In Vitro Comparison of Four Bone-Height-Measurement Techniques
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Objectives: The aim of the present study was to evaluate the accuracy of different diagnostic modalities (radiographs, photographs and caliper) for linear bone height measurements (i.e., BHa – the distance between the cemento-enamel junction (CEJ) and alveolar crest (AC) and BHb – the distance between CEJ and the base of the defect (BD)) when compared to periodontal probing. Further objectives were to compare the intra-user and inter-user variability of bone height measurements (BHa and BHb) and computer-based landmarks indication (CEJ, AC and BD) and to determine the reliability of standardized periapical (PA) and bitewing (BW) radiographs.Materials and Methods: One hundred forty-nine tooth sites were identified on six human dry skulls. Direct bone height measurements of BHa and BHb were made with periodontal probe and electronic caliper. Indirect measurements were taken by landmarks indication on standardized (PA and BW) radiographic and photographic images using computer-software (ImageJ®). Eight users performed the measurements twice and separated by at least one week. The average differences of the measurements of each modality from probing measurements and standard deviations (SD) were used in simple t-test to evaluate the statistical significance of the differences at the 0.05 level. For intra- and inter-user variations, the mean variability and SD about the mean was calculated. Results: No statistically significance differences (p> 0.05) between probing measurements and standardized (PA and BW) radiographs, photographs and caliper for alveolar bone height measurement. The inter-user variability was found to be higher than intra-user variability across all modalities for BHa and BHb measurements with greatest variation was observed for caliper (0.63 mm) and probing measurements (0.62 mm).The lowest variation was seen for BW radiographs (0.4 mm). The overall variations of CEJ, AC and BD indications were 0.3 mm, 1.8 mm and 0.36 mm, respectively. Although BW radiographs showed the lowest overall variation the difference between PA and BW was in order of 0.1 mm.Conclusions: Overall, the all four modalities are useful for periodontal research and practice. Compared to probing, assessment of radiographs by means of computer-based bone height measurements are reliable (variation less than 0.4) and the precision needed to detect small changes in periodontal health has the potential for further improvement as the technology evolves. The variabilities of bone height measurements from standardized periapical and bitewing radiographs were found to be comparable (BW is slightly better). The AC and CEJ are reliably indicated on radiographs (variation less than 0.3).