Evaluation of gingival recessions with conventional versus digital methods

Abstract

Objectives: The present study aimed to compare the conventional clinical and a digital method for evaluating differences in gingival recession (ΔREC) in patients with advanced periodontitis treated with the non-surgical treatment protocol.

Methods: Agreement between the methods was evaluated on a sample of ten patients with periodontitis (stage III/IV, grade B/C) with acquired clinical measurements and digital models from baseline (T0) and 12-months after non-surgical treatment of periodontitis (T1). The evaluation was performed on maxillary teeth from right to left second premolar resulting in overall 99 teeth. Clinical evaluation was performed by subtracting the distance measurements between gingival margin and cemento-enamel junction, obtained at T0 and T1 by a calibrated examiner (intra-examiner agreement >90%). The digital evaluation was performed directly by measuring the distance between the gingival margins on superimposed T0 and T1 digital models. Using Bland-Altman and statistical analysis, all six measurements sites around each included tooth (n=594) acquired with both methods were compared.

Results: Median ΔREC (5th and 95th percentile) acquired with a conventional clinical and digital method was 0.0mm (-2.0 - 1.0) and -0.4mm (-1.6 - 0.8), respectively (p<0.0001). The complete agreement between rounded digital and clinical ΔREC values was only 38%, revealing high disagreement also confirmed by Bland-Altman analysis with 95% limits of agreement ranging from -2.6 to 1.8mm. Absolute differences between the methods higher than 0.5 and 1 mm, was found in 61% and 38% of measurement sites, respectively.

Conclusions: The conventional clinical method for ΔREC evaluation exhibits lower sensitivity and accuracy than the digital method.

Clinical significance: The quality of both clinical and research data in periodontology and implantology can be considerably improved by the digital method while still preserving the compatibility with the conventional clinical method.

Keywords: Dental models; Gingival recession; Image analysis; Intraoral scanning; Periodontal disease; Superimposition.