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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 30  |  Issue : 2  |  Page : 142-147

Comparison between conventional and digital radiography in assessing alveolar bone loss: An original research


1 Department of Oral Medicine and Radiology, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
2 Department of Oral Medicine and Radiology, CODS, Mangalore, Karnataka, India
3 Department of Oral Medicine and Radiology, Career Dental College and Hospital, Lucknow, Uttar Pradesh, India
4 Department of Periodontology, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
5 Department of Dentistry, RNT Medical College, Udaipur, Rajasthan, India

Date of Submission14-Nov-2017
Date of Acceptance07-Mar-2018
Date of Web Publication16-Jul-2018

Correspondence Address:
Dr. Narender Singh Bansal
Department of Dentistry, RNT Medical College, Udaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_105_17

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   Abstract 


Aim: The aim of this study was to compare the efficiency of conventional and digital radiography in assessing alveolar bone loss. Materials and Methods: The study group comprised 50 participants (25 males and 25 females) between 25 and 45 years of age. The participants were screened for all clinical features of periodontitis. A series of conventional bitewing radiographs of right and left of both maxillary and mandibular posterior region (15,16,17,25,26,27,35,36,37,45,46,47) were taken for each of 50 patients by examiner 1. Similarly, a series of digital bitewing radiographs were taken by examiner 2 for each 50 patients by using RVG of Planmeca Dixi 2 B Series. In digital bitewing radiographs, the measurement was done by examiner 2, using Planmeca Dixi 2 B Digital Software, by dragging the cursor to make a line by joining the linear points. Bone level less than 2 mm from the cementoenamel junction (CEJ) was considered normal while above that was considered bone loss. In case of conventional bitewing radiographs, alveolar bone loss was measured by the same examiner by measuring the distance from the CEJ to the most apical level of crestal bone using a divider and transparent ruler. The above collected data of examiners 1 and 2 were handed over to examiner 3 for statistical evaluation. Results: Comparison of conventional and digital radiographic techniques in left maxilla, left and right mandible, and between maxilla and mandible in the total sample and in females aged 25–35 and 36–45 years yielded a significant correlation while comparison of the two techniques in the right maxilla and between maxilla and mandible in males yielded a nonsignificant correlation. Conclusion: Direct digital radiography provides an edge over conventional radiography in assessing the periodontal bone destruction.

Keywords: Alveolar bone level, conventional intraoral bitewing radiographs, direct digital radiography, periodontal disease


How to cite this article:
Mathur H, Ahmed J, Tripathi P, Singh MP, Bhuvaneshwari S, Mathur A, Bansal NS. Comparison between conventional and digital radiography in assessing alveolar bone loss: An original research. J Indian Acad Oral Med Radiol 2018;30:142-7

How to cite this URL:
Mathur H, Ahmed J, Tripathi P, Singh MP, Bhuvaneshwari S, Mathur A, Bansal NS. Comparison between conventional and digital radiography in assessing alveolar bone loss: An original research. J Indian Acad Oral Med Radiol [serial online] 2018 [cited 2021 Aug 5];30:142-7. Available from: https://www.jiaomr.in/text.asp?2018/30/2/142/236718




   Introduction Top


Periodontal disease is one of the most extensively occurring diseases in the general population.[1] Radiographs play an integral role in the assessment of periodontal diseases, caries, periapical pathologies, and dentoalveolar fractures. The radiographic features of periodontal disease are changes in morphologic features of supporting alveolar bone due to interproximal crestal bone loss and change in internal density and trabecular pattern which reflect reduction or an increase in bone structure. The most used radiographic methods in the diagnosis of periodontal diseases are panoramic radiography, bitewings, and periapical radiography.[2]

Conventional radiographs are easy to setup and are cost effective. Bitewing technique is characterized by its simplicity and reduction of radiation exposure since fewer films are needed than when the periapical technique is used.[3] The distortions with bitewing radiographs are relatively minimal, but their diagnostic accuracy is notoriously imprecise.[4]

A recent advance in computer technology has led to the development of digital imaging, which has made a significant impact on dental radiographs.[1] Digital radiographic methods facilitate clinical practice as they eliminate chemical processing, reduce radiation exposure, and the images can be manipulated with the use of software.[5] This possibility of enhancing digital images optimizes diagnosis, unlike the static images of conventional films, which cannot be manipulated or enhanced.[2]

The present study was conducted to evaluate and compare the diagnostic efficacy of digital radiographs against that of conventional radiographs for assessing interproximal bone loss under normal clinical conditions.

