avveolar bone loss determination

7/30/2019 avveolar bone loss determination

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Lira-Junior R, Freires Id, de Oliveira IL,da

Silva ES, da Silva S, de Brito RL J Indian Soc

Periodontol 2013;17:87-90

Comparative study between twotechniques for alveolar bone loss

assessment: A pilot study


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Objective:

To conduct a comparative study between twotechniques for assessment of alveolar bone loss.


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Materials and Methods:

Absolute and relative techniques were evaluated.The sample consisted of 16 radiographs

supposed to meet a single criterion:

The reference points applied (Cementum-enamel

junction (CEJ) alveolar bone crest and root apex)

should be visible. Bone height was measured in

the selected radiographs as the percentage of

root length through both techniques


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Data were submitted to the Statistical Packagefor Social Science software.

Results obtained by both methods were

converted into bone loss index values and then

categorized.

Sensitivity and specificity of the relative

technique, compared to the absolute technique,

were calculated. Wilcoxon test and the Bland and

Altmans method were employed for

comparisons.

Significance level was set at 5%.


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Results:

For the absolute and relative techniques, meansof bone loss index were respectively of 4.81

(2.25) and 4.75 (1.80). Bone loss index 6

(alveolar bone loss 50%) was found in 5 (31.2%)

teeth, in the absolute technique, and in 4 (25%)teeth, according to the relative technique.

There was no statistically significant difference

between both methods (P>0.05).


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According to the Bland and Altmans method, itwas verified a bias of 0.06, and limits of upper

and lower agreement of, respectively, 1.58 and

1.45.

Sensitivity of 0.8 and specificity of 1 were found

for the relative technique compared to the

absolute one.


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Conclusion:

There was no significant difference between thetechniques evaluated, and the relative technique

was found to be reliable for measuring alveolar

bone loss.


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Absolute technique

We measured, in millimeters, the distancebetween CEJ and

the alveolar bone crest, as well as the distance

between CEJ

and the root apex.

Bone loss percentage was determined by the

difference between those distances multiplied by

100.All measurements were made in different days

within a dark ambience on the negatoscope by a

single previously trained examiner, with the aid of

a needle point compass and a millimeter ruler.


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Relative technique

It was conducted by using the Schei ruler.

It is a transparent plastic ruler stamping 1 mm

thickness along its margins and 10 equidistant

lines radiating from a central point, each one

representing a bone loss equivalent to 10%.

The marking of 1 mm thickness represents the

distance between CEJ and the alveolar crest in

normal humans without bone loss.


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Schei ruler - representative image


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This technique results in the determination ofbone loss as a percentage of the original bone

level, starting 1 mm below CEJ, regardless root

length, its extension in the radiograph and

direction of the X-rays beam.

The bone crest level was defined as the point

along the root where an intact lamina was found.

As for the absolute technique, data were

registered in a form. For both techniques, after 30

minutes of evaluation, a 15-minute break was

respected to avoid eyestrain.


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DISCUSSION Radiographic assessment complements the

periodontal clinical examination, contributing tothe establishment of a diagnosis and beingeffective for a retrospective analysis of

periodontal disease evolution. Numerous scientific evidences have aroused

attention to the importance of clinical andradiological follow-up of periodontal patients.

Nonetheless, there is still no consensus on thebest technique for measuring bone level.

This study was designed in order to analyze thedifferences between two techniques for alveolarbone loss assessment


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Wolf B, Von Bethlenfalvy E, Hassfeld S, Staehle HJ, Eickholz P:

Reliability of assessing interproximal bone loss by digital

radiography: intrabony defects. J Clin Periodontol 2001; 28: 869

878.

The aim of the present study was to assess thereproducibility and validity of linear measurements ofinterproximal bone loss in intrabony defects ondigitized radiographic images after application ofdifferent filters and magnifications.

In this study, the chosen digital manipulations (filters:spreading, structure) of radiographic images failed toresult in statistically significantly more reproducible or

valid measurements of interproximal bone loss withinintra-bony defects when compared to the digitized butunchanged images. All radio-graphic assessments onthe digitized images except for use of enhancement ofgrey level differences (structure) came close to the

intrasurgical gold standard.


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When comparing techniques, the absolute onemeasured greater alveolar bone loss than the relative,but without statistically significant difference.

Although evaluating different methods, Teeuw et al.found that an analyzer software measured a greater

extent of bone loss than the Schei technique, but nostatistically significant difference was found as well.

Albandar and Abbas[compared three techniques formeasuring bone loss (absolute, Scheisand Bjornstechniques (bone level as a percentage of the tooth).

Absolute technique was found to demonstrate ease ofreading, while the Scheis technique demonstratedgreater ability to detect changes in bone level.


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Benn DK: A review of the reliability of radiographic

measurements in estimating alveolar bone changes. J

Clin Periodontol 1990; 17: 14-21.

Despite tlieir widespread use, denta! radiographshave numerous shortcomings for measuring

alveo!ar bone changes. In order to develop

guide!ines for improving the re!iability of

radiographic measurements, factors affecting theformation of an image v^^ere reviewed.

These were considered regarding the design of a

clinica! monitoring system, capab!e of detecting

the loss of smal! amounts of a!veo!ar bone crestfrom serial fi!ms


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it appears that routine screening of patients bygeneral dental practitioners for small amounts of

bone loss is unlike!y to be successfu! without the

use of

(i) repositionab!e stentless film holders to

standardise the irradiation geometry,

(ii) a very accurate reproducible measuring

technique which

(iii) wil! probably require an automatic computer-

based measuring system.


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avveolar bone loss determination

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