Oral Radiology

, Volume 34, Issue 3, pp 208–218 | Cite as

Comparison of periodontal evaluation by cone-beam computed tomography, and clinical and intraoral radiographic examinations

  • Wenjian ZhangEmail author
  • Shazia Rajani
  • Bing-Yan Wang
Original Article



Cone-beam computed tomography (CBCT) has been widely used in many fields of dentistry. However, little is known about the accuracy of CBCT for evaluation of periodontal status. The objective of this study was to compare and correlate periodontal assessments among CBCT, clinical attachment loss (CAL) measurement, and periapical (PA)/bitewing (BW) radiography.


Eighty patients (28 males, 52 females; age range, 19–84 years) from the University of Texas School of Dentistry at Houston were evaluated retrospectively. Measurements were taken on the central incisors, canines, and first molars of the right maxilla and left mandible. CAL was extracted from periodontal charts. The radiographic distance from the cementum–enamel junction (CEJ) to the alveolar crest was measured for tooth mesial and distal sites on PA/BW and CBCT images using MiPacs software and Anatomage Invivo software, respectively. One-way ANOVA and Pearson analysis were performed for statistical analyses.


The CEJ–crest distances for CBCT, PA/BW, and CAL were 2.56 ± 0.12, 2.04 ± 0.12, and 2.08 ± 0.17 mm (mean ± SD), respectively. CBCT exhibited larger values than the other two methods (p < 0.05). There were highly significant positive correlations among CBCT, PA/BW, and CAL measurements at all examined sites (p < 0.001). The Pearson correlation coefficient was higher for CBCT with CAL relative to PA/BW with CAL, but the difference was not significant (r = 0.64 and r = 0.55, respectively, p > 0.05).


This study validates the suitability of CBCT for periodontal assessment. Further studies are necessary to optimize the measurement methodology with CBCT.


Cone-beam computed tomography Clinical attachment loss Intraoral radiography Periodontal assessment 


Compliance with ethical standards

Conflict of interest

Wenjian Zhang, Shazia Rajani, and Bing-Yan Wang declare that they have no conflict of interest.

Human rights statement

All procedures followed were in accordance with the ethical standards of the responsible national and institutional committees on human experimentation and with the Helsinki Declaration of 1964 and later versions. The Institutional Review Board (IRB) of the University of Texas Health Science Center at Houston approval was granted prior to the start of the study (HSC-DB-16-0398).

Informed consent

The study was a retrospective chart review, and the requirement for informed consent was waived under IRB approval.


