Isp Pg Convention Lucknow

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.