Transcript
presented by:
DR HASSAN SHAHED T
Post GraduateDepartment Of Periodontics
Yenepoya Dental College
Comparison OfIntra-oral Periapical And
Panoramic Radiographs For The Assessment Of Alveolar
Bone Height
GUIDED BY
Dr. Shashikanth Hegde HOD and Professor
Dr. Rajesh K.S Professor
Dr. Arun Kumar M. S Professor
YENEPOYA DENTAL COLLEGE, MANGALORE
The main goals of the diagnosis of
periodontal diseases and subsequent therapy are
to eliminate periodontal infection and to reduce
the risk for future progression of the disease. To
determine the amount of remaining bone,
clinicians rely on clinical and radiological data.
Intra-Oral Periapical (IOPA) and
Orthopantomogram (OPG) are the standard
radiological investigation techniques used in
routine clinical practice.
INTRODUCTION
Intraoral radiographs provides a more
accurate diagnosis of periodontal diseases (Kim.T.S
et al 2008). However it must be considered
whether a panoramic radiograph also produces the
same information. The aim of this study was to
compare these two radiographs and determine the
amount of agreement between them.
• To Measure The Alveolar Bone Height On IOPA
• To Measure The Alveolar Bone Height On OPG
• To Assess And Compare The Difference In Measurements Of Alveolar Bone Height From IOPA And OPG
OBJECTIVES
Ethical clearance had been obtained from the
institutional ethical committee before commencing
the study.
SOURCE OF DATA
Out patients attending the department of
Periodontics,
Yenepoya Dental College, Mangalore.
NUMBER OF SUBJECTS 20 (40 sites)
METHODOLOGY
INCLUSION CRITERIA
Age Group – 18yrs and above
Subjects with chronic periodontitis having a
probing depth of >3mm in mandibular molars
EXCLUSION CRITERIA
Pregnant and lactating mothers
History of periodontal surgical therapy for last 6
months
ARMAMENTARIUM
OPGIOPAHOLDER
DIGITALIZER
PROCEDURE
IOPA of mandibular molar
site/sites were taken using
paralleling cone technique
using SERONA Intra-oral X-ray .
OPG were also taken for
all the patients using
PLANMECA PROMAX.
These radiographs were then
calibrated and digitalized using a
X-ray DIGITIZER.
Distance from Cemento Enamel junction (CEJ) to
Base of the Defect (BD) was measured on IOPA.
IOPA
CEJ
BD
Distance from CEJ to BD at the same site was also
measured on OPG
OPG
CEJ
BD
All these values were then tabulated and
subjected to statistical analysis using Intra
Class Co-relation Coefficient (ICC) and t-test.
ICC value less than 0.8 will suggest a strong
correlation between IOPA and OPG.
p value less than 0.05 will be considered
significant and values less then 0.01 will be
considered highly significant.
RESULTS
►Highly Significant►Strong Correlation►But on an average – shows significant difference
STATISTICAL ANALYSIS
MEAN
STD DEVIATIO
N
IOPA
.4871
.20907
OPG
.5861
.21489
MEAN DIFFERENC
E
STD DEVIATION
OF DIFFERENC
E
t valu
e
p valu
eICC
.09902 .08255 7.681
.000 .835
IOPA OPG0
0.10.20.30.40.50.60.70.80.9
STD DEVIATION
MEAN
Fig 1: Bar diagram showing mean values of IOPA and OPG with their respective standard
deviation.
IOPA explains OPG by 85.4% IOPA = -0.040 + 0.899 x OPG
0 0.2 0.4 0.6 0.8 1 1.20
0.2
0.4
0.6
0.8
1
1.2
1.4
IOP
A
OPG
Fig 2: Scatter diagram between IOPA and OPG
REGRESSION ANALYSIS
DISCUSSION
Radiographs are important in periodontal diagnosis
and provide a general overview periodontal breakdown
(Lang and Hill 1977). Periodontal probing alone is
insufficient for complete and accurate diagnosis unless
it is supplemented by radiographs.
Being a two dimensional view of a three
dimensional structure, radiographs also have limitation
when it comes to determination of buccal and lingual
aspect of teeth. It can only provide information on
interproximal relationship between alveolar crest and
reference points on the tooth.(Frohlich 1956)
Periapical radiography describes intra-oral techniques
designed to show individual teeth and the tissue around the
apices, whereas panoramic view gives an un obstructed
view of entire maxillary and mandibular arch.
Periapical radiographs are mainly used for detecting
infections, periodontal status, position and morphology of
root, endodontic purposes etc., where as panoramic view
are mostly indicated in trauma, impacted tooth, larger
lesions, generalized disease and assessing surgical
procedures.
It also has an advantage of minimal exposure to
radiation, but at the same time there is also distortion
of image.
The present study was designed to compare two
radiographic techniques to estimate the alveolar bone
height. In this study an agreement of 85% was
obtained between IOPA and OPG which was very close
to the result of 87% agreement obtained by Molander
B et al in 1991, where they had concluded that OPG
can be used for the assessment of bone loss.
Similar study was done by Kim T S et al in 2008,
where they observed 81% agreement between IOPA
and OPG.
Another study done by Persson R E et al in 2003
also observed an agreement between IOPA and OPG.
But in a study done by Akesson L et al in 1992,
they had concluded that Periapical radiograph was more
accurate than panoramic and bitewing radiograph.
Similar results were seen in a study done by
Papapanou P N and Wennstrom J L in 1989, where
they found a strong correlation between IOPA and
probing measurement.
Further studies have to be carried out
including other teeth and clinical measurements.
CONCLUSION
In our study an agreement of 85% was
achieved between IOPA and OPG, based on which
we could conclude, there is no significant difference
between IOPA and OPG. With the increasing concern
of radiation exposure and patient comfort, a single
OPG can be used instead of a full mouth IOPA for
the assessment of alveolar bone height.
top related