  1. 1.
    Loe H, Anerud A, Boysen H, Morrison E. Natural history of periodontal disease in man. Rapid, moderate and no loss of attachment in Sri Lankan laborers 14–46 years of age. J Clin Periodontol. 1986;13:431–45.CrossRefPubMedGoogle Scholar
  2. 2.
    Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. Lancet. 2005;366:1809–20.CrossRefPubMedGoogle Scholar
  3. 3.
    Eke PI, Dye BA, Wei L, Slade GD, Thornton-Evans GO, Borgnakke WS, et al. Update on prevalence of periodontitis in adults in the United States: NHANES 2009 to 2012. J Periodontol. 2015;86:611–22.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJ. CDC Periodontal Disease Surveillance workgroup: James Beck GDRP: prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res. 2012;91:914–20.CrossRefPubMedGoogle Scholar
  5. 5.
    Beck JD, Eke P, Heiss G, Madianos P, Couper D, Lin D, et al. Periodontal disease and coronary heart disease: a reappraisal of the exposure. Circulation. 2005;112:19–24.CrossRefPubMedGoogle Scholar
  6. 6.
    Offenbacher S. Maternal periodontal infections, prematurity, and growth restriction. Clin Obstet Gynecol. 2004;47:808–21.CrossRefPubMedGoogle Scholar
  7. 7.
    Scannapieco FA. Periodontal inflammation: from gingivitis to systemic disease? Compend Contin Educ Dent. 2004;25:16–25.PubMedGoogle Scholar
  8. 8.
    Highfield J. Diagnosis and classification of periodontal disease. Aust Dent J. 2009;54:S11–26.CrossRefPubMedGoogle Scholar
  9. 9.
    Holtfreter B, Alte D, Schwahn C, Desvarieux M, Kocher T. Effects of different manual periodontal probes on periodontal measurements. J Clin Periodontol. 2012;39:1032–41.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Bulthuis HM, Barendregt DS, Timmerman MF, Loos BG, van der Velden U. Probe penetration in relation to the connective tissue attachment level: influence of tine shape and probing force. J Clin Periodontol. 1998;25:417–23.CrossRefPubMedGoogle Scholar
  11. 11.
    van der Velden U. Probing force and the relationship of the probe tip to the periodontal tissues. J Clin Periodontol. 1979;6:106–14.CrossRefPubMedGoogle Scholar
  12. 12.
    Clerehugh V, Abdeia R, Hull PS. The effect of subgingival calculus on the validity of clinical probing measurements. J Dent. 1996;24:329–33.CrossRefPubMedGoogle Scholar
  13. 13.
    Corraini P, Baelum V, Lopez R. Reliability of direct and indirect clinical attachment level measurements. J Clin Periodontol. 2013;40:896–905.CrossRefPubMedGoogle Scholar
  14. 14.
    Fowler C, Garrett S, Crigger M, Egelberg J. Histologic probe position in treated and untreated human periodontal tissues. J Clin Periodontol. 1982;9:373–85.CrossRefPubMedGoogle Scholar
  15. 15.
    Magnusson I, Listgarten MA. Histological evaluation of probing depth following periodontal treatment. J Clin Periodontol. 1980;7:26–31.CrossRefPubMedGoogle Scholar
  16. 16.
    Hill EG, Slate EH, Wiegand RE, Grossi SG, Salinas CF. Study design for calibration of clinical examiners measuring periodontal parameters. J Periodontol. 2006;77:1129–41.CrossRefPubMedGoogle Scholar
  17. 17.
    Michalowicz BS, Hodges JS, Pihlstrom BL. Is change in probing depth a reliable predictor of change in clinical attachment loss? J Am Dent Assoc. 2013;144:171–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Corbet EF, Ho DK, Lai SM. Radiographs in periodontal disease diagnosis and management. Aust Dent J. 2009;54:S27–43.CrossRefPubMedGoogle Scholar
  19. 19.
    Hausmann E, Allen K, Clerehugh V. What alveolar crest level on a bite-wing radiograph represents bone loss? J Periodontol. 1991;62:570–2.CrossRefPubMedGoogle Scholar
  20. 20.
    Jeffcoat MK. Current concepts in periodontal disease testing. J Am Dent Assoc. 1994;125:1071–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Reddy MS. Radiographic methods in the evaluation of periodontal therapy. J Periodontol. 1992;63:1078–84.CrossRefGoogle Scholar
  22. 22.
    Bragger U. Radiographic parameters: biological significance and clinical use. Periodontology. 2000;2005(39):73–90.Google Scholar
  23. 23.
    Kim TS, Obst C, Zehaczek S, Geenen C. Detection of bone loss with different X-ray techniques in periodontal patients. J Periodontol. 2008;79:1141–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Mol A. Imaging methods in periodontology. Periodontology. 2000;2004(34):34–48.Google Scholar
  25. 25.
    Aljehani YA. Diagnostic applications of cone-beam CT for periodontal diseases. Int J Dent. 2014;. doi: 10.1155/2014/865079.Google Scholar
  26. 26.
    Mol A, Balasundaram A. In vitro cone beam computed tomography imaging of periodontal bone. Dentomaxillofac Radiol. 2008;37:319–24.CrossRefPubMedGoogle Scholar
  27. 27.
    Pinsky HM, Dyda S, Pinsky RW, Misch KA, Sarment DP. Accuracy of three-dimensional measurements using cone-beam CT. Dentomaxillofac Radiol. 2006;35:410–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Raichur PS, Setty SB, Thakur SL, Naikmasur VG. Comparison of radiovisiography and digital volume tomography to direct surgical measurements in the detection of infrabony defects. J Clin Exp Dent. 2012;4:e43–7.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Dutta A, Smith-Jack F, Saunders WP. Prevalence of periradicular periodontitis in a Scottish subpopulation found on CBCT images. Int Endod J. 2014;47:854–63.CrossRefPubMedGoogle Scholar
