Intraoral radiographs for the diagnosis, treatment, and follow-up of periodontal disease: Position paper from the Canadian Dental Hygienists Association.

Objective: This position paper examined, through a systematic review, the role of intraoral radiographs as the standard of care for diagnosing and monitoring periodontal disease while also informing treatment planning, intervention delivery, and the evaluation of periodontal care. Methods: This review adhered to PRISMA guidelines and was registered under protocol nº CRD42024579081. Searches were conducted through Ovid MEDLINE, Ovid Embase, Web of Science, and the Cochrane Library, with additional screening of grey literature and reference lists. Studies evaluating intraoral radiographs for diagnostic accuracy and treatment-planning effectiveness for periodontal disease among adults were included. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Results: Thirty studies involving 1,645 adult patients (mean age 35 to 59 years), were included. Intraoral radiographs demonstrated a moderate to high sensitivity (60% to 90%) compared to direct measurement (flap surgery) or clinical attachment level measurements for assessing periodontitis and peri-implantitis bone loss. A moderate association (r = 0.5 to 0.8 across 13 studies) was observed between clinical measurements and intraoral radiographs of alveolar bone loss, with radiographs underestimating bone loss by 0.5 mm to 2.8 mm compared to clinical methods. Conclusion: Periapical and bitewing radiographs are tools with moderate to high sensitivity for periodontal assessment, suggesting that they are the most accurate and appropriate tools for oral health professionals to use as an adjunct to clinical evaluation.