Aims and objectives

The aim of the study was to evaluate and compare the diagnostic efficacy of digital radiographs against that of conventional radiographs for assessment of interproximal bone loss.

The objectives of the study were first to evaluate and compare the amount of bone loss between conventional and digital radiography; the second objective was to measure the average bone loss in different age groups, in maxillary and mandibular region, and in relation to gender.


   Materials and Methods Top


The study was conducted in Pacific Dental College and Hospital, Udaipur. Total number of patients were 50 (25 males and 25 females), aged between 25 and 45 years, selected from the outpatient section of the department.

The participants were screened for all clinical features of periodontitis which included probing pocket depth >5 mm, periodontal attachment loss, gingival recession, presence of suppuration, and tooth mobility. Bone loss was recorded on three surfaces per quadrant which included the mesial and distal surface of the first molar and mesial surface of the second molar.

Ethical clearance was obtained from the ethical committee of the institution to conduct the study.

Patients with right and left first and second molars in both maxillary and mandibular arches aged between 25 and 45 years were included in the study. The exclusion criteria of the study were patients contraindicated for radiography, noncooperative and syndromic patients, patients having fixed and removable prosthesis in posterior region, and patients having malocclusion with supraerupted or drifted teeth.

After obtaining the duly signed consent, a series of conventional bitewing radiographs [Figure 1] of right and left of both maxillary and mandibular posterior region (15,16,17,25,26,27,35,36,37,45,46,47) were taken for each of the 50 patients by examiner 1 using Gnatus dental X-ray unit operated at 70 kvp and 8 mA with radiation exposure of 0.8 seconds [Figure 2]. The film used was Kodak E–speed, No. 2 of size 31 × 41 mm (Ekta speed, Eastman Kodak Rochester, USA) and processing of film was done manually (time and temperature and visual method). Radiographs were mounted on an X-ray viewer and alveolar bone loss was measured by the same examiner from CEJ to the most apical level of crestal bone. This was done by using a divider and transparent ruler [Figure 3]. Similarly, a series of digital bitewing radiographs [Figure 4] were taken by examiner 2 for all 50 patients by using RVG of Planmeca Dixi 2 B Series [Figure 5] and Gnatus dental X-ray unit operated at 70 kvp and 8 mA with a radiation exposure of 0.3 seconds. To ensure maximum hygiene, the sensor was covered with a plastic sleeve, and for each new patient a new plastic cover was used. The system used in our study contained a charge coupled device (CCD) sensor. The measurement in RVG was done by examiner 2 using Planmeca Dixi 2 B Digital Software by dragging the cursor to make a line by joining the linear points. Bone level less than 2 mm from the CEJ was considered normal while above that was considered as bone loss.
Figure 1: Conventional bitewing

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Figure 2: Gnatus intraoral X-ray machine

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Figure 3: Measurement being recorded on scale

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Figure 4: Digital bitewing

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Figure 5: RVG equipment

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The above collected data of examiners 1 and 2 were handed over to examiner 3 for statistical evaluation.


   Results Top


The data derived for each of the group was analyzed by paired t-test, Post Hoc test, and Pearson correlation test.

For all tests, a P value of <0.05 (5%) was considered significant.

P-value of <0.01 (1%) was considered highly significant.

