Comparison of periodontal evaluation by cone-beam computed tomography, and clinical and intraoral radiographic examinations

Prevalence of apical periodontitis in endodontically-treated maxillary and mandibular posterior teeth in a Saudi Arabian population: a cone-beam computed tomography study

OBJECTIVE

The aim of this retrospective study was to assess the prevalence of apical periodontitis (AP) in root canal-treated maxillary and mandibular posterior teeth in a Saudi Arabian population based on findings from images taken using cone-beam computed tomography (CBCT).

METHODS

The sample included 300 CBCT images from patients (150 females and 150 males) aged between 18 and 80 years old and they were analyzed to detect AP in endodontically treated maxillary and mandibular premolars and molars. Also, the correlation between the prevalence of AP and gender along with location (right/left side of jaw) were analyzed. Periapical lesions were defined as lamina dura gaps appearing disrupted around the width of periodontal ligament and apex at the apical third of the roots.

RESULTS

There was higher prevalence of AP in maxillary (19.1%) when compared to mandibular posterior teeth (17.3%). Mandibular first and maxillary second molars were the most affected teeth with AP (P = 0.05 and P = 0.04, respectively). Also, there was higher prevalence of AP cases with a predilection toward males (Maxillary P = 0.005; Mandibular P = 0.00) and on the right side of the mandibular jaw (P = 0.03).

CONCLUSION

In this study, the prevalence of AP had a significant association between gender with a predilection in males and location with a tendency to occur on the mandibular right side as observed in endodontically treated maxillary and mandibular posterior teeth using CBCT.

Use of the deep learning approach to measure alveolar bone level

AIM

The goal was to use a deep convolutional neural network to measure the radiographic alveolar bone level to aid periodontal diagnosis.

MATERIALS AND METHODS

A deep learning (DL) model was developed by integrating three segmentation networks (bone area, tooth, cemento-enamel junction) and image analysis to measure the radiographic bone level and assign radiographic bone loss (RBL) stages. The percentage of RBL was calculated to determine the stage of RBL for each tooth. A provisional periodontal diagnosis was assigned using the 2018 periodontitis classification. RBL percentage, staging, and presumptive diagnosis were compared with the measurements and diagnoses made by the independent examiners.

RESULTS

The average Dice Similarity Coefficient (DSC) for segmentation was over 0.91. There was no significant difference in the RBL percentage measurements determined by DL and examiners ( p = .65 ). The area under the receiver operating characteristics curve of RBL stage assignment for stages I, II, and III was 0.89, 0.90, and 0.90, respectively. The accuracy of the case diagnosis was 0.85.

CONCLUSIONS

The proposed DL model provides reliable RBL measurements and image-based periodontal diagnosis using periapical radiographic images. However, this model has to be further optimized and validated by a larger number of images to facilitate its application.

Assessment of alveolar bone changes in response to minimally invasive periodontal surgery: A cone-beam computed tomographic evaluation

Purpose

The aim of this study was to evaluate 3-dimensional cone-beam computed tomography (CBCT) images of alveolar bone changes in patients who underwent minimally invasive periodontal surgery-namely, the pinhole surgical technique (PST).

Materials and Methods

Alveolar bone height was measured and compared on CBCT images of 254 teeth from 23 consecutive patients with Miller class I, II, or III recession who had undergone PST. No patient with active periodontal disease was selected for surgery. Two different methods were used to assess the alveolar bone changes postoperatively. In both methods, the distance between the apex of the tooth and the mid-buccal alveolar crestal bone on pre- and post-surgical CBCT studies was measured.

Results

An average alveolar bone gain >0.5 mm following PST was identified using CBCT (P=0.05). None of the demographic variables, including sex, age, and time since surgery, had any significant effect on bone gain during follow-up, which ranged from 8 months to 3 years.

Conclusion

PST appears to be a promising treatment modality for recession that results in stable clinical outcomes and may lead to some level of resolution on the bone level. More long-term studies must be done to evaluate the impact of this novel technique on bone remodeling and to assess sustained bone levels within a larger study population.

