The accuracy of linear measurements in cone beam computed tomography for assessing intrabony and furcation defects: A systematic review and meta-analysis.

  • Nurul Ain Mohamed Yusof Center for Periodontology Studies, Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia.
  • Erni Noor Center for Periodontology Studies, Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia.
  • Mohd Yusmiaidil Putera Mohd Yusof Center for Oral and Maxillofacial Diagnostics and Medicine Studies, Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia.-Institute of Pathology, Laboratory and Forensic Medicine (I-PerForM), Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia.


Objective: This study aims to assess the accuracy of the linear measurements of intrabony and/or furcation defect quantified by cone beam computed tomography (CBCT). Material and Methods: A systematic search of the literature was conducted by two authors independently from the PubMed, Scopus, and EBSCO for full articles published in journals between January 2003 and March 2017. Eligible studies were assessed for quality and heterogeneity using the QUADAS-2 tool. A meta-analysis was performed to identify the accuracy of CBCT in the measurement of intrabony defects. The effect size was estimated and reported as the standardised mean difference (SMD). Results: A total of 105 titles and abstracts were screened. Of those, 11 articles met the inclusion criteria for the systematic review while only four were selected for meta-analysis. The overall effects of standardized mean difference and 95% CI was -0.03 [95% CI -0.67 to 0.60] with a x2 statistic of 0.49 with 3 degrees of freedom (p>0.05), I2= 0.01%. Conclusion: CBCT is highly accurate and reproducible regarding linear measurements for assessing intrabony defects with a weighted standardized mean difference of 0.03 mm. More randomised controlled trials are required to assess the accuracy of CBCT in assessing patients with periodontal defects.


1. Graziani F, Karapetsa D, Alonso B, Herrera D. Nonsurgical and surgical treatment of periodontitis: how many options for one disease? Periodontol 2000. 2017.
2. Frencken JE, Sharma P, Stenhouse L, Green D, Laverty D, Dietrich T. Global epidemiology of dental caries and severe periodontitis – a comprehensive review. J Clin Periodontol. 2017.
3. Listgarten MA. Periodontal probing: What does it mean? J Clin Periodontol. 1980.
4. Highfield J. Diagnosis and classification of periodontal disease. Aust Dent J. 2009.
5. Corraini P, Baelum V, Lopez R. Reliability of direct and indirect clinical attachment level measurements. J Clin Periodontol. 2013.
6. Clerehugh V, Abdeia R, Hull PS. The effect of subgingival calculus on the validity of clinical probing measurements. J Dent. 1996.
7. Garnick JJ, Silverstein L. Periodontal Probing: Probe Tip Diameter. J Periodontol. 2000.
8. Renatus A, Trentzsch L, Schönfelder A, Schwarzenberger F, Jentsch H. Evaluation of an electronic periodontal probe versus a manual probe. J Clin Diagnostic Res. 2016.
9. Korostoff J, Aratsu A, Kasten B, Mupparapu M. Radiologic Assessment of the Periodontal Patient. Dent Clin North Am. 2016.
10. Jeffcoat MK, Wang I ‐Chung, Reddy MS. Radiographic diagnosis in periodontics. Periodontol 2000. 1995.
11. Tugnait A, Clerehugh V, Hirschmann PN. The usefulness of radiographs in diagnosis and management of periodontal diseases: A review. J Dent. 2000.
12. Scarfe WC, Azevedo B, Pinheiro LR, Priaminiarti M, Sales MAO. The emerging role of maxillofacial radiology in the diagnosis and management of patients with complex periodontitis. Periodontol 2000. 2017.
13. Hausmann E, Allen K, Carpio L, Christersson L a, Clerehugh V. Computerized methodology for detection of alveolar crestal bone loss from serial intraoral radiographs. J Periodontol. 1992.
14. Corbet E, Ho D, Lai S. Radiographs in periodontal disease diagnosis and management. Aust Dent J. 2009.
15. Mol A. Imaging methods in periodontology. Periodontol 2000. 2004.
16. Acar B, Kamburoğlu K. Use of cone beam computed tomography in periodontology. World J Radiol. 2014.
17. Aljehani YA. Diagnostic applications of cone-beam CT for periodontal diseases. Int J Dent. 2014.
18. Sedentexct. Radiation Protection 172: Cone Beam CT for Dental and Maxillofacial Radiology - Evidence-based Guidelines. Off Off Publ Eur Communities. 2012.