This study was conducted to compare the depth of alveolar bone loss by conventional radiography and digital radiography using bitewing technique. The present study was conducted among 50 patients with chronic periodontitis. Bitewing radiographs were taken for all the four quadrants and alveolar bone loss was measured at three sites per quadrant. Paired t-test was used to compare the alveolar bone loss measured by conventional and digital radiographs. For alveolar bone loss measured for right maxilla, the mean score for conventional radiographs was 3.52 mm with standard deviation of ±0.62 while it was 3.83 mm ± 0.63 for digital radiographic technique. When both the techniques were compared no significant difference (P value 0.061) was observed [Table 1].
Table 1: Comparison of conventional and digital radiographic technique in the left and right maxilla

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In the left maxilla, conventional radiographs showed a mean bone loss of 3.39 mm while it was 3.70 mm for the digital radiographic technique. Comparison of conventional and digital radiographs showed statistically significant difference (P value 0.037) [Table 1].

The mean bone loss in right mandible was 3.52 mm ± 0.53 in right mandible for conventional radiograph and 3.837 mm ± 0.57 for digital radiographs. Statistically significant difference (P value 0.029) was observed when both the techniques were compared [Table 2].
Table 2: Comparison of conventional and digital radiographic technique in left and right mandible

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Significant difference (P value 0.047) was observed on comparison of conventional and digital radiographs in the left mandibular quadrant with mean bone of 3.5 mm and 3.77 mm for conventional and digital radiographs, respectively [Table 2].

Overall comparison of bone loss was done for maxilla independent of age and sex. Mean alveolar bone loss observed in maxilla was 3.45 mm for conventional radiographs and 3.76 mm for digital radiographs with a P value of 0.005 [Table 3].
Table 3: Comparison of conventional and digital radiographic technique in maxilla and mandible

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Mean bone loss of 3.508 mm and 3.803 mm was observed in mandibular sites for conventional and digital radiographs, respectively. Statistically significant difference (P value 0.003) was seen when both the techniques were compared [Table 3].

Paired t-test was applied to determine which technique was better for determination of alveolar bone loss. Mean bone loss of 6.9 mm was observed for conventional radiographic technique whereas a mean bone loss of 7.6 mm was observed by digital radiographic technique. Significant difference (P value 0.002) was seen when both the techniques were compared [Table 4].
Table 4: Overall comparison of conventional and digital radiographic technique

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Mean bone loss of 3.51 mm and 3.80 mm was observed in maxillary sites in males by conventional and digital radiographic techniques. Application of paired t-test showed a statistically nonsignificant difference (P value = 0.076) between both the techniques [Table 5]. Similar results were seen in mandibular sites with mean bone loss of 3.56 mm and 3.82 mm (P value = 0.082) [Table 5].
Table 5: Comparison of conventional and digital radiographic technique in maxilla and mandible among males and females

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A similar comparison was done to compare both the techniques in females. A statistically significant difference (P value = 0.029) with mean bone loss of 3.4 mm and 3.72 mm was observed in female maxillary sites [Table 5]. The mandibular sites showed an average bone loss of 3.45 mm and 3.78 mm by conventional and digital radiographic techniques [Table 5]. This result was statistically significant with a P value of 0.012.

Fifty patients were further divided into two groups on the basis of age into 25–35 years and 36–45 years. In the age group of 25–35 years, mean bone loss of 3.41 mm and 3.72 mm was observed by conventional and digital radiographic technique. This was statistically significant with P value of 0.019 [Table 6]. In the age group of 35–45 years, the mean bone loss of 3.54 mm and 3.84 mm was observed by conventional and digital radiographic technique, respectively. This was statistically significant (P value = 0.047) [Table 6].
Table 6: Comparison of conventional and digital radiographic technique in 25-35 years and in 36-45 years

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   Discussion Top


Radiographs play an integral role in the assessment of periodontal disease. They provide unique information about the status of the periodontium and a permanent record of the condition of the bone throughout the disease course. Radiographs aid the clinician in identifying the extent of the destruction of alveolar bone, local contributing factors, and feature of the periodontium that influence the prognosis.

