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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 11  |  Issue : 4  |  Page : 85-89

Assessment of alveolar bone loss at mandibular first molar on panoramic radiographs


Department of Periodontics and Oral Implantology, School of Dentistry, D Y Patil University, Navi Mumbai, Maharashtra, India

Date of Submission04-Mar-2021
Date of Decision06-Mar-2021
Date of Acceptance06-Jun-2021
Date of Web Publication16-Oct-2021

Correspondence Address:
Apoorva Mhatre
Department of Periodontics and Oral Implantology, School of Dentistry, D Y Patil University, Nerul, Navi Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aihb.aihb_32_21

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  Abstract 


Introduction: The loss of alveolar bone is one of the important indicators of periodontitis. There is a widespread use of panoramic radiographs for the detection of bone loss due to periodontitis. The present study is aimed to evaluate the severity and prevalence of alveolar bone loss at mandibular first molar sites on randomly selected 250 orthopantomograms. Materials and Methods: The alveolar bone level was assessed by direct measurements from the cemento-enamel junction to the crest of alveolar bone at the mandibular first molar region at the mesial and distal surface with a Hu-Friedy University of North Carolina probe-15 Probe. Bone loss was assessed based on gender and age. Results: The results indicated that the bone loss was statistically higher in the mandibular molar region on the distal surface than the mesial surface. The bone loss notably increased with age. Conclusion: In conclusion, the study is in accordance with the finding that radiographic bone loss can be used as an important tool to identify patients susceptible to periodontitis.

Keywords: Bone loss, mandibular first molar, panoramic radiographs, periodontitis


How to cite this article:
Mhatre A, Shetty D, Shetty A, Dharmadhikari S, Wadkar P. Assessment of alveolar bone loss at mandibular first molar on panoramic radiographs. Adv Hum Biol 2021;11:85-9

How to cite this URL:
Mhatre A, Shetty D, Shetty A, Dharmadhikari S, Wadkar P. Assessment of alveolar bone loss at mandibular first molar on panoramic radiographs. Adv Hum Biol [serial online] 2021 [cited 2021 Dec 4];11:85-9. Available from: https://www.aihbonline.com/text.asp?2021/11/4/85/328395




  Introduction Top


Periodontitis is an inflammatory condition of the teeth and their supporting structures. The inflammatory process, initially occurring as a response to the bacterial biofilm, has detrimental effects in the periodontal unit. The damage resulting from the periodontal disease manifests in variable destruction of the tooth-supporting bone. Destruction of the bone can eventually lead to tooth loss. Radiographic evaluation of the bone helps in the detection of the extent and severity of bone loss, thus eventually helping in establishing an exact diagnosis, prognosis as well as treatment planning of periodontal disease. Furthermore, it is necessary to assess the remaining bone for estimating the long-term prognosis of the tooth. Therefore, multiple methods have been employed to assess bone loss. The panoramic radiograph should be considered as the standard radiographic procedure for periodontal radiographic assessment.[1] Method used for detecting bone loss can chiefly be classified as methods where bone loss is expressed as a proportion of the total length of the tooth or of the root length alone and as methods where bone loss is calculated directly in millimetres from the cementoenamel junction (CEJ) to the alveolar bone.[2],[3],[4] Direct measurement from cementoenamel (CEJ to alveolar bone made from panoramic radiographs is reproducible, possesses validity and may be used in investigations of patterns of bone loss in periodontitis.[5] Because of the advantages of orthopantomogram (OPG) having relatively low radiation exposure as compared to full mouth intraoral radiographs as well as having a radiographic image of both maxilla and mandible displayed on the same radiographic sheet, OPGs have been widely used in the field of Periodontics to detect bone loss. Furthermore, there is an increased acceptance of the use of OPG. Thus, an OPG can be effectively used to assess bone loss in periodontitis. Pepelassi et al. found angular defects most frequent in upper and lower molars and least frequent in the mandibular anterior region.[6] Larato, in a study on a dry human skull, also found angular bony defects occurring with increased frequency in upper and lower the first molars.[7] Kasaj et al. observed that the bone defects were found to occur more commonly in the mandible than maxilla and bone loss occurred most frequently in the mandibular first molar region than any other tooth group.[8] Therefore, the aim of the present survey is to evaluate the severity and prevalence of alveolar bone loss at mandibular first molar sites on randomly selected OPGs.


