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Assessment of periodontal bone level revisited : a controlled study on the diagnostic accuracy of clinical evaluation methods and intra-oral radiography

Véronique Christiaens (UGent) , Hugo De Bruyn (UGent) , Eric Thevissen (UGent) , Sebastiaan Koole (UGent) , Melissa Dierens (UGent) and Jan Cosyn (UGent)
(2018) CLINICAL ORAL INVESTIGATIONS. 22(1). p.425-431
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Abstract
Objectives: The accuracy of analogue and especially digital intra-oral radiography in assessing interdental bone level needs further documentation. The aim of this study was to compare clinical and radiographic bone level assessment to intra-surgical bone level registration (1) and to identify the clinical variables rendering interdental bone level assessment inaccurate (2). Materials and methods: The study sample included 49 interdental sites in 17 periodontitis patients. Evaluation methods included vertical relative probing attachment level (RAL-V), analogue and digital intra-oral radiography and bone sounding without and with flap elevation. The latter was considered the true bone level. Five examiners evaluated all radiographs. Results: Significant underestimation of the true bone level was observed for all evaluation methods pointing to 2.7 mm on average for analogue radiography, 2.5 mm for digital radiography, 1.8 mm for RAL-V and 0.6 mm for bone sounding without flap elevation (p< 0.001). Radiographic underestimation of the true bone level was higher in the (pre)molar region (p) and increased with defect depth (p< 0.001). Variation between clinicians was huge (range analogue radiography: 2.2-3.2 mm; range digital radiography: 2.1-3.0 mm). Conclusion: All evaluation methods significantly underestimated the true bone level. Bone sounding was most accurate, whereas intra-oral radiographs were least accurate. Deep periodontal defects in the (pre)molar region were most underrated by intra-oral radiography. Clinical relevance: Bone sounding had the highest accuracy in assessing interdental bone level.
Keywords
Intra-oral radiography, bone defect, periodontal disease, digital radiographs, DIGITAL RADIOGRAPHY, DISEASE, VALIDITY, ADULTS, RISK, FILM

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Chicago
Christiaens, Véronique, Hugo De Bruyn, Eric Thevissen, Sebastiaan Koole, Melissa Dierens, and Jan Cosyn. 2018. “Assessment of Periodontal Bone Level Revisited : a Controlled Study on the Diagnostic Accuracy of Clinical Evaluation Methods and Intra-oral Radiography.” Clinical Oral Investigations 22 (1): 425–431.
APA
Christiaens, V., De Bruyn, H., Thevissen, E., Koole, S., Dierens, M., & Cosyn, J. (2018). Assessment of periodontal bone level revisited : a controlled study on the diagnostic accuracy of clinical evaluation methods and intra-oral radiography. CLINICAL ORAL INVESTIGATIONS, 22(1), 425–431.
Vancouver
1.
Christiaens V, De Bruyn H, Thevissen E, Koole S, Dierens M, Cosyn J. Assessment of periodontal bone level revisited : a controlled study on the diagnostic accuracy of clinical evaluation methods and intra-oral radiography. CLINICAL ORAL INVESTIGATIONS. 2018;22(1):425–31.
MLA
Christiaens, Véronique, Hugo De Bruyn, Eric Thevissen, et al. “Assessment of Periodontal Bone Level Revisited : a Controlled Study on the Diagnostic Accuracy of Clinical Evaluation Methods and Intra-oral Radiography.” CLINICAL ORAL INVESTIGATIONS 22.1 (2018): 425–431. Print.
@article{8521669,
  abstract     = {Objectives: The accuracy of analogue and especially digital intra-oral radiography in assessing interdental bone level needs further documentation. The aim of this study was to compare clinical and radiographic bone level assessment to intra-surgical bone level registration (1) and to identify the clinical variables rendering interdental bone level assessment inaccurate (2).
Materials and methods: The study sample included 49 interdental sites in 17 periodontitis patients. Evaluation methods included vertical relative probing attachment level (RAL-V), analogue and digital intra-oral radiography and bone sounding without and with flap elevation. The latter was considered the true bone level. Five examiners evaluated all radiographs.
Results: Significant underestimation of the true bone level was observed for all evaluation methods pointing to 2.7 mm on average for analogue radiography, 2.5 mm for digital radiography, 1.8 mm for RAL-V and 0.6 mm for bone sounding without flap elevation (p{\textlangle} 0.001). Radiographic underestimation of the true bone level was higher in the (pre)molar region (p) and increased with defect depth (p{\textlangle} 0.001). Variation between clinicians was huge (range analogue radiography: 2.2-3.2 mm; range digital radiography: 2.1-3.0 mm).
Conclusion: All evaluation methods significantly underestimated the true bone level. Bone sounding was most accurate, whereas intra-oral radiographs were least accurate. Deep periodontal defects in the (pre)molar region were most underrated by intra-oral radiography.  
Clinical relevance: Bone sounding had the highest accuracy in assessing interdental bone level.},
  author       = {Christiaens, V{\'e}ronique and De Bruyn, Hugo and Thevissen, Eric and Koole, Sebastiaan and Dierens, Melissa and Cosyn, Jan},
  issn         = {1432-6981},
  journal      = {CLINICAL ORAL INVESTIGATIONS},
  keyword      = {Intra-oral radiography,bone defect,periodontal disease,digital radiographs,DIGITAL RADIOGRAPHY,DISEASE,VALIDITY,ADULTS,RISK,FILM},
  language     = {eng},
  number       = {1},
  pages        = {425--431},
  title        = {Assessment of periodontal bone level revisited : a controlled study on the diagnostic accuracy of clinical evaluation methods and intra-oral radiography},
  url          = {http://dx.doi.org/10.1007/s00784-017-2129-8},
  volume       = {22},
  year         = {2018},
}

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