Aim: The aim of the present study was to assess the reproducibility and val
idity of linear measurements of interproximal bone loss in intrabony defect
s on digitized radiographic images after application of different filters a
nd magnifications.
Methods: Immediately before surgery 50 radiographs of 50 periodontally dise
ased teeth exhibiting interproximal intrabony defects were obtained by a st
andardized technique in 50 patients. Intrasurgically the distances from the
cemento-enamel-junction (CEJ) to the alveolar crest (AC) and from the CEJ
to the deepest extension of the bony defect (BD) were assessed. All radiogr
aphs were digitized by a flatbed scanner (resolution: 600 X 1200 dpi). Usin
g the FRIACOM-soft ware, the linear distances CEJ to AC and CEJ to BD were
measured at 50 intrabony defects on digitized but unchanged radiographic im
ages and also after use of 2 different basic image processing modes (filter
s: enhancement of grey level differences, spreading of grey values) with 7-
fold and 14-fold magnification by 2 different examiners.
Results: Repeated measures MANOVA revealed reproducibility of the measureme
nt of the distance CEJ to AC to be significantly influenced by examiner (p
= 0.027) and filter in combination with the height of 2 wall component of t
he intrabony defect (p = 0.066). For the distance CEJ to BD filters had sig
nificant influence on reproducibility in correlation with vertical angulati
on difference (p = 0.001). On the average in this study radiographic measur
ements tended to overestimate the amount of bone loss as assessed by intras
urgical measurements (CEJ-AC: 0.74-1.91 mm; CEJ-DB: -0.04-0.77 mm). Validit
y of measurement of the distance CEJ-AC was shown to be significantly influ
enced by the depth of the intrabony defect (p < 0.003). Validity of the dis
tance CEJ-BD was significantly influenced by intrasurgically assessed bone
loss (p = 0.029), horizontal angulation (p = 0.066). Filters influenced the
validity only in combination with examiner (p < 0.001).
Conclusions: In this study, the chosen digital manipulations (filters: spre
ading, structure) of radiographic images failed to result in statistically
significantly more reproducible or valid measurements of interproximal bone
loss within intrabony defects when compared to the digitized but unchanged
images. All radiographic assessments on the digitized images except for us
e of enhancement of grey level differences (structure) came close to the in
trasurgical gold standard.