19. Takeshita W, Vessoni Iwaki L, Da Silva M, Tonin R. Evaluation of diagnostic accuracy of conventional and digital periapical radiography, panoramic radiography, and cone-beam computed tomography in the assessment of alveolar bone loss. Contemp Clin Dent. 2014.
20. Pahwa P, Lamba A, Grewal H, Faraz F, Tandon S, Yadav N. Evaluation of two-dimensional and three-dimensional radiography with direct surgical assessment of periodontal osseous defects: A clinical Study. Indian J Dent Res. 2014.
21. Cimbaljevic MM, Spin-Neto RR, Miletic VJ, Jankovic SM, Aleksic ZM, Nikolic-Jakoba NS. Clinical and CBCT-based diagnosis of furcation involvement in patients with severe periodontitis. Quintessence Int. 2015.
22. Walter C, Schmidt JC, Dula K, Sculean A. Cone beam computed tomography (CBCT) for diagnosis and treatment planning in periodontology: A systematic review. Quintessence Int. 2016.
23. Anter E, Zayet MK, El-Dessouky SH. Accuracy and precision of cone beam computed tomography in periodontal defects measurement (systematic review). J Indian Soc Periodontol. 2016.
24. Nikolic-Jakoba N, Spin-Neto R, Wenzel A. Cone-Beam Computed Tomography for Detection of Intrabony and Furcation Defects: A Systematic Review Based on a Hierarchical Model for Diagnostic Efficacy. J Periodontol. 2016.
25. Pajnigara N, Kolte A, Kolte R, Pajnigara N, Lathiya V. Diagnostic accuracy of cone beam computed tomography in identification and postoperative evaluation of furcation defects. J Indian Soc Periodontol. 2016.
26. Qiao J, Wang S, Duan J, Zhang Y, Qiu Y, Sun C, Liu D.The accuracy of cone-beam computed tomography in assessing maxillary molar furcation involvement. J Clin Periodontol. 2014.
27. Walter C, Weiger R, Zitzmann NU. Accuracy of three-dimensional imaging in assessing maxillary molar furcation involvement. J Clin Periodontol. 2010. doi:10.1111/j.1600-051X.2010.01556.x
28. Claffey N, Loos B, Gantes B, Martin M, Heins P, Egelberg J. The relative effects of therapy and periodontal disease on loss of probing attachment after root debridement. J Clin Periodontol. 1988.
29. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Med. 2009.
30. SA M. Enhancing your practice through evidence-based decision making: PICO, learning how to ask good questions. J Evid based Dent Pract. 2001.
31. Whiting PF, Rutjes AWS, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011.
32. Whiting P, Rutjes AWS, Reitsma JB, Bossuyt PMM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol. 2003.
33. Viechtbauer W. Conducting Meta-Analyses in R with the metafor Package. J Stat Softw. 2010.
34. Misch KA, Yi ES, Sarment DP. Accuracy of Cone Beam Computed Tomography for Periodontal Defect Measurements. J Periodontol. 2006.
35. Vandenberghe B, Jacobs R, Yang J. Detection of periodontal bone loss using digital intraoral and cone beam computed tomography images: An in vitro assessment of bony and/or infrabony defects. Dentomaxillofacial Radiol. 2008.
36. Raichur PS, Setty SB, Thakur SL, Naikmasur VG. Comparison of radiovisiography and digital volume tomography to direct surgical measurements in the detection of infrabony defects. J Clin Exp Dent. 2012.
37. Li F, Jia PY, Ouyang XY. Comparison of Measurements on Cone Beam Computed Tomography for Periodontal Intrabony Defect with Intra-surgical Measurements. Chin J Dent Res. 2015.
38. Grimard BA, Hoidal MJ, Mills MP, Mellonig JT, Nummikoski P V, Mealey BL. Comparison of Clinical, Periapical Radiograph, and Cone-Beam Volume Tomography Measurement Techniques for Assessing Bone Level Changes Following Regenerative Periodontal Therapy. J Periodontol. 2009.
39. Banodkar AB, Gaikwad RP, Gunjikar TU, Lobo TA. Evaluation of accuracy of cone beam computed tomography for measurement of periodontal defects: A clinical study. J Indian Soc Periodontol. 2015.
40. C CPPNHDR. Cone-beam computed tomography: Three-dimensional imaging in periodontal diagnosis. J Indian Acad Dent Spec Res. 2017;4(1):12.
