Evaluation of reliability of radiographic (linear and surface area) measurements, for the determination of bone behavior of periodontally compromised teeth with or without periodontal therapy

Postgraduate Thesis uoadl:1446807 619 Read counter

Unit:
Κατεύθυνση Περιοδοντολογία (Κλινικές Ειδικεύσεις)
Βιβλιοθήκη Οδοντιατρικής
Deposit date:
2017-03-29
Year:
2016
Author:
Karaiskou Maria
Supervisors info:
Αλεξάνδρα Τσάμη-Πανδή, Αναπληρώτρια Καθηγήτρια, Εργαστήριο Περιοδοντολογίας, ΕΚΠΑ
Ιωάννης Καρούσης, Αναπληρωτής Καθηγητής, Εργαστήριο Περιοδοντολογίας, ΕΚΠΑ
Ιωάννης Φουρμούζης, Επίκουρος Καθηγητής, Εργαστήριο Περιοδοντολογίας, ΕΚΠΑ
Original Title:
Αξιολόγηση της αξιοπιστίας των ακτινογραφικών μετρήσεων, γραμμικών και εμβαδομετρικών, για τον προσδιορισμό της οστικής συμπεριφοράς περιοδοντικά θεραπευμένων ή μη δοντιών
Languages:
Greek
Translated title:
Evaluation of reliability of radiographic (linear and surface area) measurements, for the determination of bone behavior of periodontally compromised teeth with or without periodontal therapy
Summary:
The aim of this retrospective radiographic study was to evaluate bone behavior of periodontally compromised teeth treated or not for chronic periodontitis. Clinical crown-root ratio and residual over physiologic bone support, were examined as diagnostic factors. This assessment was performed using both linear and surface area measurements in digital images which have been generated by conventional non-standardized periapical radiographs, with the EMAGO software.
The sample was selected from already existing conventional periapical radiographs of radiographic files of 45 patients suffering from advanced or moderate chronic periodontitis. These patients were examined clinically 5 to 10 years ago and the radiographs were performed with the parallel technique and application of radiographic holders. Subsequently, these patients either completed periodontal treatment and never included in a supportive periodontal treatment (Group A, 15 patients) or responded to it adequately (Group B, 15 patients) or did not perform the necessary treatment but they came few years later to undergo this treatment (Group C). In all three groups of patients a second full mouth radiographic examination was performed in order to assess the extent and severity of periodontal disease.
The collection of the sample as well as the evaluation of the maxillary and mandibular front teeth was performed under specific selection criteria. These criteria on a patient level included good general health (patients with any systematic condition or under medication that could affect the progression of periodontal disease or the treatment outcome were excluded), smoking habits (patients should not smoke more than 10 cigarettes per day), and a full dentition, or in case of partial posterior edentulism, prosthetic restorations should be misfitted during the period between the two radiographic examinations. The inclusion criteria on a tooth level included crown-root ratio varying from 0.5 to 0.72, the absence of any deep and narrow intraosseous defect, proximities, misfitting prosthetic restorations, tooth mobility and tooth movement, extrusion and trauma from occlusion.
After the collection of archival material the two non-standardized (initial and subsequent) conventional radiographs were converted to indirect digital images. Followingly these digital radiographic images were processed in pairs and a second digital image (later radiograph) with the same geometric formulation of the original digital image (initial radiograph) was produced. Therefore a third digital image was reconstructed (reconstruction image), aiming to correct the density and contrast of the second digital image.
Subsequently, the linear and surface area measurements were based on specific benchmarks to identify the ratios. The benchmarks were for each tooth the most prominent point of its crown, the cemento-enamel junction, the root appex and the most coronal point of the alveolar crest.
Specifically, the linear measurements of the anatomical crown and root were performed only in the original digital radiography, while the measurements of the clinical crown and root, of the remaining bone support as well as physiologic bone support were evaluated in the initial and reconstructed digital radiographs. Correspondingly, surface area measurements related to the area of the anatomic crown and root were performed only in the initial digital radiograph, while those corresponding to the surface of the remaining bone support, normal bone support, as well as the clinical crown and root were performed both in the initial and the reconstructed digital radiographs.
Linear measurements were made on the interproximal surfaces of the examined teeth and the mean value of these two measurements was recorded. Moreover, both linear and surface area measurements on each tooth were twice evaluated within a period of 15 days by the same calibrated examiner, determining the final value of each measurement as the mean value of two recordings. This procedure was necessary in order to minimize the probability of underestimation or overestimation of the data. All measurements performed in this study were expressed exclusively in pixels, which is the measurement unit of the EMAGO software. 10 pixels are equivalent to 1 mm.
For the statistical analysis of the results, parametric methods were applied, namely the one way analysis of variance (ANOVA), the Student's t-test pairs assay, the X2 test as well as linear regression analysis which was performed as univariance analysis. Moreover, Pearson rank correlation coefficient (r) and the linear regression coefficient of variance (b), coefficients were determined. Furthermore, a fourfold table was used in order to determine the sensitivity, specificity, positive and negative predictive value between the two recordings (linear and surface area measurements) of the ratios of both clinical crown and root and residual versus normal bone support. The fourfold table was done separately for all the examined teeth of each group of patients (180 teeth) and cut off point, as already mentioned the 10 pixels, i.e. 1 mm.
For all the comparisons and correlations as well as the criteria for assessment between the two measurements of the evaluated ratios, statistical significance was determined with 1% error probability threshold (p≤0.01). Analysis of the results in this study was done with the statistical package STATA 9.0.
The following findings can be extracted from the results of this study as to the ratios of the clinical crown and root and the residual versus normal bone support:
1. both ratios can reliably recognize bone behavior of periodontally compromised teeth after periodontal treatment, or in its absence.
2. surface area evaluation of these two ratios is superior to linear as a diagnostic method for bone behavior, since it can "recognize" a higher percentage of changes smaller than 1 mm.
3. surface area evaluation of these ratios presents a high negative predictive value, which ranged for changes in the clinical crown and root ratio from 80.55% to 86.67% and for the ratio of residual versus normal bone support from 82.78% to 85.55%.
4. every unit increment of the area measuring for determining changes in the ratio of the clinical crown and root represents an increase of 0.93 units of the corresponding linear determination and this concerns the untreated and treated patients but non compliant at the maintenance program as well as a decrease of 0.81 units of the corresponding linear determination and this concerns treated periodontally and fully responding patients in the a maintenance phase.
5. every unit increment of the area measured for the determination of changes in the ratio of residual versus normal bone support represents an increase of 0.77 units of the corresponding linear determination and this concerns patients treated periodontally and fully complying to the maintenance program as well as a reduction of 0.71 and 0.79 units of the corresponding linear determination and this concerns patients treated periodοntally but non compliers in the maintenance program and to untreated patients respectively.
Main subject category:
Health Sciences
Keywords:
clinical crown-root ratio, residual over physiologic bone support, prognostic factors, digital radiography, linear and surface area measurements
Index:
Yes
Number of index pages:
2
Contains images:
Yes
Number of references:
776
Number of pages:
344
File:
File access is restricted only to the intranet of UoA.

Καραϊσκου Μαρία.pdf
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