  Materials and Methods Top


Panoramic radiographs of 250 patients (164 males and 86 females) aged between 18 and 62 were randomly selected from the records of the department of periodontics and oral implantology. The radiographs were shot on Kodak and printed on Carestream. The radiographs were taken by adjusting the tube voltage at 60–90 kV and tube current at 2–15 mA with an exposure time of 2–12 s. The panoramic radiographs were placed on an X-ray viewer and evaluated by the same examiner. Radiographic measurements were obtained by using a calibrated periodontal probe University of North Carolina probe (UNC-15) (Hu-Friedy). Bone loss was assessed on OPG by direct measurement of the distance between CEJ to the most coronal portion of the alveolar crest at the mandibular first molar region at mesial and distal surfaces with UNC-15 Probe (Hu-Friedy).

Inclusion criteria

  • Presence of both mandibular first molars.


Exclusion criteria

  • Absence of either of the mandibular first molars
  • Distorted, overlapped and unclear images were excluded from the study
  • Interproximal projection of CEJ could not be identified.


The samples were divided into the following groups

  1. According to gender: Male and female
  2. Based on age group: <30 years, 30–50 years and > 50 years
  3. Depending on site: Mesial and distal.


For the descriptive illustrations of the results, percentage, frequencies, tables and charts were used.

Statistical analysis

Statistical analysis was performed using the Statistical Product and Service Solution (SPSS) version 21 for Windows (SPSS Inc., Chicago, IL, USA). For the gender and site group comparison, an independent t-test was used. The group comparison for age distribution was analysed using the ANOVA test, and Tukey's post hoc test was used for individual pairwise comparison. P < 0.05 was considered significant, and < 0.001 were considered highly significant.


  Results Top


Two hundred and fifty OPGs were examined. The males contributed 65.6%, whereas females contributed 34.4% of the total sample size. [Table 1] and [Figure 1] illustrate the gender prevalence. [Table 2] and [Figure 2] show the age wise distribution of the collected data. The samples were divided into three groups. Less than 30 years age group comprised of 25.2% of the total sample, whereas 30 years–50 years age group formed 60% and above 50 years age group contributed to the remaining 14.8%. There was a statistically highly significant (P < 0.001) difference among the prevalence of participants in different age groups.
Figure 1: Gender distribution.

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Figure 2: Age group distribution.

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Table 1: Gender distribution

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Table 2: Age group distribution

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When the alveolar bone loss was measured on mesial and distal on a mandibular first molar, it was observed that the mean alveolar bone loss occurring on the mesial site was 5.23 (±2.31) mm while that on the distal site was 5.84 (±2.32) mm. The difference in alveolar bone loss in relation to mesial and distal sides was found to be statistically significant (P < 0.05). [Table 3] and [Figure 3] illustrate the mean alveolar bone loss occuring at the mesial and distal site. [Table 4] and [Figure 4] exhibit the comparison of bone loss occuring in males and females. Mean alveolar bone loss in male participants was found to be 5.57 (±2.23) mm, whereas in female participants, it was 5.47 (±1.99) mm. There was no statistically significant difference among males and females in relation to mean alveolar bone loss (P > 0.05).
Figure 3: Bone loss at mesial and distal side of mandibular first molar.

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Figure 4: Comparison of gender distribution and bone loss.

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Table 3: Bone loss at mesial and distal side of mandibular first molar

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Table 4: Comparison of gender distribution and bone loss

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[Table 5] and [Figure 5] show comparison of bone loss across the three age groups. On intergroup comparison, it was observed that the greatest amount of bone loss was in the above 50 years age group (6.62 mm) while the <30 years age group had the least amount of bone loss (4.55 mm). Bone loss occurring in the 30–50 years age group was 70 mm.
Figure 5: Comparison of age groups with alveolar bone loss.

