Three-dimensional volumetric analysis of bone volume change in grade II mandibular furcation defects: A CBCT-based methodological study.

OBJECTIVE

To establish and assess the inter- and intra-rater reliability of a novel, semi-automated protocol for three-dimensional (3D) volumetric analysis of bone volume changes in mandibular Grade II furcation defects using Cone-Beam Computed Tomography (CBCT).

METHODS

The reliability of this methodological proof-of-concept study was the primary endpoint. Inter- and intra-rater agreement were rigorously assessed on a substantial dataset of 100 Regions of Interest (ROIs) by two examiners using the Bland-Altman method and the Intraclass Correlation Coefficient (ICC). The protocol utilized automatically segmented STL files from high-resolution CBCT scans. Following ratification, the protocol was applied on an exploratory basis only to an illustrative subset of 13 defects to demonstrate its clinical application in calculating volumetric bone differences at different timepoints of observation; specifically, at baseline and nine months later, following regenerative periodontal therapy(ΔV = V₉-V₀).

RESULTS

The volumetric measurement protocol demonstrated excellent reliability. The inter-rater and intra-rater ICC values were both >0.99 (p < 0.001). Bland-Altman analysis showed narrow limits of agreement and no significant systematic differences between or within examiners (p > 0.05). In the preliminary patient subset, the calculated volumetric bone difference (ΔV) ranged from -33.01 mm³ to 8.93 mm³.

CONCLUSION

This study successfully established a highly reliable, semi-automated method for the 3D volumetric analysis of alveolar bone changes in furcation defects due to periodontal treatment or progress of periodontal disease.

CLINICAL SIGNIFICANCE: This ratified, non-invasive protocol provides a precise and objective tool for quantifying hard tissue changes following periodontal regenerative therapy. By overcoming the limitations of traditional 2D methods and subjective clinical probing, it can significantly enhance the accuracy and objectivity of future clinical research in periodontal regeneration.