Inter- and intraobserver variability in radiographic bone level assessment at Branemark fixtures

The aim was to determine inter- and intraobserver variability in radiographic bone level assessments at Branemark fixtures and to study the influence of various factors (radiographic density; projection geometry; jaw in which the fixtures were inserted; degree of bone loss; time after fixture loading; and number of radiographs of each fixture) on the variability. Intraoral radiographs from bridge connection and 1- and 3-year check-ups from 15 upper and 15 lower jaws (172 fixtures) were assessed by 6 observers. Measurements were taken from a reference point on the fixture to the marginal bone level, and some were repeated by all observers after 1 month. Results showed a small interobserver variation (0.14 mm) with the intraobserver variation (0.08 mm) as its largest component. The radiographic density and the degree of bone loss showed the strongest influence on the interobserver variation. The only variable with a significant effect on the intraobserver variation was the number of radiographs of each fixture. Calculated confidence values showed that measurement reliability can be improved by letting one observer or preferably more make several, independent readings, allowing for the demonstration of minor differences in bone height over time or between implant systems.