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| SHORT COMMUNICATION |
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| Year : 2016 | Volume
: 3
| Issue : 2 | Page : 79-81 |
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Growing bone assessment made easy at chairside
Priyanka Dalvi, KL Vandana
Department of Periodontics, College of Dental Sciences, Davangere, Karnataka, India
| Date of Web Publication | 16-Jun-2016 |
Correspondence Address:
K L Vandana
Department of Periodontics, College of Dental Sciences, Davangere, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2348-2915.184218
Various intraoral radiographic techniques have been utilized to study bone changes following periodontal therapy, for example, digital subtraction radiography, computer-assisted densitometric image analysis, computed tomography (CT), and cone bean CT. This short communication provides an insight about a novel yet simple technique which utilizes a user-friendly software (Adobe Photoshop CS3) and provides the clinician a quick, objective economical tool to assess periodontal regeneration (bone fill) radiographically. The use of this software is recommended in any clinical trial, wherein bone is target tissue to be assessed at different time intervals. It can find clinical applications include endodontic periapical cyst therapy, implant, oral and maxillofacial surgery, and orthopedics surgeries. This method is simple, reliable, and reproducible and helps in objective assessment of radiographic changes of the periodontal osseous defects following periodontal therapy. Keywords: Osseous defects, periodontal disease, radiography
How to cite this article:
Dalvi P, Vandana K L. Growing bone assessment made easy at chairside. J Dent Res Rev 2016;3:79-81 |
| Introduction | |  |
Periodontal therapy involves not only the control of further breakdown by eliminating periodontal infection but also the regeneration of previously lost periodontal support. Periodontal regeneration continues to be one of the primary therapeutic approaches toward the management of periodontal defects.
In the different studies, clinical, radiographic, and histological techniques were used for assessing the pre- and post-surgical conditions of the teeth involved, the dynamics of the healing process and the mechanism of bone regeneration following the surgical interventions. Various intraoral radiographic techniques have been utilized to study bone changes following periodontal therapy, for example, digital subtraction radiography, computer-assisted densitometric image analysis, computed tomography (CT), and cone bean CT (CBCT). All the radiographic techniques need identical projection alignment of sequential radiographs and utilize positioning device along with specialized software.
With a basic understanding of the various radiographic measurements used in periodontics to evaluate the periodontal regeneration, through this short communication, we hereby present a simple objective method of assessing bone changes over time (bone fill) following periodontal therapy using Adobe Photoshop CS3 for evaluating bone changes following periodontal therapy for the first time in periodontal literature.
Procedure
We applied Adobe Photoshop CS3 (version 10) to serially obtained radiovisiography (RVG) (identical projections) of the periodontal osseous defect site to study the radiodensity changes over time which is suggestive of bone fill after periodontal osseous regenerative therapy. The baseline RVG image was opened using Adobe Photoshop CS3, and the area to be measured was cropped using the cropping tool then histogram tab was chosen from window tool on the taskbar of the software. This histogram panel displays the following statistical information of the cropped area of interest (osseous defect). Mean represents the average intensity value; Standard deviation (standard deviation) represents how widely intensity values vary; median shows the middle value in the range of intensity values; pixels represent the total number of pixels used to calculate the histogram; level displays the intensity level of the area underneath the pointer; count shows the total number of pixels corresponding to the intensity level underneath the pointer; percentile displays the cumulative number of pixels at or below the level underneath the pointer. This value is expressed as a percentage of all the pixels in the image, from 0% at the far left to 100% at the far right. A simple formula (index of relative bone healing)[1],[2] can be applied to study the bone density changes [Figure 1]a, [Figure 1]b and [Figure 2]a, [Figure 2]b. | Figure 1: (a) Baseline radiograph (right mandibular second molar), (b) histogram of periodontal osseous defect at baseline
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 | Figure 2: (a) Radiograph at 1 year (right mandibular second molar), (b) histogram of periodontal osseous defect at 1 year follow-up
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Linear measurement of osseous defects can be performed on digitized radiographic images [Figure 3] and [Figure 4]. The scanned images stored in JPEG format can be transferred to Corel DRAW 7 (Corel). Using the connector line tool, a line can be drawn from the cementoenamel junction (CEJ) to the base of the defect. The length of the line gets displayed in the size property box of the software.[3] Thus, the linear measurements and density changes together help to assess the outcome of the therapy noninvasively. The linear measurements can be calculated using the following formulae: | Figure 3: Baseline intraoral periapical radiograph (scanned), yellow: Cementoenamel junction, Red: Defect depth, purple: Alveolar crest
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 | Figure 4: One-year intraoral periapical radiograph (scanned), yellow: Cementoenamel junction, Red: Defect depth, purple: Alveolar crest
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Baseline defect depth = Baseline CEJ to base of the defect − Baseline CEJ to alveolar crest
Postsurgical defect depth = Postsurgical CEJ to base of the defect − Postsurgical CEJ to alveolar crest
Amount of defect fill = Initial defect depth − Postsurgical defect depth
Changes in alveolar crest = Alveolar crest at baseline − Change in alveolar crest postsurgically
The mean standard deviation can recorded over time and correlated with the radiodensity changes were seen at the defect site over a period of time at 0 day, 3 months, 6 months, 9 months, and 1 year to appreciate the bone fill at the defect site.