41. Dillenseger JP, Gros CI, Sayeh A, et al. Image quality evaluation of small FOV and large FOV CBCT devices for oral and maxillofacial radiology. Dentomaxillofacial Radiol. 2016.
42. Walter C, Weiger R, Dietrich T, Lang NP, Zitzmann NU. Does three-dimensional imaging offer a financial benefit for treating maxillary molars with furcation involvement? - A pilot clinical case series. Clin Oral Implants Res. 2012. 43. Zhu J; Ouyang XY. Observation of bone morphology in furcation defects of mandibular molars using cone beam computed tomography. J Peking Univ Heal Sci. 2017;49(1):67.
44. Jie Z; Ouyang XY. Assessing Maxillary Molar Furcation Involvement by Cone Beam Computed Tomography. Chin J Dent Res. 2016;19(3):145-151.
45. Darby I, Sanelli M, Shan S, et al. Comparison of clinical and cone beam computed tomography measurements to diagnose furcation involvement. Int J Dent Hyg. 2015.
46. Allen J. Evaluation of Maxillary Molar Furcations, Clinical Measurements versus Cone Beam Computed Tomography. 2014.
47. Braun X, Ritter L, Jervøe-Storm PM, Frentzen M. Diagnostic accuracy of CBCT for periodontal lesions. Clin Oral Investig. 2014.
48. De Faria Vasconcelos K, Evangelista KM, Rodrigues CD, Estrela C, De Sousa TO, Silva MAG. Detection of periodontal bone loss using cone beam CT and intraoral radiography. Dentomaxillofacial Radiol. 2012.
49. Songa VM, Jampani ND, Babu V, Buggapati L, Mittapally S. Accuracy of cone beam computed tomography in diagnosis and treatment planning of periodontal bone defects: a case report. J Clin Diagn Res. 2014.
50. Fleiner J, Hannig C, Schulze D, Stricker A, Jacobs R. Digital method for quantification of circumferential periodontal bone level using cone beam CT. Clin Oral Investig. 2013.
51. Laky M, Majdalani S, Kapferer I, et al. Periodontal Probing of Dental Furcations Compared With Diagnosis by Low-Dose Computed Tomography: A Case Series. J Periodontol. 2013.
52. Umetsubo OS, Gaia BF, Costa FF, Cavalcanti MGP. Detection of simulated incipient furcation involvement by CBCT: an in vitro study using pig mandibles. Braz Oral Res. 2012.
53. el Zoheiry; Hany Salah; Abou-Khalaf Ashraf; Farid; Mary Medhat. Assessment of periodontal defects using cone beam computed tomography: an in-vitro study. Egypt J Oral Maxillofac Surg. 2011;2(1):27-33.
54. Zhong J, Ou-Yang X, Liu D, Cao C. [Evaluation of the in vitro quantitative measurement of II degree furcation involvements in mandibular molars by cone-beam computed tomography]. Beijing Da Xue Xue Bao. 2010.
55. Walter C, Kaner D, Berndt DC, Weiger R, Zitzmann NU. Three-dimensional imaging as a pre-operative tool in decision making for furcation surgery. J Clin Periodontol. 2009. 56. Noujeim M, Prihoda TJ, Langlais R, Nummikoski P. Evaluation of high-resolution cone beam computed tomography in the detection of simulated interradicular bone lesions. Dentomaxillofacial Radiol. 2009.
57. Mol A, Balasundaram A. In vitro cone beam computed tomography imaging of periodontal bone. Dentomaxillofac Radiol. 2008.
58. Vandenberghe B, Jacobs R, Yang J. Diagnostic validity (or acuity) of 2D CCD versus 3D CBCT-images for assessing periodontal breakdown. Oral Surgery, Oral Med Oral Pathol Oral Radiol Endodontology. 2007.
59. Mengel R, Candir M, Shiratori K, Flores-de-Jacoby L. Digital volume tomography in the diagnosis of periodontal defects: an in vitro study on native pig and human mandibles. J Periodontol. 2005.
How to Cite
YUSOF, Nurul Ain Mohamed; NOOR, Erni; YUSOF, Mohd Yusmiaidil Putera Mohd. The accuracy of linear measurements in cone beam computed tomography for assessing intrabony and furcation defects: A systematic review and meta-analysis.. Journal of Oral Research, [S.l.], v. 8, n. 6, p. 527-539, feb. 2020. ISSN 0719-2479. Available at: <>. Date accessed: 28 feb. 2020. doi: