Abstract
The use of radiographic indices is noticeably diminished due to the lack of simplicity and standardisation among the existing ones. The aim of this study was to introduce a radiographic index to aid clinicians in determining the extent and severity of interproximal alveolar bone loss (iABL), in relation to individual root lengths, among patients suffering from periodontitis. A retrospective analysis of 50 anonymised dental panoramic tomograms (DPTs) of patients with periodontitis was conducted. Visual interpretation of iABL was recorded by a single investigator and by 20 volunteering clinicians for the ‘worst site’ in each quintet. Results were compared to a gold standard quantification method. Intra-examiner and inter-examiner agreement were measured using the Kappa coefficient and the intra-class correlation coefficient, respectively. Validity was assessed using Cramér’s V test. The mean intra-examiner agreement on the severity and pattern of iABL was 0.808 (K) and 0.802 (K), respectively. A stronger overall inter-examiner agreement was noted when the severity in contrast to the pattern of iABL and presence/absence of furcation involvement were analysed. The statistically significant total mean agreement values from this correlation coefficient were 0.892 and 0.739, respectively. A very strong association between all the visual interpretations carried out by all participants and the gold standard measurements was evident. Within the limitations of this study, the proposed radiographic index may serve as a simple, yet valid and reliable, adjunctive screening tool to further assist clinicians in determining the extent and severity of iABL in patients with periodontitis.
Highlights
Periodontitis is among the commonest of all forms of chronic diseases worldwide.Since a considerable loss of connective tissue and alveolar bone support via the inflammatory nature of the disease process is further complicated by an array of signs and symptoms that negatively influence the quality of life of those affected, detailed evaluation of the periodontium is a crucial element to ensure adequate patient management [1]
In order to analyse intra-examiner repeatability, a single investigator (ZS) visually interpreted the severity and extent of alveolar bone loss in relation to root lengths using the proposed radiographic index from the 50 printed dental panoramic tomograms (DPTs) in a well-illuminated room on two occasions separated by a one-month period and the results were compared
In contrast to inter-examiner repeatability, 30 volunteering participants of varying clinical experience comprised of dental undergraduate students (UG: n = 8), dental postgraduate students (PGT: n = 20), and consultants in restorative dentistry (Consultants: n = 2) were asked to visually interpret the same 50 printed DPTs and were advised to do so under adequate lighting in two equal batches separated by a one-month period
Summary
Periodontitis is among the commonest of all forms of chronic diseases worldwide.Since a considerable loss of connective tissue and alveolar bone support via the inflammatory nature of the disease process is further complicated by an array of signs and symptoms that negatively influence the quality of life of those affected, detailed evaluation of the periodontium is a crucial element to ensure adequate patient management [1]. An index system for periodontitis should be a quantitative scoring system that indicates the severity of disease with reasonable accuracy and repeatability to allow for statistical evaluation that is applicable to clinical, epidemiological, and combined clinical-epidemiological investigations [2]. Among the key advantages of developing such index systems for periodontitis was the consequent development of screening tools, such as the basic periodontal examination (BPE)—the commonly used tool in the United Kingdom since 1986. It continues to be the most popular screening assessment for indicating the level of examination required and providing basic guidance on periodontal treatment need [3]
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