| Discussion | | |
In most studies on the effects of regenerative periodontal surgery, the outcomes are evaluated by clinical methods in which a probe is used to determine pocket depth, attachment level, and bone level. However, periodontal probing cannot accurately determine the coronal level of the connective tissue attachment. Radiographic methods allow assessment of the bone adjacent to the tooth. This technique requires carefully standardized techniques for reproducible positioning of the film and the tube. Several studies have demonstrated that radiographs are less reliable than clinical probing techniques. Tonetti et al.[4] showed that radiographic analysis significantly underestimates pretreatment bone loss and posttreatment bone fill. Surgical reentry of a treated defect after a period of healing can provide a guide view of the state of bone crest. Models of impression of bone taken at initial surgery and later at reentry can be used to assess the results of therapy; however, it requires unnecessary second procedure and does not show the type of attachment (that is long junctional epithelium or new attachment). Histologic method is the only valid method to assess the formation of new attachment as it offers clear evidence of new attachment apparatus; however; it requires the location of attachment level before therapy. In few studies, histologic reference notches were placed in apical extent of calculus deposits, but may not reflect the exact position of the periodontitis involved root surface before treatment. Histologic evaluation requires to remove a tooth with periodontium after successful treatment, limits this method to volunteers. Bone healing is an important subject in various fields of dentistry such as prosthodontics, periodontics, implant, and surgery. Out of the aforementioned methods, clinical method (e.g., probing) and adjunctive radiographical method practically aids the clinician to evaluate the outcome of periodontal therapy, whereas histologic and surgical reentry are least embraced methods. The linear measurements and density changes easily computed using a user-friendly software together helps to assess the outcome of the therapy noninvasively.
| Conclusion | | |
This method is simple, reliable, and reproducible and helps in objective assessment of radiographic changes of the periodontal osseous defects following periodontal therapy. This technique can be applied to digital RVG and digital orthopantomography to study bone density changes over time can be utilized as a constructive tool in assessment of mandibular bone density changes for screening osteoporotic patients in dental outpatient department and healing of bony cysts and tumors after therapy.
Simplicity of the technique and use of user-friendly software (Adobe Photoshop CS3), along with linear measurements provides the clinician a quick, objective economical tool to assess periodontal regeneration. The use of this software in stem cell application in periodontal regeneration technique [5] has been interesting and saved the tooth being pulled out for histological examination after being successfully treated with periodontal ligament stem cells. The use of this software is recommended in any clinical trial, wherein bone is target tissue to be assessed at different time intervals. It can find clinical applications include endodontic periapical cyst therapy, implant, oral and maxillofacial surgery, and orthopedics surgeries. Nonetheless, it does not overweigh the benefits of CBCT, but it serves a simple, affordable objective test for bone regeneration assessment.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Jeffcoat MK, Reddy MS. Advances in measurements of periodontal bone and attachment loss. In: Faller RV, editor. Assessment of Oral Health. Vol. 17. Monographs in Oral Science. Basel: Karger; 2000. p. 56-72.  |
| 2. | Ihan Hren N, Miljavec M. Spontaneous bone healing of the large bone defects in the mandible. Int J Oral Maxillofac Surg 2008;37:1111-6. |
| 3. | Vandana KL, Shah K, Prakash S. Clinical and radiographic evaluation of Emdogain as a regenerative material in the treatment of interproximal vertical defects in chronic and aggressive periodontitis patients. Int J Periodontics Restorative Dent 2004;24:185-91. |
| 4. | Tonetti MS, Pini-Prato G, Cortellini P. Periodontal regeneration of human intrabony defects. IV. Determinants of healing response. J Periodontol 1993;64:934-40. |
| 5. | Vandana KL, Desai R, Dalvi PJ. Autologous stem cell application in periodontal regeneration technique (SAI-PRT) using PDLSCs directly from an extracted tooth···An Insight. Int J Stem Cells 2015;8:235-7. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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