Comparative Analysis of Data Efficiency Between Conventional Periapical Radiography and Digital Subtraction Radiography in Chronic Periodontitis Patients

Abstract

Purpose: Advancements in technology have driven a shift towards digital techniques alongside conventional screening methods in dental radiology and across medical disciplines. This study aims to compare the efficacy of two radiographic techniques, periapical radiography and digital subtraction radiography, in assessing bone recovery processes. Materials and Methods: Sixty mandibular premolar and molar regions in eighteen chronic periodontitis patients undergoing flap surgery were examined pre- and post-operatively using both periapical radiographs and digital subtraction radiography. Periodontal surgery outcomes were monitored by recording periodontal index, pocket depth, and gingival recession preoperatively (baseline) and at the 3rd and 6th months postoperatively. Standardized parallel periapical radiographs and via digital subtraction radiography images were analyzed by different observers to evaluate changes in alveolar bones and assess surgical outcomes. Results: Results showed significant reductions in index values and pocket depths, along with an increase in gingival recession. Intraobserver consistency was found to be good and fair, while interobserver consistency was poor across the 0-3, 3-6, and 0-6 month periods. Radiographic evaluation demonstrated a statistically significant increase in digital subtraction radiography data compared to conventional radiography in defect recovery throughout the follow-up period. Conclusions: This study demonstrated that the digital subtraction radiography technique is more efficient in detecting minimal changes in mineralised tissues that cannot be clearly traced by conventional radiographic techniques. Keywords: Chronic Periodontitis, Dental, Digital Subtraction

Keywords

• Radiography
• Dental
• Digital Subtraction
• Chronic Periodontitis

References

1. Chang HJ, Lee SJ, Yong TH, Shin NY, Jang BG, Kim JE, et al. Deep learning hybrid method to automatically diagnose periodontal bone loss and stage periodontitis. Sci Rep. 2020;10(1):7531. doi:10.1038/s41598-020-64509-z.
2. Kim J, Lee HS, Song IS, Jung KH. DeNTNet: Deep Neural Transfer Network for the detection of periodontal bone loss using panoramic dental radiographs. Sci Rep. 2019;9(1):17615. doi:10.1038/s41598-019-53758-2.
3. Tonetti MS, Jepsen S, Jin L, Otomo-Corgel J. Impact of the global burden of periodontal diseases on health, nutrition and wellbeing of mankind: A call for global action. J Clin Periodontol. 2017;44(5):456–462. doi:10.1111/jcpe.12732.
4. Carranza F, Newman M, Takei H. Clinical Periodontology, Ed. Ke-9 [Generic]. W.B. Saunders Co, Philadelphia; 2002.
5. White SC, Pharoah MJ. Oral radiology: principles and interpretation. Elsevier Health Sciences; 2013.
6. Gröndahl HG, Gröndahl K. Subtraction radiography for the diagnosis of periodontal bone lesions. Oral Surg Oral Med Oral Pathol. 1983;55(2):208–213. doi:10.1016/0030-4220(83)90180-9.
7. Gröndahl K, Gröndahl H, Wennstrom J, Heijl L. Examiner agreement in estimating changes in periodontal bone from conventional and subtraction radiographs. J Clin Periodontol. 1987;14(2):74–79. doi:10.1111/j.1600-051x.1987.tb00945.x.
8. Van der Stelt P, Van der Linden L, Geraets W, Alons C. Digitized pattern recognition in the diagnosis of periodontal bone defects. J Clin Periodontol. 1985;12(10):822–827. doi:10.1111/j.1600-051x.1985.tb01359.x.