The diagnosis of the periodontal diseases is primarily based on clinical examination. The clinical findings of periodontal osseous destruction can be confirmed by radiographic examination, but radiographs on their own cannot help in diagnosis. They are adjunct to the clinical examination not the substitute. They also help in the assessment of recurrence of disease progression by comparative evaluation.

In the present study, participants with crowded teeth were excluded as these teeth show a significantly higher bone loss as compared to noncrowded teeth (Jensen et al. 1989)[6] because in periodontal patients local crowding and tooth angulation predisposes to increased bone loss.

In contrast to the study by Albander et al. (1985),[7] the present study observed that the mandibular sites showed a higher amount of bone loss compared to maxillary sites. The mean bone loss in maxilla was 3.4 mm and 3.7 mm by conventional and digital radiographic technique, whereas 3.7 mm and 3.8 mm bone loss was observed in mandibular sites when both the radiographic techniques were compared.

The present study evaluated the mean bone loss by conventional and digital radiographs in various age groups. Age group of 25–35 years showed mean bone loss of 3.41 mm and 3.72 mm by conventional and digital radiographic method whereas age group of 36–45 years showed a mean loss of 3.54 mm and 3.84 mm by both the techniques. These results are in accordance with a study by Aass et al. in 1994[8] that showed that the frequency of participants with radiographic alveolar bone loss increased significantly with age.

In our study, the results showed that overall the digital bitewing images averaged 0.6 mm greater bone loss than the conventional images with a significant P value. Whereas in a study conducted by Kotch et al. (2003),[9] digital radiography measured 0.3 mm greater bone loss than conventional bitewing with a significant P value, which is relatively consistent with our results. Given the overall difference between conventional and digital radiographs, we wanted to know if this difference was consistent across all sextant of the mouth. Therefore, we computed paired t-test for each of the sextant available, and our results showed measurement differences in RVG and conventional radiographs in all 4 sextant of the jaw.

RVG showed more bone loss in both maxilla and mandible than conventional radiographs, however, in maxilla both methods showed almost similar measurement with a mean difference of 0.3 mm only, which is in accordance with the study by Kotch et al. (2003).[9] Digital radiographs only in posterior mandibular region indicated bone loss, and measurements of bone loss in posterior maxillary region were similar between the two radiographic methods.

Li (2007)[10] stated that, as such there was no significant difference in conventional and digital radiographs, digital radiographs had measurement accuracy than conventional radiographs while measuring alveolar bone loss.

The results of our study showed that in the normal clinical use significant difference exists between alveolar bone loss measurements on digital and conventional radiographs in several regions in the mouth. This difference between the two imaging systems may be attributed to variation in measurement, which were done manually in case of conventional radiographs and digitally in case of digital radiographs because RVG was showing 0.6 mm greater bone loss than conventional radiographs while comparing the total samples. These variations may be due to flexibility of the conventional radiograph film and sensor used in digital radiograph.

Over the past few years, system that can generate radiographic digital images without the need for radiographic film have become available for use in clinical practice and are gaining popularity. Electronic probing system, subtraction radiography, CADIA (computer-assisted densitometric image analyses system), dark field microscopy, DNA probes, immunodiagnostic methods have been developed in recent times, which help in the precise diagnosis of periodontal diseases.

Khocht (2003)[9] pointed that digital radiography offers many advantages over conventional methods. It eliminates the need for film and film developing and allows lower radiation exposure. The generated image is available immediately for evaluation on a computer screen and can be manipulated digitally to enhance viewing. In addition, digital tools are available to record electronic measurement and to cut, paste, and colorize the image. The image can be easily filed and retrieved from the hard disk or removable storage medium, or the images can be transferred electronically to third party carriers.

