Abstract Periodontitis is an inflammatory condition that affects the supporting structures of teeth, including the gingiva, periodontal ligament, cementum, and alveolar bone. The diagnosis of periodontitis involves anamnesis, clinical examination, and radiographic assessment. Clinical attachment loss (CAL) measured through clinical examination and alveolar bone level (ABL) assessed via radiography are key metrics for diagnosis and therapy evaluation in periodontitis. Despite limited research on the correlation between CAL and ABL, existing studies provide inconclusive results. This review aims to determine the relationship between CAL and radiographic ABL measurements. The review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, with the research question formulated using the PICO strategy. A comprehensive search of electronic databases, including Scopus, PubMed, and Web of Science, as well as manual hand-searches, was performed. Article screening involved evaluating titles and abstracts related to the topic, followed by selection based on predefined inclusion and exclusion criteria. The screening and filtering process occurred in multiple stages, including the removal of duplicates and a thorough analysis of titles, abstracts, and full texts of included articles. A total of 1,755 articles were retrieved from the electronic databases, and after duplicate removal and full-text selection, 10 articles met the inclusion criteria for this review. The risk of bias was evaluated using the Quality Assessment in Prognostic Studies tool. The reviewed studies consistently demonstrated a positive correlation between CAL and ABL, with correlation coefficients (r) ranging from 0.35 to 0.88. Parallel periapical radiography (r = 0.88) achieved the strongest correlation among two-dimensional methods, demonstrating the importance of image standardization and parallel positioning. Cone-beam computed tomography offers comparable high correlations and superior three-dimensional accuracy but remains limited by cost, accessibility, and radiation exposure. Bitewing and panoramic radiographs exhibited weaker associations due to geometric distortion, overlapping anatomy, and restricted coverage. In conclusion, a significant association exists between CAL and radiographic ABLs. Integrating both clinical and radiographic assessments yields the most accurate diagnosis.
Larasati et al. (Mon,) studied this question.
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