SELECTION OF THE MOST ACCURATE METHOD OF CONVENTIONAL RADIOGRAPHY FORTHE ASSESSMENT OF PERIODONTAL OSSEOUS DESTRUCTION

The purpose of the present study was to compare the radiographic measu rements of periodontal osseous destruction with the surgical measureme nts, which represent the true value of osseous destruction, and to sel ect the most successful method of conventional radiography in detectin g and accurately assessing periodontal osseous destruction. A total of 5072 proximal surfaces in 2536 teeth of 100 patients with periodontit is were evaluated surgically during periodontal flap surgery and radio graphically by using periapical and panoramic radiography. Comparative evaluation of the measurements obtained by these 3 different methods of osseous destruction assessment revealed the following. (1) The radi ographic detection ability of small osseous destruction (1-4 mm) was v ery low for both methods of assessment and became even lower for the i nitial osseous destruction (1 or 2 mm). (2) Periapical radiography was more successful than panoramic in the detection of osseous destructio n, especially of the small destruction (4.7x). (3) Panoramic radiograp hy underestimated the osseous destruction, whereas periapical radiogra phy was relatively accurate in the osseous destruction assessment. (4) Periapical radiography was more accurate in the osseous destruction a ssessment than panoramic, regardless of the location of the dental sur faces (jaw, tooth group, mesial or distal) and the degree of osseous d estruction. (5) The deviation of the radiographic measurements of osse ous destruction from the surgical measurements, as well as the differe nce between the two radiographic methods, depended on the jaw location , the tooth group and the degree of osseous destruction. (6) The radio graphic assessment of osseous destruction underestimated the osseous d estruction in initial periodontitis, it was relatively accurate in mod erate periodontitis, but Overestimated it in severe periodontitis. The radiographic measurements of osseous destruction deviated least from the surgical measurements in the group of moderate periodontitis and m ost in that of severe osseous destruction. (7) The 2 radiographic meth ods agreed most in the assessment of osseous destruction in the severe periodontitis group and least in the initial periodontitis group. (8) The indirect Schei method was less successful in detecting the small osseous destruction and less accurate in assessing the osseous destruc tion than the direct millimetric method of radiographic evaluation. (9 ) The osseous destruction as assessed from periapical radiographs by t he Schei method was not significantly different from that assessed by the radiopaque Fixot-Everett grid. The results of the present study su ggest that periapical radiography is more successful in detecting peri odontal osseous destruction and more accurate in assessing it than pan oramic radiography.