The Relationship Between Probing Attachment Loss and Computerized Radiographic Analysis in Monitoring Progression of Periodontitis

Abstract

This study attempted to evaluate quantitative changes in radiographic density as an indicator of progression of periodontitis. Twenty-one subjects with a history of periodontitis were monitored at baseline, 3, 6, and 9 months using duplicate probing attachment level (PAL) measurements from stents and computer assisted densitometric image analysis (CADIA) of standardized radiographs. Results indicate that the majority of sites exhibited no PAL change during the 9-month period; however, the percentage of sites with loss increased with time. A mean of 6.1% of the sites/patient exhibited probing attachment loss during the study, as compared to a mean of 38.3% of the sites/patient that exhibited a loss of radiographic density. Due to the two dimensional nature of radiographs, density analysis was calculated in terms of radiographic "complexes" of multiple probing sites. There was significantly more density loss at complexes with greater than or equal to 2 mm of attachment loss than at sites with no change in PAL at 9 months; there was no such difference noted at 3 and 6 months. Also, density loss tended to increase as more sites within each complex experienced PAL. Although there was a significant correlation between mean density and PAL changes during the same time interval, there were wide variations at individual sites. This study suggests that there is a complex relationship between density change on radiographs and PAL change. The difficulties inherent in comparing highly sensitive new technologies to relatively imprecise clinical measurements of the attachment level are discussed.(ABSTRACT TRUNCATED AT 250 WORDS)

Radiographic parameters: biological significance and clinical use

“…By using radiographic techniques, other studies have documented a phase of bone resorption immediately after periodontal flap procedures, followed later by bone apposition in patients undergoing crown lengthening and after surgical access flap procedures in patients with periodontitis (25). Untreated periodontal sites or sites with unsuccessful healing after therapy tend to lose bone density (35, 50, 74).…”

Analysis of gingival crevice fluid and risk of progression of periodontitis

“…Another serious impediment to the evaluation of GCF components as potential markers of the progression of periodontitis is that only a small percentage of sites that have been assigned the clinical diagnosis of periodontitis actually progress in a given period of time. In untreated human populations, if a ≥2 mm increase in clinical attachment loss is used as the criterion for progression, only about 5–10% of sites with periodontitis will progress in a 12‐month period (9, 32, 59, 69). Therefore, even if a GCF component distinguishes between gingivitis and periodontitis, it may not be able to reliably separate progressing and non‐progressing periodontitis sites.…”

Prevalence of horizontal attachment loss in extracted teeth

“…Periodontal attachment level is the most frequently used variable in monitoring longitudinal studies of periodontal disease. However, reproducibility of clinical measurements is affected by several factors, including periodontal pocket depth (Deas et al 1991), tooth type (molar versus non‐molar) (Goodson et al 1982) and location of the measured site (buccal versus lingual/palatal) (Halazonetis et al 1989). Awareness of root morphology and the condition of the periodontal tissues is also essential for reliable periodontal pocket probing.…”