الفهرس 
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Abstract
The aim of the present study was to assess the accuracy and reliability of CBCT in the evaluation of different artificially created periodontal defects using different sizes of CBCT resolutions and digital intraoral bitewing images in comparison with real physical measurements created in dry human jaws, for optimum application in diagnosing periodontally compromised patients.
The study was conducted as an experimental part and a clinical part. In the experimental part, periodontal defects (infraboney defect, dehiscence and fenestration) of variable sizes were created in eight dry human skulls. The defects were measured using a digital caliper (gold standard), then were scanned with CBCT (High and low resolutions) and bitewing radiographs. The results of both scans were compared with the real physical measures (gold standard).
The clinical part of this study was conducted on twelve adult patients with moderate to advanced periodontitis. Patients were examined clinically and the present periodontal defects were measured using a graduated periodontal probe (gold standard). Then, the patients were scanned using high resolution CBCT and digital intraoral bitewings to compare the measurements with the real physical measures of the periodontal probe.
In the experimental part of the study, high resolution CBCT showed better results versus the standard resolution and digital bitewings when compared to the real physical measures for infrabony defect. While for dehiscence and fenestration defects, high resolution CBCT again showed better results versus the standard resolution CBCT when
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compared to the real physical measures. However, digital intraoral bitewing images failed to detect the created fenestration and dehiscence defects. therefore, regarding the dehiscence and fenestration only high and standard resolutions were compared. In the clinical part, when high resolution CBCT and digital intraoral bitewing images for infrabony defects were compared to the gold standard, high resolution CBCT showed better results than the digital bitewings when compared to the actual measures (gold standard).
from the results of this study, we can conclude that;
1- High resolution CBCT is an accurate and reliable method for detection and assessment of the smallest periodontal defects.
2- Only CBCT can detect and assess the presence of fenestration and dehiscence defects with great accuracy.
3- When evaluating patients with expected large/advanced periodontal defects, standard resolution CBCT can replace high resolution CBCT to reduce amount of radiation received by the patient.
4- In small sized /initial infraboney defects, both CBCT and digital intraoral bitewing protocols can provide good detectability and assessment of the depth and dimensions of interproximal periodontal defects.
5- CBCT shows overall higher accuracy for the assessment of simulated fenestration defects than for simulated dehiscence defects.
6-Scanning small lesions with high resolution CBCT using voxel size of 0.25mm or less is appropriate for detection of most types of periodontal defects.
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Recommendations
After completion of the present study, the following could be recommended:
1-Although CBCT has proven its superiority in detection and assessment of periodontal defects, however CBCT should not be used as the first option for diagnosis, and should only be used in cases where 2D radiographs are of no added value, such as Volume assessment, Anatomical superimposition, Inaccessible areas, Furcation involvement, Suspected facial/lingual periodontal defects, Idiopathic periodontal pain.
2-Further clinical investigation of dehiscence and fenestration of different sizes should be carried out and correlated with radiographic CBCT results.