Accuracy of Panoramic Radiograph for Diagnosing Periodontitis Comparing to Clinical Examination

Abstract

In this study, we explore the diagnostic accuracy of a Radiographic-based Periodontal Bone Loss (R-PBL) method as a screening tool for periodontitis, in the form of radiographic bone loss, under the 2018 case definition in comparison to the 2012 case definition. The analysis was based on 456 patients (253 females and 203 males), screened for periodontal status in the Study of Periodontal Health in Almada-Seixal (SoPHiAS) project and subjected to a panoramic dental X-ray. Patients were diagnosed for the presence of periodontitis following the 2018 and 2012 case definition. R-PBL classification was defined by alveolar bone loss and diagnosed as no periodontitis (≥80% remaining alveolar bone), mild to moderate periodontitis (66% to 79%), or severe periodontitis (<66%). We appraise the X-ray quality to look for the influence on the performance of R-PBL. Sensitivity, specificity, accuracy, and precision, through several indicators, were determined. Performance measurement was assessed through binary and multiclass Receiver operating characteristic/are under the curve (ROC/AUC) analyses. Our results show that the tested R-PBL method under the 2018 case definition is a reliable tool in periodontitis cases screening. This method does not replace clinical periodontal evaluation, but rather, it screens patients towards a definitive periodontitis diagnosis. These results will contribute to support the development of automated prediction systems towards periodontitis surveillance.

The Chairside Periodontal Diagnostic Toolkit: Past, Present, and Future

“…Since it visualizes the entire area in a single film, including maxilla, mandible, and temporomandibular joints, it is useful for treatment planning of extractions, implants, and dentures. Also, it is a reliable tool in observation of alveolar bone loss caused by periodontal disease; however, this method is not suitable to diagnose the activity of periodontal disease since it hardly provides information about periodontal soft tissues [83]. Intraoral X-rays take an image with a radiographic film or a detector placed inside the mouth and are used in periapical views to provide precise and detailed information about each tooth and partial bone with various views.…”

Accuracy of radiographic pixel linear analysis in detecting bone loss in periodontal disease: Study in diabetic rats

“…However, Machado et al (2020) highlighted limitations of radiographic assessment, such as the inability to reproduce the bone structure three-dimensionally, which may decrease accuracy. Also, lack of standardization in radiography may show milder bone destruction than observed ( Vijay and Raghavan, 2013 ).…”

“…Although intraoral radiographs may be less accurate than other techniques, recent studies focus on computer-assisted radiography to overcome human visual limitations in detecting bone loss. Recent studies suggested that automated systems could allow more reliable and accurate assessments of periodontal bone loss on panoramic dental radiographs, and the development of automated prediction systems could enhance periodontitis surveillance ( Krois et al, 2019 , Machado et al, 2020 ).…”

“…The assessment of periodontal disease diagnoses, stage and progression is provided by the association between clinical examination and imaging techniques, as intraoral and/or panoramic radiographs, to determine bone loss ( Lang and Bartold, 2018 , Machado et al, 2020 ). Even with the possibility of using superior imaging technique as micro-tomography, radiography is still considered a reliable tool for periodontitis detection ( Machado et al, 2020 ).…”

“…Linear measurements between the cementoenamel junction and the alveolar crest are used to analyze bone defects to determine possible therapy outcomes and periodontal risk assessment ( Mol, 2004 ), with a positive correlation between clinical bone sounding and bone height via analysis of dental radiographs ( Zybutz et al, 2000 ). Moreover, automated systems such as computer software could allow more accurate assessments of periodontal bone loss on dental radiographs ( Krois et al, 2019 , Machado et al, 2020 ). However, the inconsistency in maintaining nearly identical alignment in successive radiographic images may reduce reliability ( Rawlinson et al, 2005 , Vijay et al, 2013 ).…”