subjective visual interpretation.
- A quantitative reference for classifying vertical bone loss on dental radiographs is lacking.
Purpose of the Study:
- To establish a consensus-based angular threshold for classifying interproximal bone loss as vertical on dental radiographs.
- To evaluate factors influencing clinicians' interpretation of vertical bone loss.
- To provide a reproducible reference for radiographic interpretation.
Main Methods:
- An international panel of periodontists evaluated digitally modified radiographs with simulated interproximal bone loss angles (0°–35°).
- Seventy complete responses from specialists across 22 countries were analyzed.
- Mixed-model analysis was used to assess variability and influencing factors.
Main Results:
- The classification of bone loss as vertical increased with angular deviation, with a notable transition between 20° and 30°.
- A 35° angle achieved a consensus agreement threshold (≥70%) across most sites.
- Mandibular sites were more frequently classified as vertical, and angled cementoenamel junction alignment increased false positives.
Conclusions:
- A consensus threshold of approximately 35° can be used to classify vertical bone loss on dental radiographs.
- Clinician interpretation of vertical bone loss shows significant variability, highlighting observer dependency.
- These findings offer educational value and a reproducible reference for radiographic interpretation of vertical bone loss in periodontitis.