Apart from this they also have other advantages such as immediate observation of radiographic images. Only few digital radiography devices, e.g., charged coupled devices, provide immediate viewing. However, phosphorus plate technology requires placement of irradiated sensor in a processing device to scan and put the information into a computer so that the image can be viewed. In conventional radiographic techniques, the delay in reading the image usually forces the clinician to change his gloves and do something else till the radiograph develops.[3]

Along with advantages, there are disadvantages as well. They include cost of the devices as well as converting previous records to digital, which are very high, thickness and rigidity of sensor that makes the patient uncomfortable, and loss or breakage of sensor, which can prove very costly.

The clinical implication of radiography in the diagnosis of periodontal diseases are two-fold; to visualize the initial status of the bone tissue and to illustrate changes in bone tissue overtime when there are so many radiographic techniques – the clinician is in a dilemma as to which technique should be used. Therefore, this study is an attempt to help the clinician select the radiographic method in the detection and imaging of periodontal osseous destruction.

Within the limitation of our study, we recommend that the direct digital radiography provides an edge over conventional radiography to assess the periodontal bone destruction, however, the cost of RVG results in its limited use by clinicians in their clinic.


   Summary and Conclusion Top


The present study compared the efficacy of digital radiographs in measuring the alveolar bone loss. A total of 50 patients were evaluated (25 males and 25 females) who were aged between 25 and 45 years of age. Alveolar bone loss was measured from the CEJ to the most apical level of marginal bone on the readable surfaces. Seven hundred and twenty image sites were examined using conventional and digital bitewing radiographs showing more bone loss using digital radiographs in all the 4 sextant of the jaws than conventional radiograph. The data obtained were recorded in tabloid form and statistically analyzed using paired t-test, Post Hoc test, and Pearson correlation test. After analyzing the data following conclusions were drawn:

Under normal clinical use, significant difference existed between alveolar bone measurements on digital and conventional radiographs in several regions of the mouth.

Thus, it could be said that the digital radiograph had an upper hand compared to conventional radiographs in terms of measurement of alveolar bone loss. Although RVG is superior in measuring the alveolar bone loss compared to conventional radiographs, its cost must be taken into account, which is quite high than the conventional radiograph.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Asif S, Nagesh KS, Waghray S, Pavankumar K, Ramana V. Comparative study of direct digital and conventional intra oral bitewing radiographs in detecting alveolar bone loss. J Oral Health Res 2011;2:33-9.  Back to cited text no. 1
    
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Takeshita WM, Vessoni Iwaki LC, Da Silva MC, Tonin RH. Evaluation of diagnostic accuracy of conventional and digital periapical radiography, panoramic radiography, and cone-beam computed tomography in the assessment of alveolar bone loss. Contemp Clin Dent 2014;5:318-23.  Back to cited text no. 2
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Albandar JM, Abbas DK, Waerhaug M, Gjermo P. Comparison between standardized periapical and bitewing radiographs in assessing alveolar bone loss. Community Dent Oral Epidemiol 1985;13:222-5.  Back to cited text no. 3
    
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Sahingur SE, Cohen RE. Analysis of host responses and risk for disease progression. Periodontol 2000 2004;34:57-83.  Back to cited text no. 4
    
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Kavadella A, Karayiannis A, Nicopoulou-Karayianni K. Detectability of experimental peri-implant cancellous bone lesions using conventional and direct digital radiography. Aust Dent J 2006;51:180-6.  Back to cited text no. 6
    
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Aass AM, Tollefsen T, Gjermo P. A cohort study of radiographic alveolar bone loss during adolescence. J Clin Periodontol 1994;21:133-8.  Back to cited text no. 8
    
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Khocht A, Janal M, Harasty L, Chang KM. Comparison of direct digital and conventional intraoral radiographs in detecting alveolar bone loss. J Am Dent Assoc 2003;134:1468-75.  Back to cited text no. 9
    
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Li G, Engström PE, Nasström K, Lü ZY, Sanderink G, Welander U. Marginal bone levels measured in film and digital radiographs corrected for attenuation and visual response: An in vivo study. Dentomaxillofac Radiol 2007;36:7-11.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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