clinical and radiographic examination Flashcards
what six criteria are needed for a complete periodontal examination?
- perio probing
- clinical attachment loss
- BOP
- mobility
- furcation involvement
- plaque index.
what 2 probes are traditionally used for perio probing?
UNC and CP
how do you probe interproximally?
line the cusp tip and the root apex up with the perio probe.
probing force should be how many newtons?
.75N
What is the preferred method for determining periodontal diagnosis?
clinical attachment loss
mild, moderate, and severe CAL levels
mild- 1-2mm of loss
moderate- 3-4 mm of loss
severe- 5mm+ of loss
when does the probing dept=CAL?
when gingival margin is at CEJ
When do you subtract from you probing depth?
pseudopockets, when gingival margin is above CEJ
when do you add to your pocket depth fo CAL?
recession, when gingival margin is below CEJ
Bleeding upon probing
one of eariliest signs of gingival inflammation. This occurs even sooner than color change or other visual signs
whats one of the most common reasons for BOP?
chronic inflammation, caplillaries are engoreged and close to the surface.
miller tooth mobility classes
1- fist distinguishable sign of movement greater than “normal”
- 1mm of combined movement
- 1+mm in any direction and /or vertical depression or rotation of the crown in its socket( the moement it becomes compressible its a 3)
what probe is used for furcation detection?
neighbors probe
class 1 furcation
the concavity above the furcation can be felt but not the furcation itself
class 2 furcation
probe partially enters furcation extending ~1/3 the width of tooth
class 3 furcation
in mandibular molars the probe passes completely through the furcation.
In maxillary molars the probe passes through until being impeded by the palatal root.
class 4 furcation
same as class 3 but entrance to furcation is visible clinally.
whats the average width of a furcation entrance and a scaler?
furcation entrance- .5mm.
scaler- .75mm.
its hard to fit the scaler in.
whats the plaque index used for?
to determine patients ability to remove plaque and material from teeth
plaque index scores 0-3
PI0- no plaque in gingival area
PI1- film of plaque adhering to FGM & adjacent areas. This plaque is only seen be running probe on tooth surface
PI2- soft deposits within gingival sulcus and FGM. This can be seen by the naked eye
PI3- abundance of soft matter within the gingival sulcus, and FGM
how is PI calculated?
count sites with plaque
divide by sites that dont have plaque
what films can be used for a proper periodontal diagnosis?
intra oral radiographs panorex CT scans ( implants)
Intra oral radiographs are most accurate because….
they produce the least amount of magnification ( 6-7%)
periapicals and bitewings
whats the pritchard criteria for periapical films?
includes cusp tips with little to none of the occlusal surface showing
enamel caps and pulp chambers showing
open interproximals
proximal contacts shouldnt overlap unless teeth are our of line
bitewing films
for posterior crowns, alveolar bone height in relation to CEJ
horizontal bitwings are commonly used for what?
detection of interproximal caries
vertical bitweings are commonly used for what?
evaluate bone for periodontal involvement.
Panorex uses
to view large anatomical structures
implants, pathology, TMJ
what are the positives of panorex
allows for full mouth imaging
low radiation
fixed head position for standardization
whats the bad of panorex?
25-30% magnification
cant obtain precise view of perio structures
whats the ugly of panorex?
mutschelknauss and vonder ohe did a study and found FMX with right angle to alveolar bone was superior to panorex
is CT scan usefull to periodontists?
yes, its great for implants and helps with pathology diagnosis
what do dentists call a CT scan?
dentascan
why is examining the interdental septa usefull?
because roots can obscure facial and lingual surfaces of alveolar bone
the angulation of the interdental septa is useually aligned with what?
parallel to a line connecting the adjacent teeths CEJ
why is it good to look at lamina dura?
( radiopaque border next to PDL)
loss of lamina dura limited to alveolar crest may indicate extension of gingival inflammatory process into underlying alveolar bone.
does Manson think the lamina dura even actually exist?
no, the line appearance is just made by the shape and position of the tooth root in relation to the x-ray beam.” manson”
does Rams think the lamina dura exists?
yes,
and he says its associated with PD ( look at slide 47)
height of crest
hausman
kallestal
general
hausman- .04-1.9mm
kallestal- maxilla .9-1.0 mm, mandible .7-.8mm.
general- 2mm
what causes the wide range of height of crest numbers?
Regan said the x-ray angulation
This is why theyre strictly just an adjuct to clinical exam.
what are some radiologic evidences of periodontal disease?
vertical/horizontal bone loss and calculus
whats an early sign of periodontal disease?
a wedge like appearece mesially or distally to teeth on the aveolar bone
whats horizontal bone loss?
reduction in interdental septa with the crest horizontal and perpendicular to long axis of adjacent teeth.
Yoon says bone loss 2mm or moreparallel to CEJ of surrounding teeth
whats vertical bone loss
reduction in interdental septa with crest having an angular disposition
commonly in aggressive disease
classified into number of walls
how much bone loss is needed to see vertical bone loss on radiographs?
.5-1.0mm
why are radiographs not so great in vertical defects detection?
thick bony cortical plates and ruut surfaces can block the defect.
whats the best way to detect vertical bone loss?
surgical exploration.
whats a furcation arrow?
small triangular radiographic shadow over either the mesial or distal root in the proximal furaction area.
Hardekopf noted 18% mesial sites and 7% distal sites exhibited a furcation arrow
