Comparing the diagnostic efficacy of intraoral radiography and cone beam computed tomography volume registration in the detection of mandibular alveolar bone defects.

OBJECTIVES: The aim of this study was to (1) compare bone loss detection accuracy with intraoral radiography and registered cone beam computed tomography (CBCT); (2) assess repeatability with both modalities; (3) determine factors affecting defect detection; and (4) determine the effect of buccolingual bone thickness on defect detection. STUDY DESIGN: Six observers viewed intraoral radiographs and CBCT scans before and after the defect to determine defect presence and extent. Receiver operating characteristic (ROC), sensitivity, specificity, logistic regression, odds ratio, intraclass correlation coefficient, and weighted kappa were used. RESULTS: CBCT and intraoral radiography mean ROC area under the curve values were not statistically different (0.90 vs 0.81; P = .06). CBCT had higher sensitivity compared with intraoral radiography (0.85 vs 0.63; P = .01) but similar specificity (0.91 vs 0.84; P = .45). Bone thickness, imaging modality, and observer had significant effects on defect detection (P < .001). Odds ratios for CBCT vs intraoral radiography were 2.29 for diagnostic accuracy and 1.52 for buccolingual bone thickness. There was moderate interobserver agreement for detection of defects and substantial intraobserver agreement for measurement of extent. CONCLUSIONS: CBCT showed equivalent diagnostic efficacy and specificity for defect detection and higher sensitivity compared with intraoral radiography. CBCT increases the odds of accurate defect assessment more than 2-fold compared with intraoral radiography. The odds of bone loss detection increase by approximately 50% per millimeter of buccolingual alveolar bone loss.