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Table 5: Comparison of age groups with alveolar bone loss

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In the comparison of mean alveolar bone loss across the age groups, it was observed that there was the occurrence of a significant difference when the 30–50 years age group was compared with <30 years and more than 50 years age group. However, a highly significant difference was observed when <30 years age group was compared with above 50 years age group.


  Discussion Top


In periodontitis, the loss of bone is the terminal event of the inflammatory process. Although bone loss has been classified as either horizontal or vertical bone loss, the bone loss occurring in the tooth-supporting bone is a combination of both horizontal and vertical bone loss. Therefore, the knowledge of the bony topography, severity and pattern of bone loss is of utmost importance for determining the essential treatment to be provided. The amount of remaining tooth-supporting bone dictates the ability to retain, maintain and prevent further loss of the teeth due to periodontal disease. Thus numerous methods have been implemented in periodontics to determine the bone loss and the amount of bone remaining. Radiographs play a vital role in the assessment of bone levels. Radiographs are non-invasive and are easily accepted by the general population. Panoramic radiographs have been extensively employed to estimate the amount of bone loss. Panoramic projections are useful screening images giving a broad picture of both the jaws. Panoramic images are familiar among dentist and easier to interpret. In the present survey, bone loss was determined by direct measurements on the OPGs from the CEJ to the most coronal portion of the alveolar crest at the mandibular first molar region at both mesial and distal sites using UNC-15 probe (Hu-Friedy). Bjorn and Holmberg had suggested a method for estimating bone loss as a proportion of the total length of the tooth or of the root length alone.[2] This method estimated the amount of the root that was supported. Thus, this method was more effective when the long-term prognosis of the tooth was to be considered. Direct measurements from the CEJ yield a better assessment of actual bone loss.[5] Thus, this method should be primarily employed to detect the loss of tooth-supporting bone. Persson RE illustrated that the direct measurements from the CEJ to the alveolar bone were in accordance with the panoramic and intra-oral radiographs than the proportional values of the root length.[1] This finding thus indicated that panoramic radiographs should be considered as conventional radiographs for periodontal radiographic evaluation. In this study, it was observed that there was no statistical difference in mean alveolar bone loss between males and females. This finding was in disagreement with the study by Van der Velden (1989),[9] where it was found that the female/male ratio was 1.3/1 for aggressive periodontitis. This finding of the study is also in disagreement with the study of Faraedon et al., where females showed non-significantly higher bone loss than males.[10] Another finding of the study was that the mean alveolar bone loss was found to increase with age. This finding was in agreement with previous studies by Nielsen et al., Papapanou et al. and Kasaj.[8],[11],[12] It was observed that the mean alveolar bone loss occurring at the distal surface of the mandibular first molar was significantly higher than on the mesial surface. This finding was in accordance with the study by Nielsen (1980), where a higher amount of defects were observed adjacent to the distal surface than the mesial surface of the teeth.[11] This observation was in disagreement with Persson et al. (2003), Larato, Wouters et al., Müller and Ulbrich, where more defects were observed on the mesial surface than the distal surface.[1],[7],[13],[14] Prichard, Nielsen (1979), Tal suggested that a wide interproximal bone septum was more prone to the development of intrabony defects.[15],[16] The septum between mandibular first and second molars consisted of lamina dura and cancellous bone in 85.2% of the specimens and only lamina dura in the other 14.8%.[17] Heins and Wieder had suggested that bone loss occurring due to periodontitis could be correlated with increased interproximal width.[17] It was also observed that because of the vascular nature of the cancellous bone, it was found to be more reactive than the cortical bone and lamina dura.[11],[16],[18],[19]


  Conclusion Top


Within the limitations of this study, it was found that there was no predilection for males or females for mean alveolar bone loss. The bone loss occurring on the distal side of the mandibular first molar was significantly more than on the mesial side. It can thus be concluded that radiographic bone loss can be used as an important tool to identify patients susceptible to periodontitis.

