Observer performance based on marginal bone tissue visibility in Scanora panoramic radiography and posterior bitewing radiography.

OBJECTIVES To evaluate image quality for marginal bone tissue assessment on panoramic radiographs taken with the Scanora dental programme and on posterior bitewing radiographs. METHODS Panoramic and bitewing radiographs were taken of 96 patients. Six observers rated marginal bone level visibility as excellent, acceptable, or unacceptable. Five observers assessed image quality for detection of vertical bone defects and furcation involvements as acceptable or unacceptable. Observer agreement was calculated as overall agreement and kappa values. RESULTS Image quality of 36% of the panoramic and 6% of the bitewing sites was rated unacceptable for marginal bone loss assessment in the maxillae while 8% of the panoramic and bitewing sites in the mandible were unacceptable. For detecting vertical bone defects, image quality was unacceptable at one-third of the maxillary sites and 5% of the mandibular sites on the panoramic radiographs. Detection of furcation involvement was acceptable at most sites on both types of radiographs. Kappa values for intra- and inter-observer agreement were higher for panoramic than for bitewing radiographs. The kappa value for marginal bone loss assessment by several observers was moderate (0.45) for panorama and fair (0.28) for bitewing radiography. Corresponding kappa values for detection of vertical bone defects were substantial (0.62) and fair (0.25). CONCLUSION Image quality as evaluated by visual grading analysis is adequate for marginal bone tissue assessment in mandibular molar and premolar regions and unacceptable in maxillary molar and premolar regions on panoramic radiographs taken with the Scanora technique compared to bitewing radiography.