THE RELATIONSHIP BETWEEN PROBING ATTACHMENT LOSS AND COMPUTERIZED RADIOGRAPHIC ANALYSIS IN MONITORING PROGRESSION OF PERIODONTITIS

THIS STUDY ATTEMPTED TO EVALUATE quantitative changes in radiographic density as an indicator of progression of periodontitis. Twenty-one subjects with a history of periodontitis were monitored at baseline, 3, 6, and 9 months using duplicate probing attachment level (PAL) measurements from stents and computer assisted densitometric image analysis (CADIA) of standardized radiographs. Results indicate that the majority of sites exhibited no PAL change during the 9-month period; however, the percentage of sites with loss increased with time. A mean of 6.1% of the sites/patient exhibited probing attachment loss during the study, as compared to a mean of 38.3% of the sites/patient that exhibited a loss of radiographic density. Due to the two dimensional nature of radiographs, density analysis was calculated in terms of radiographic "complexes" of multiple probing sites. There was significantly more density loss at complexes with greater-than-or-less-than 2 mm of attachment loss than at sites with no change in PAL at 9 months; there was no such difference noted at 3 and 6 months. Also, density loss tended to increase as more sites within each complex experienced PAL. Although there was a significant correlation between mean density and PAL changes during the same time interval, there were wide variations at individual sites. This study suggests that there is a complex relationship between density change on radiographs and PAL change. The difficulties inherent in comparing highly sensitive new technologies to relatively imprecise clinical measurements of the attachment level are discussed. Future studies should attempt to clarify the relationships between techniques that assess hard tissue and soft tissue changes in the periodontium and determine the clinical significance of the sensitive detection of radiographic density changes.