Comparative Evaluation of Digital Panoramic and Digital Intraoral Periapical Radiographic Techniques for the Assessment of Interproximal Bone Loss: A Cross-Sectional Study

Abstract

Introduction Accurate assessment of interproximal bone loss is essential for diagnosing and managing chronic periodontitis, a leading cause of tooth loss. Digital panoramic and intraoral periapical radiography are widely used, but their diagnostic accuracy, compared to intrasurgical measurements, remains debated. This study evaluated the reliability of these digital radiographic techniques in assessing interproximal bone loss in patients with moderate to advanced chronic periodontitis. Methodology An observational cross-sectional study was conducted with 35 patients (23 females and 12 males, aged 30-50 years) with moderate to advanced chronic periodontitis. Digital panoramic radiographs (ORTHOPHOS XG; Sirona, Bensheim, Germany) and intraoral periapical radiographs (SuniRay; Suni Medical Imaging, San Jose, CA, USA, long-cone paralleling technique) were obtained for 117 posterior teeth (234 sites). Bone loss was measured from the cemento-enamel junction to the alveolar crest and compared with intrasurgical measurements (gold standard) using a UNC-15 periodontal probe (Hu-Friedy, Chicago, IL, USA). Intraclass correlation coefficients (ICC), sensitivity, specificity, and chi-square tests were used to assess agreement and diagnostic accuracy. Results Both radiographic techniques showed almost perfect agreement with intrasurgical measurements (ICC 0.97 for panoramic and 0.98 for intraoral). Mean bone loss was 5.9957 ± 2.08 mm (panoramic), 5.8932 ± 2.10 mm (intraoral), and 5.7607 ± 2.07 mm (intrasurgical), with no significant differences (p > 0.05). Both methods slightly overestimated bone loss (0.235 mm for panoramic and 0.132 mm for intraoral). Sensitivity was 77.8% (panoramic) and 76.7% (intraoral), with specificities of 98.7% and 97.4%, respectively. Bilateral symmetry was significant (ICC 0.8 for the maxilla and 0.73 for the mandible). Conclusion Digital panoramic and intraoral periapical radiography are highly accurate for assessing interproximal bone loss, with digital panoramic radiography offering a viable alternative to intraoral radiography due to comparable accuracy, reduced radiation, and enhanced patient comfort. Future research should explore anterior quadrants and three-dimensional imaging.

Keywords: digital panoramic radiography; interproximal bone loss; intraoral periapical radiography; intrasurgical measurements; periodontitis.