Drawback

The present study is based on the manual assessment of alveolar bone loss; a digital assessment on the OPGs would have been more favourable.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Persson RE, Tzannetou S, Feloutzis AG, Brӓgger U, Persson GR, Lang NP. Comparison between panoramic and intra oral radiographs for the assessment of alveolar bone levels in a periodontal maintenance population. J Clin Periodontol 2003;30:833-9.  Back to cited text no. 1
    
2.
Bjorn H, Holmberg K. Radiographic determination of periodontal destruction in epidemiological research. Odontoloisk Revy 1966;17:232-50.  Back to cited text no. 2
    
3.
Schei O, Waerhaug J, Lovdal A, Arno A. Alveolar bone loss as related to oral hygiene and age. J Periodontol 1959;30:7-16.  Back to cited text no. 3
    
4.
Suomi JD, Plumbo J, Barbano JP. A comparative study of radiographs and pocket measurements in periodontal disease evaluation. J Periodontol 1968;39:311-5.  Back to cited text no. 4
    
5.
Kaimenyi JT, Ashley FP. Assessment of bone loss in periodontitis from panoramic radiographs. J Clin Periodontol 1988;15:170-4.  Back to cited text no. 5
    
6.
Pepelassi EA, Tsiklakis K, Diamanti-Kipioti A. Radiographic detection and assessment of the periodontal endosseous defects. J Clin Periodontol 2000;27:224-30.  Back to cited text no. 6
    
7.
Larato DC. Intrabony defects in the dry human skull. J Periodontol 1970;41:496-8.  Back to cited text no. 7
    
8.
Kasaj A, Vasiliu Ch, Willershausen B. Assessment of alveolar bone loss and angular bony defects on panoramic radiographs. Eur J Med Res 2008;13:26-30.  Back to cited text no. 8
    
9.
Van der Velden U, Abbas F, van Steenbergen TJ, De Zoete OJ, Hesse M, C De Ruyter. Prevalence of periodontal breakdown in adolescents and presence of Actinobacillus actinomycetemcomitans in subjects with attachment loss. J Periodontol 1989;60:604-10.  Back to cited text no. 9
    
10.
Zardawi FM, Aboud AN, Khursheed DA. A retrospective panoramic study for alveolar bone loss among young adults in Sulaimani City, Iraq. Sulaimani Dent J 2014;1:94-8.  Back to cited text no. 10
    
11.
Nielsen IM, Glavind L, Karring T. Interproximal periodontal intrabony defects. Prevalence, localization and etiological factors. J Clin Periodontol 1980;7:187-98.  Back to cited text no. 11
    
12.
Papapanou PN, Wennström JL, Gröndahl K. Periodontal status in relation to age and tooth type. A cross-sectional radiographic study. J Clin Periodontol 1988;15:469-78.  Back to cited text no. 12
    
13.
Wouters FR, Salonen LE, Helldén LB, Frithiof L. Prevalence of interproximal periodontal intrabony defects in an adult population in Sweden. A radiographic study. J Clin Periodontol 1989;16:144-9.  Back to cited text no. 13
    
14.
Müller HP, Ulbrich M. Alveolar bone levels in adults as assessed on panoramic radiographs.(I) Prevalence, extent and severity of even and angular bone loss. Clin Oral Invest 2005;9:98-104.  Back to cited text no. 14
    
15.
Prichard JF. The etiology, diagnosis and treatment of the intrabony defect. J Periodontol 1967;38:455-65.  Back to cited text no. 15
    
16.
Tal H. Relationship between the interproximal distance of roots and the prevalence of intrabony pockets. J Periodontol 1984;55:604-7.  Back to cited text no. 16
    
17.
Heins PJ, Wieder SM. A histologic study of the width and nature of inter-radicular spaces in human adult pre-molars and molars. J Dent Res 1986;65:948-51.  Back to cited text no. 17
    
18.
Akiyoshi M, Mori M. Marginal periodontitis: A histological study of the incipient stage. J Periodontol 1967;38:45-52.  Back to cited text no. 18
    
19.
Raisz LG, Kream BE. Regulation of bone formation. N Engl J Med 1983;309:29-35.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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