Comparison Of Intra-oral Periapical And Panoramic Radiographs For The Assessment Of Alveolar Bone Height

presented by:

DR HASSAN SHAHED T
Post Graduate Department Of Periodontics Yenepoya Dental College

GUIDED BY Dr. Shashikanth Hegde HOD and Professor Dr. Rajesh K.S Professor Dr. Arun Kumar M. S Professor

YENEPOYA DENTAL COLLEGE, MANGALORE

INTRODUCTION

The main goals of the diagnosis of periodontal diseases

and subsequent therapy are to eliminate periodontal infection and to reduce the risk for future progression of the disease. To determine the amount of remaining bone, clinicians rely on clinical and radiological data. Intra-Oral Periapical (IOPA)

and Orthopantomogram (OPG) are the standard radiological

investigation techniques used in routine clinical practice.

Intraoral radiographs provides a more accurate

diagnosis of periodontal diseases (Kim.T.S et al 2008). However it must be considered whether a panoramic radiograph also produces the same information. The aim of this study was to compare these two radiographs and

determine the amount of agreement between them.

OBJECTIVES

To Measure The Alveolar Bone Height On IOPA

To Measure The Alveolar Bone Height On OPG

To Assess And Compare The Difference In Measurements Of Alveolar Bone Height From IOPA And OPG

METHODOLOGY

Ethical clearance had been obtained from the institutional ethical committee before commencing the study.
SOURCE OF DATA

Out patients attending the department of Periodontics, Yenepoya Dental College, Mangalore.
NUMBER OF SUBJECTS

20 (40 sites)

INCLUSION CRITERIA

Age Group 18yrs and above

Subjects with chronic periodontitis having a probing depth

of >3mm in mandibular molars

EXCLUSION CRITERIA

Pregnant and lactating mothers

History of periodontal surgical therapy for last 6 months

ARMAMENTARIUM

PROCEDURE

IOPA of mandibular molar site/sites

were taken using paralleling cone technique using SERONA Intra-oral Xray .

 OPG were also taken for

all the patients using

PLANMECA PROMAX.

These radiographs were then calibrated and digitalized using a X-ray DIGITIZER.

 Distance from Cemento Enamel junction (CEJ) to Base of the

Defect (BD) was measured on IOPA.

CEJ

BD

IOPA

 Distance from CEJ to BD at the same site was also measured on OPG

CEJ

BD

OPG

 All these values were then tabulated and subjected to

statistical analysis using Intra Class Co-relation Coefficient (ICC) and t-test.

ICC value less than 0.8 will suggest a strong correlation

between IOPA and OPG. p value less than 0.05 will be considered significant and values less then 0.01 will be considered highly significant.

RESULTS

STATISTICAL ANALYSIS

MEAN

STD DEVIATION

MEAN DIFFERENCE

STD DEVIATION OF DIFFERENCE

t value

p value

ICC

IOPA .4871 OPG

.5861

.20907 .21489 .09902 .08255 7.681 .000 .835

Highly Significant Strong Correlation But on an average shows significant difference

0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0

STD DEVIATION MEAN

IOPA

OPG

Fig 1: Bar diagram showing mean values of IOPA and OPG with their respective standard deviation.

REGRESSION ANALYSIS

1.4 1.2 1

IOPA

0.8 0.6 0.4 0.2 0 0 0.2 0.4 0.6 0.8 1 1.2

OPG

IOPA explains OPG by 85.4%

IOPA = -0.040 + 0.899 x OPG

Fig 2: Scatter diagram between IOPA and OPG

DISCUSSION

Radiographs are important in periodontal diagnosis and provide a general overview periodontal breakdown (Lang

and Hill 1977). Periodontal probing alone is insufficient for

complete and accurate diagnosis unless it is supplemented by radiographs. Being a two dimensional view of a three dimensional structure, radiographs also have limitation when it comes to determination of buccal and lingual aspect of teeth. It can only provide information on interproximal relationship between alveolar crest and reference points on the tooth.(Frohlich 1956)

Periapical radiography describes intra-oral techniques

designed to show individual teeth and the tissue around the

apices, whereas panoramic view gives an un obstructed view of entire maxillary and mandibular arch. Periapical radiographs are mainly used for detecting infections, periodontal status, position and morphology of root,

endodontic purposes etc., where as panoramic view are mostly

indicated in trauma, impacted tooth, larger lesions, generalized disease and assessing surgical procedures.

It also has an advantage of minimal exposure to radiation, but at the same time there is also distortion of image. The present study was designed to compare two

radiographic techniques to estimate the alveolar bone height.

In this study an agreement of 85% was obtained between IOPA and OPG which was very close to the result of 87% agreement

obtained by
loss.

Molander B et al in 1991, where they had

concluded that OPG can be used for the assessment of bone

Similar study was done by Kim T S et al in 2008,

where they observed 81% agreement between IOPA and OPG.

Another study done by Persson R E et al in 2003 also observed an agreement between IOPA and OPG. But in a study done by Akesson L et al in 1992, they had concluded that Periapical radiograph was more accurate than panoramic and bitewing radiograph.

Similar results were seen in a study done by Papapanou

P N and Wennstrom J L in 1989, where they found a strong correlation between IOPA and probing measurement. Further studies have to be carried out including other teeth and clinical measurements.

CONCLUSION

In our study an agreement of 85% was

achieved between IOPA and OPG, based on which we could conclude, there is no significant difference between IOPA and OPG. With the increasing concern of radiation exposure and patient comfort, a single OPG can be used instead of a full mouth IOPA for the assessment of alveolar bone height.