Objective: To evaluate the accuracy and reliability of detecting alveolar bone dehiscence and fenestration of maxillary anterior teeth of Angle class III by cone-beam computed tomography (CBCT).
Methods: Eighteen Angle class III patients with 108 maxillary anterior teeth were included (3 males and 15 females) who accepted modified corticotomy in orthodontic therapy. The mean age was 23.6 years (18-30 years). The clinical detection of dehiscence and fenestration was done when modified corticotomy was performed by the same periodontist. The CBCT examination was conducted pre-operation and the detection of dehiscence and fenestration by CBCT was done by two periodontists. The data in modified corticotomy were used as the golden standard to calculate the parameters, such as sensitivity, specificity, positive and negative predictive values, Youden index (YI), positive and negative likelihood ratio. Kappa statistic was used to analyze the agreement between the clinical detection and the CBCT detection.
Results: The incidence of dehiscence and fenestration was about 10.19% and 13.89% respectively, which mainly occurred on lateral incisors and canines. The median values of length and width of dehiscence were about 5 mm and 4 mm, and the median values of length and width of fenestration were 3 mm and 2 mm, respectively. Most fenestrations were detected on the middle third to the apical third of the root. For dehiscence, the agreement between clinical detection and CBCT detection was statistically significant (P<0.05). For fenestration, the agreement between clinical detection and CBCT detection was statistically significant (P<0.05). The values of sensitivity and specificity for detecting dehiscence were more than 0.7. The values of positive and negative predictive values for detecting dehiscence were 0.44 and 0.97. The values of sensitivity and specificity for detecting fenestration were 0.93 and 0.52. The values of positive and negative predictive values for detecting fenestration were 0.24 and 0.98.
Conclusion: For dehiscence, the agreement between clinical detection and CBCT detection was good. For fenestration, the agreement between clinical detection and CBCT detection was general. Detection of dehiscence and fenestration of maxillary anterior teeth of Angle class III by CBCT had limited diagnostic value in clinical practice with overestimation of dehiscence and fenestration incidence.