  30. 30.
    Guerrero ME, Jacobs R, Loubele M, Schutyser F, Suetens P, van Steenberghe D. State-of-the-art on cone beam CT imaging for preoperative planning of implant placement. Clin Oral Investig. 2006;10:1–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Honda K, Arai Y, Kashima M, Takano Y, Sawada K, Ejima K, et al. Evaluation of the usefulness of the limited cone-beam CT (3DX) in the assessment of the thickness of the roof of the glenoid fossa of the temporomandibular joint. Dentomaxillofac Radiol. 2004;33:391–5.CrossRefPubMedGoogle Scholar
  32. 32.
    Liu DG, Zhang WL, Zhang ZY, Wu YT, Ma XC. Localization of impacted maxillary canines and observation of adjacent incisor resorption with cone-beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105:91–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Nakajima K, Yamaguchi T, Maki K. Surgical orthodontic treatment for a patient with advanced periodontal disease: evaluation with electromyography and 3-dimensional cone-beam computed tomography. Am J Orthod Dentofac Orthop. 2009;136:450–9.CrossRefGoogle Scholar
  34. 34.
    du Bois AH, Kardachi B, Bartold PM. Is there a role for the use of volumetric cone beam computed tomography in periodontics? Aust Dent J. 2012;57:103–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Misch KA, Yi ES, Sarment DP. Accuracy of cone beam computed tomography for periodontal defect measurements. J Periodontol. 2006;77:1261–6.CrossRefPubMedGoogle Scholar
  36. 36.
    Vandenberghe B, Jacobs R, Yang J. Diagnostic validity (or acuity) of 2D CCD versus 3D CBCT-images for assessing periodontal breakdown. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104:395–401.CrossRefPubMedGoogle Scholar
  37. 37.
    Grimard BA, Hoidal MJ, Mills MP, Mellonig JT, Nummikoski PV, Mealey BL. Comparison of clinical, periapical radiograph, and cone-beam volume tomography measurement techniques for assessing bone level changes following regenerative periodontal therapy. J Periodontol. 2009;80:48–55.CrossRefPubMedGoogle Scholar
  38. 38.
    Vandenberghe B, Jacobs R, Yang J. Detection of periodontal bone loss using digital intraoral and cone beam computed tomography images: an in vitro assessment of bony and/or infrabony defects. Dentomaxillofac Radiol. 2008;37:252–60.CrossRefPubMedGoogle Scholar
  39. 39.
    de Vasconcelos Faria K, Evangelista KM, Rodrigues CD, Estrela C, de Sousa TO, et al. Detection of periodontal bone loss using cone beam CT and intraoral radiography. Dentomaxillofac Radiol. 2012;41:64–9.CrossRefGoogle Scholar
  40. 40.
    Fuhrmann RA, Bucker A, Diedrich PR. Assessment of alveolar bone loss with high resolution computed tomography. J Periodontal Res. 1995;30:258–63.CrossRefPubMedGoogle Scholar
  41. 41.
    Takeshita WM, Iwaki LCV, 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.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Anter E, Zayet MK, El-Dessouky SH. Accuracy and precision of cone beam computed tomography in periodontal defects measurement (systematic review). J Indian Soc Period. 2016;20:235–43.Google Scholar
  43. 43.
    Feijo CV, Lucena JG, Kurita LM, Pereira SL. Evaluation of cone beam computed tomography in the detection of horizontal periodontal bone defects: an in vivo study. Int J Periodontics Restor Dent. 2012;32:e162–8.Google Scholar
  44. 44.
    Ising N, Kim KB, Araujo E, Buschang P. Evaluation of dehiscences using cone beam computed tomography. Angle Orthod. 2012;82:122–30.CrossRefPubMedGoogle Scholar
  45. 45.
    Guo YJ, Ge ZP, Ma RH, Hou JX, Li G. A six-site method for the evaluation of periodontal bone loss in cone-beam CT images. Dentomaxillofac Radiol. 2016;. doi: 10.1259/dmfr.20150265.Google Scholar
  46. 46.
    Ferrare N, Leite AF, Caracas HC, de Azevedo RB, de Melo NS, de Souza Figueiredo PT. Cone-beam computed tomography and microtomography for alveolar bone measurements. Surg Radiol Anat. 2013;35:495–502.CrossRefPubMedGoogle Scholar
  47. 47.
    Leung CC, Palomo L, Griffith R, Hans MG. Accuracy and reliability of cone-beam computed tomography for measuring alveolar bone height and detecting bony dehiscences and fenestrations. Am J Orthod Dentofac Orthop. 2010;137:S109–19.CrossRefGoogle Scholar
  48. 48.
    White SC, Pharoah MJ. Oral radiology principles and interpretation. 7th ed. St. Louis: Elsevier; 2014.Google Scholar

Copyright information

© Japanese Society for Oral and Maxillofacial Radiology and Springer Japan KK 2017

Authors and Affiliations

  1. 1.Department of Diagnostic and Biomedical Sciences, School of DentistryUniversity of Texas Health Science Center at HoustonHoustonUSA
  2. 2.Dental Hygiene Program, School of DentistryUniversity of Texas Health Science Center at HoustonHoustonUSA
  3. 3.Department of Periodontics and Dental Hygiene, School of DentistryUniversity of Texas Health Science Center at HoustonHoustonUSA

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