Is MRI able to detect early periodontitis?

According to a study published in the Journal of Clinical Periodontology, MRI could help in early detection of gum disease. It can show periodontitis-linked changes to the jawbones of patients before bone defects occur.

The authors stated that imaging showed that patients who had positive bleeding-on–probing tests were at greater risk of developing bone edema. This was despite the fact that probing pockets are considered to have minimal risk for periodontal diseases.

“Osseous edema could serve as a surrogate marker in the early stages of periodontal diseases and MRI may offer new options for detection and decision making regarding periodontitis,” said Dr. Monika Probst, from the Department of Diagnostic and Intervention Neuroradiology at University Hospital Rechts der Isar, Munich.

Periodontitis can be diagnosed by increased probing depth and bleeding on probing. Conebeam CT allows for 3D views of the tooth-supporting bones, which can be used to aid in treatment planning. However, xrays and CBCT scans can’t see soft-tissue changes such as inflammatory changes that are linked to bone water retention. These modalities are unable to detect early bone changes before inflammation-induced bone loss.

MRI scans on the other hand provide detailed images of the dental pulp, nerves, gums, and bone. MRI scans can provide information to clinicians about bone loss and the extent of periodontal attachment earlier, potentially reducing the chance of tooth loss.

The current study involved 42 patients who had clinical evidence of periodontal disease. They were admitted to the Ludwig Maximilian University of Munich’s periodontology department between May 2018 and December 2018. Additionally, prospective enrollment was made for 34 healthy controls. All participants provided current x-rays if they were able.

Participants were tested for bleeding during probing and their probing pockets depths at six locations per tooth. If there was clinical periodontal loss at more than two interdental sites (non-adjacent) and/or a deeper probing pocket at the oral or lingual sites, it was diagnosed as periodontitis.

To find periodontal disease, a neuroradiologist, radiologist, and dentist examined MRI scans from the participants. According to the authors, MRI scans revealed bone edema that was greater than the amount of demineralized bone. This may indicate that the imaging modality could help with the earlier diagnosis of periodontal diseases.

MRI revealed a strong association between positive bleeding-on probing tests and bone edema. A positive test resulted in a 2.5-fold increase of bone edema risk for patients with the same tooth. This was even with teeth that were deemed healthy at 3 mm and less (95% confidence interval [CI], 1.54-41.11).

The study was limited by the tedious manual segmentation. The authors stated that thresholds might be helpful, but that MRI signal values do not have absolute values like CT. Therefore, thresholds would need change for each patient.

Future studies should examine the histopathology and causes of edema. They noted that such research could be useful in understanding bone’s processes before it demineralizes. Probst and his colleagues concluded that these findings provide new options for monitoring, diagnosis and decision-making regarding periodontal disease.

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