Diagnosis of Periodontal Disease

Question 1

When should radiographs be taken in relation to periodontal disease?

Answer 1

• radiographs follow full examination and should aid management/alter treatment
• radiographs taken for other reasons may be helpful
• radiographs taken for caries diagnosis should always be checked for periodontal disease

Question 2

What pocket depths would indicate horizontal bitewings?

Vertical bitewings?

When would bitewings with or w/out paralleling periapicals be indicated?

Paralleling periapicals?

Answer 2

Horizontal BWs: uniform pocketing <6mm

Vertical BWs: pockets >6mm supplemented with parallel periapical views if perio-endo lesion suspected

BWs +/- paralleling periapicals: irregular pocketing

Paralleling periapicals: anterior teeth

Question 3

How often should radiographs be taken for periodontal disease?

Which radiographs are best in terms of technology?

Answer 3

• no clear evidence to support any recommendations regarding how often radiographs should be taken for periodontal reasons
• sequential intraoral radiographs should be placed reproducibly to allow for radiographic assessment of changes in bone levels
• digital radiographs may offer improved measurement of accuracy when assessing alveolar bone levels

Question 4

What radiographic challenges may we face in patients with periodontal disease?

Answer 4

• difficult to take paralleling films of mobile teeth
• difficult to use film holders and bite blocks if opposing teeth are missing
• full mouth periapical films have been considered the ‘gold standard’ for periodontal disease but what about dose to patient
• always consider whether taking the radiograph is going to change the management of the patient