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

Periodontal diseases comprise a group of globally prevalent, chronic oral inflammatory conditions caused by microbial dysbiosis and the host immune response. These diseases specifically affect the tooth-supporting tissues (i.e., the periodontium) but are also known to contribute to systemic inflammation. If left untreated, periodontal diseases can ultimately progress to tooth loss, lead to compromised oral function, and negatively impact the overall quality of life. Therefore, it is important for the clinician to accurately diagnose these diseases both early and accurately chairside. Currently, the staging and grading of periodontal diseases are based on recording medical and dental histories, thorough oral examination, and multiple clinical and radiographic analyses of the periodontium. There have been numerous attempts to improve, automate, and digitize the collection of this information with varied success. Recent studies focused on the subgingival microbiome and the host immune response suggest there is an untapped potential for non-invasive oral sampling to assist clinicians in the chairside diagnosis and, potentially, prognosis. Here, we review the available toolkit available for diagnosing periodontal diseases, discuss commercially available options, and highlight the need for collaborative research initiatives and state-of-the-art technology development across disciplines to overcome the challenges of rapid periodontal disease diagnosis.

Reliability assessment between clinical attachment loss and alveolar bone level in dental radiographs

Background

The clinical attachment level (CAL) and radiographically assessed bone levels are used to assess the loss of periodontal tissue support in periodontitis, a chronic, multifactorial inflammatory disease of the periodontium. However, few studies have been done to study the relationship between these two parameters. According to our knowledge, this is the first study investigating the relationship between the two measurements using intraclass correlation analysis.

Aim

The aim of the study is to investigate the relationship between CAL and radiographically assessed bone level in teeth affected with periodontitis.

Methods

A retrospective cross‐sectional study was conducted by selecting a sample of 880 periodontal sites in 104 periodontitis patients, aged 25–60 years. CAL and peri‐apical radiographs of the selected sites were obtained from the computerized patient records. The distance from the cemento‐enamel junction (CEJ) to the base of the alveolar bone level (ABL) was measured. The data was analyzed using SPSS.

Results

Intraclass correlation analysis (ICC) revealed a moderate degree of reliability between CAL and CEJ to ABL measurements. The average ICC was 0.68 with a 95% confidence interval of 0.53–0.77 (p < .001) indicating moderate to good reliability. Comparing the types of teeth, the central incisors, particularly the lower central incisors showed the highest ICC values (ICC: 0.822, CI: 0.77–0.86) indicating good reliability while the premolar and molars showed poor to moderate agreement (Maxillary premolars ICC: 0.464, CI: −0.18–0.74; maxillary first molar ICC: 0.516, CI: −0.154–0.772; mandibular first premolar ICC: 0.662, CI: 0.269–0.782; mandibular first molar ICC: 0.625, CI: 0.31–0.82). A moderate correlation existed between the radiographic and the clinical assessments (r = 0.5, p < .001).

Conclusion

Despite the fact that significant varying levels of reliability has been found between CAL and radiographic bone level, both the clinical and radiographic examinations should be performed for the accuracy of diagnosis.

Diagnostic performance of cone beam computed tomography in assessing peri-implant bone loss: A systematic review

OBJECTIVES

To evaluate the diagnostic performance of cone beam computed tomography (CBCT) in the assessment of peri-implant bone loss and analyze its influencing factors.

MATERIALS AND METHODS

Clinical and preclinical studies reporting diagnostic outcomes of CBCT imaging of peri-implant bone loss compared to direct reference measurements were sought by searching five electronic databases, PubMed, MEDLINE, EMBASE, Web of Science, and CINAHL Plus, and OpenGrey. QUADAS-2 criteria were adapted for quality analysis of the included studies. A qualitative synthesis was performed. Two meta-analysis models (random-effects and mixed-effects) summarized the area under receiver operating characteristic (AUC) curve observations reported in the selected studies. The mixed-effects meta-analysis model evaluated three possible influencing factors, "defect type," "defect size," and "study effect."

RESULTS

The initial search yielded 3,716 titles, from which 18 studies (13 in vitro and 5 animal) were included. Diagnostic accuracy of CBCT was fair to excellent in detecting in vitro circumferential-intrabony and fenestration defects, but moderate to low for peri-implant dehiscences, and tended to be higher for larger defect sizes. Both, over- and underestimation of linear measurements were reported for the animal models. The meta-analyses included 37 AUC observations from eight studies. The random-effects model showed significant heterogeneity. The mixed-effects model exhibited also significant but lower heterogeneity, and "defect type" and "study effect" significantly influenced the variability of AUC observations.

CONCLUSION

In vitro, CBCT performs well in detecting peri-implant circumferential-intrabony or fenestration defects but less in depicting dehiscences. Influencing factors due to other site-related and technical parameters on the diagnostic outcome need to be addressed further in the future studies.