9. Reddy MS, Jeffcoat MK. Digital subtraction radiography. Dent Clin North Am. 1993;37(4):553–565. doi:10.1016/S0011-8532(22)00241-5.
10. Webber RL, Ruttimann UE, Grondahl HG. X-ray image subtraction as a basis for assessment of periodontal changes. J Prosthodont Res. 1982;17(5):509–511. doi:10.1111/j.1600-0765.1982.tb02041.x.
11. Watanabe C, Wada J, Mizutani K, Nagayama T, Uchida H, Shibata Y, et al. Radiographic predictive factors for 10-year survival of removable partial denture abutment teeth: Alveolar bone level and density. J Prosthodont Res. 2022;67(3):437–443. doi:10.2186/jpr.JPR_D_22_00034.
12. Watanabe C, Wada J, Nagayama T, Uchida H, Mizutani K, Foxton RM, et al. Long-term observation of periodontal condition following placement of removable partial dentures with rigid retainers and major connector in patients with/without diabetes: A retrospective study. J Prosthodont Res. 2022;66(1):117–123. doi:10.2186/jpr.JPR_D_20_00288.
13. Lee SS, Huh YJ, Kim KY, Heo MS, Choi SC, Koak JY, et al. Development and evaluation of digital subtraction radiography computer program. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;98(4):471–475. doi:10.1016/j.tripleo.2004.03.013.
14. Tarnow D, Fletcher P. Classification of the vertical component of furcation involvement. J Periodontol. 1984;55(5):283–284. doi:10.1902/jop.1984.55.5.283.
15. Aass AM, Tollefsen T, Gjermo P. A cohort study of radiographic alveolar bone loss during adolescence. J Clin Periodontol. 1994;21(2):133–138. doi:10.1111/j.1600-051x.1994.tb00291.x.
16. Nicopoulou-Karayianni K, Bragger U, Patrikiou A, Stassinakis A, Lang N. Image processing for enhanced observer agreement in the evaluation of periapical bone changes. Int Endod J. 2002;35(7):615–622. doi:10.1046/j.1365-2591.2002.00526.x.
17. Yoshioka T, Kobayashi C, Suda H, Sasaki T. An observation of the healing process of periapical lesions by digital subtraction radiography. J Endod. 2002;28(8):589–591. doi:10.1097/00004770-200208000-00006.
18. Bittar-Cortez J, Passeri L, de Almeida S, Haiter-Neto F. Comparison of peri-implant bone level assessment in digitized conventional radiographs and digital subtraction images. DMFR. 2006;35(4):258–262. doi:10.1259/dmfr/84778143.
19. Bittar-Cortez JA, Passeri LA, Bóscolo FN, Haiter-Neto F. Comparison of hard tissue density changes around implants assessed in digitized conventional radiographs and subtraction images. Clin Oral Implants Res. 2006;17(5):560–564. doi:10.1111/j.1600-0501.2006.01256.x.
20. Gegler A, Mahl C, Fontanella V. Reproducibility of and file format effect on digital subtraction radiography of simulated external root resorptions. DMFR. 2006;35(1):10–13. doi:10.1259/dmfr/86879455.
21. Dunn S, Van der Stelt P, Ponce A, Fenesy K, Shah S. A comparison of two registration techniques for digital subtraction radiography. DMFR. 1993;22(2):77–80. doi:10.1259/dmfr.22.2.8375559.
22. Zacharaki E, Matsopoulos G, Asvestas P, Nikita K, Grondahl K, Grondahl H. A digital subtraction radiography scheme based on automatic multiresolution registration. DMFR. 2004;33(6):379–390. doi:10.1259/dmfr/21571843.
23. Alpar R. Spor bilimlerinde uygulamalı istatistik. Nobel; 2006.
24. Nummikoski PV, Steffensen B, Hamilton K, Brent Dove S. Clinical validation of a new subtraction radiography technique for periodontal bone loss detection. J Periodontol. 2000;71(4):598–605. doi:10.1902/jop.2000.71.4.598.
25. Okano T, Mera T, Ohki M, Ishikawa I, Yamada N. Digital subtraction of radiograph in evaluating alveolar bone changes after initial periodontal therapy. Oral Surg Oral Med Oral Pathol. 1990;69(2):258–262. doi:10.1016/0030-4220(90)90338-s.
26. Wenzel A, Sewerin I. Sources of noise in digital subtraction radiography. Oral Surg Oral Med Oral Pathol. 1991;71(4):503–508. doi:10.1016/0030-4220(91)90441-e.
27. Janssen P, van Palenstein Helderman W, Van Aken J. The detection of in vitro produced periodontal bone lesions by conventional radiography and photographic subtraction radiography using observers and quantitative digital subtraction radiography. J Clin Periodontol. 1989;16(6):335–341. doi:10.1111/j.1600-051x.1989.tb00001.x.
28. Shi X, Eklund I, Tronje G, Welander U, Stamatakis H, Engström P, et al. Comparison of observer reliability in assessing alveolar bone changes from color-coded with subtraction radiographs. DMFR. 1999;28(1):31–36. doi:10.1038/sj.dmfr.4600401.
29. Cury PR, Araujo NS, Bowie J, Sallum EA, Jeffcoat MK. Comparison between subtraction radiography and conventional radiographic interpretation during long-term evaluation of periodontal therapy in Class II furcation defects. J Periodontol. 2004;75(8):1145–1149. doi:10.1902/jop.2004.75.8.1145.
30. Hochstetter AS, Lombardo MJ, D’eramo L, Piovano S, Bordoni N. Effectiveness of a preventive educational programme on the oral health of preschool children. Promot Educ. 2007;14(3):155–158. doi:10.1177/175797590701400304.
31. Hugoson A, Lundgren D, Asklöw B, Borgklint G. Effect of three different dental health preventive programmes on young adult individuals: a randomized, blinded, parallel group, controlled evaluation of oral hygiene behaviour on plaque and gingivitis. J Clin Periodontol. 2007;34(5):407–415. doi:10.1111/j.1600-051X.2007.001069.x.
32. Gaspirc B, Skaleric U. Clinical evaluation of periodontal surgical treatment with an Er: YAG laser: 5-year results. J Periodontol. 2007;78(10):1864–1871. doi:10.1902/jop.2007.070054.