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Title Cone Beam Computed Tomography May Provide Evaluation of Alveolar Bone Loss Equivalent to, Or Better Than, Intraoral Radiography
Clinical Question In a patient with alveolar bone loss will Cone Beam CT as compared to intraoral radiograph give a more accurate diagnosis?
Clinical Bottom Line Compared to radiographs, CBCT can detect all defects including buccal and lingual because it is a tridimensional image. CBCT using 0.4 mm thick cross-sections shows values closer to the gold standard (perhaps providing a better diagnosis of bone loss), but measurements using 5.2 mm are similar to the ones obtained using intraoral radiography. It is necessary to do more studies in vivo.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 18606746Vandenberghe /2008Two adult human skulls that contained 71 periodontal defectsLab study
Key resultsThe gold standard deviation of the measurements of bone level was 0.29 mm for the 0.4 mm cross- sectional slices, and there was a significant difference when comparing 0.4 mm cross-sectional CBCT slices and the gold standard (P=0.006). The gold standard deviation for the 0.56 mm thick cross-sections was 0.47 mm and for intraoral radiography was 0.56 mm. There was not a significant difference when comparing intraoral bone level measurements and 5.2 mm cross-sectional CBDT slices (P=0.165). The detectability of furcation and crater involvements was 100% for the CBCT, and it failed 29% for crater involvements and 44% for furcation involvements using digital intraoral.
#2) 16805691Misch/ 2006 Two human dried cadaver skulls with artificial periodontal defectsLab study
Key resultsThere were not a differences between CBCT and periapical radiography when comparing linear measurements of all defects. There was a difference between using periodontal probe and electronic caliper (P< 0.002) but no significant difference for periapical radiographs neither for CBCT. All bony defects were identifiable using CBCT, but lingual and buccal defects were not measured with radiographs.
Evidence Search (("Tomography, X-Ray Computed"[Mesh] AND cone) OR "Cone-Beam Computed Tomography"[Mesh]) AND "Alveolar Bone Loss"[Mesh]
Comments on
The Evidence
Vandenberghe had an acceptable gold standard, the gold standard was measured blind to target test, there was adequate spectrum of the disease severity, the gold standard was used in all the cases and there was not competing interest. Misch had an acceptable gold standard, this was a blind study that did not have any competing interest.
Applicability CBCT for detection of bone loss is accurate and precise; the results of this test will benefit patients because practitioners can get a more accurate diagnosis and perhaps a more accurate treatment.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Periodontics)
Keywords Alveolar bone loss, CBCT, Periodontal bone loss
ID# 2193
Date of submission: 04/03/2012spacer
E-mail lanternier@livemail.uthscsa.edu
Author Margarita Lanternier
Co-author(s) e-mail
Faculty mentor/Co-author S. Thomas Deahl, II, DMD, PhD
Faculty mentor/Co-author e-mail deahl@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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by Sabrina Chavez, Nghia Nguyen (San Antonio, Tx) on 11/28/2017
The PubMed database was searched for a comparison of cone-beam computed tomography (CBCT) and intraoral radiography (IR) in alveolar bone loss detection on 11/20/17. The articles discussed in the CAT were confirmed as the highest level of evidence published on this topic, and additional support for the conclusion is provided in a 2012 (PMID 22184627) and a 2009 (PMID 19228089) study. The de Faria Vasconcelos lab study supports the conclusion that CBCT was the only method that allowed for an analysis of all defects, including at buccal and lingual surfaces, as well as improved visualization of the morphology of the defect.The Grimard lab study concluded that, overall, CBCT was significantly more precise and accurate than IR, correlating well to surgical measurements of alveolar bone loss (r = 0.89 to 0.95), whereas IRs correlated less favorably (r = 0.53 to 0.67).

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