Variations of Bone Height Assessments Among Different Types of Intra-Oral Radiographs
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Radiographic assessment is a useful tool to diagnose and monitor periodontal disease activity and pattern of bone destruction. The aim of our study was to investigate the variability of various radiographic landmarks (CEJ and BD) used in assessments of alveolar bone height. The variability was measured on the inter- and intra-user level as well as from Bitewing and periapical radiographs. Our results demonstrated that CEJ has the lowest inter- and intra-user variability (about 0.3 mm) and for both bitewing and periapical radiographs. Our BD results demonstrated a higher intra- and inter-user variability (0.44 and 0.57mm, respectively) than those seen for the CEJ (0.3 mm each). Our results have also showed that bitewing radiographs had the lowest variability in BD indications followed by anterior radiographs, while periapical radiographs showed the highest BD variability. In addition our results have demonstrated a slightly higher BHc in the anterior teeth when compare to that of the posterior teeth. In conclusion Periodontal probing and assessment of gingival inflammation (bleeding on probing) is the mainstay of periodontal diagnosis and disease assessment. CEJ is the most reliable landmark with anterior periapical radiographs being the least reliable while BD has a higher variability especially in periapical radiographs. Bitewing is the most reliable intra-oral radiographic technique for assessment of alveolar bone.