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CC BY 4.0 · Eur J Dent 2025; 19(01): 096-102
DOI: 10.1055/s-0044-1786865
Original Article

A Reappraisal of the Accuracy of the Tactile Method for the Detection of the Subgingival Cementoenamel Junction: An In Vivo Study

Jaruta Mokhagul
1   Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
,
Attawood Lertpimonchai
1   Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
2   Center of Excellence in Periodontal Disease and Dental Implant, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
,
Lakshman Samaranayake
1   Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
3   Faculty of Dentistry, University of Hong Kong, Hospital Road, Hong Kong
,
Orawan Charatkulangkun 
1   Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
2   Center of Excellence in Periodontal Disease and Dental Implant, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
› Author Affiliations
Funding This research was financially supported by the Special Research Funding for Faculty, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand. Professor Lakshman Samaranayake was supported by the Chulalongkorn University, second century (C2) high potential professoriate fund at its Faculty of Dentistry.
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Abstract

Objectives This article reappraises the accuracy and factors associated with the detection of the cementoenamel junction (CEJ) using the tactile method.

Materials and Methods A total of 111 tooth sites of 7 patients scheduled for flap surgery were selected for the study. The CEJ was detected in a blind manner using the conventional tactile method with a standard periodontal probe by a single, trained examiner. A custom-made stent was prepared to standardize the measurements and the distance from a fixed reference point on the stent to the CEJ was measured before (apparent CEJ) and after (real CEJ) opening a gingival flap. To evaluate the effect of local anesthesia (LA) on the measurement error, assessment with and without LA given prior to the measurement was also evaluated. The bone crest-CEJ distance at each site was also recorded in all sites.

Statistical Analysis The measurement error of apparent versus real distance, if any, was compared using Cohen's weighted kappa coefficient (WKC) (± 1 mm).

Results A weak WKC (WKC = 0.539) was found between the apparent and real CEJ distance. Higher WKCs were noted at posterior and proximal sites than the anterior and buccal/lingual sites, respectively (0.840 and 0.545 vs. 0.475 and 0.488). A higher confluence of the agreements was noted when CEJ distance was measured in anesthetized sites (WKC = 0.703). Sites without bone loss showed more coronal deviation of CEJ detection, as opposed to apical deviation seen at sites with bone loss.

Conclusion The conventional CEJ detection using the tactile method was relatively imprecise depending on the anatomical location of the tooth and the bone loss at the site of measurement. However, the detection accuracy improved when the sites were anesthetized. In clinical terms, our data, reported here for the first time imply that, in the absence of visual cues, posterior tooth site measurements of periodontal attachment loss were more reliable in comparison to the other sites. The bone crest level also impacted the measurement deviation to some extent, implying that, possible overestimate of clinical attachment loss may occur at sites without bone loss.

Keywords

accuracy - cementoenamel junction - clinical attachment level - detection

Authors' Contribution

O.C., J.M., and A.L. contributed to the study conception and design, material preparation, data collection, and analysis. The first draft of the manuscript was written by O.C. and J.M. L.S. fully revised and edited the manuscript. All authors read and approved the final manuscript.




Publication History

Article published online:
17 May 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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