Final Exam- March 10-Periodontal Radiographs Flashcards
What must radiographs be used in conjuction with in order to make periodontal diagnosis?
Radiographs must always be used in conjuction with PERIODONTAL EXAM in order to come to a definitive diagnosis.
HOWEVER radiographs are necessary for diagnosis as there is information that can only be obtained by radiographs.
When is it appropriate for radiographs be taken?
Radiographs should only be performed following a thorough clinical exam to determine the number, number, type and location of images are needed for a particular patient.
What are the most commonly indicated radiographs following a full periodontal exam?
bitewing radiographs and slelective periapical radiographs are most commonly indicated.
in full dentition with full mouth series
Anatomy of the healthy Peridontium:
What is the Lamina Dura? and what does it represent?
know different layers of bone and ligaments.
What is the Alveolar Crest? Be able to identify it on radiograph.
What radiographs can it be seen on?
Alveolar crest is well corticated and is radio-opaque in periapical and bitewing films.
This Radiograph is the best in determining interproximal bone height.
THE BITEWING.
the reason for this is because the radiographic geometry can affect the representation of bone height. In Bitewing this is much less of a problem.
What type of bitewings should you take to evaluate peridontal condition properly and in what circumstances are they needed.
Vertical and Horizontal
Vertical- Needed when you have Moderate to Advanced disease. (Often need 2 bw/side in order to see al posterior segmen
Horizontal- can be used in MILD Disease (might only need one bitewing)
What are the downsides to using a horizontal bitewing?
In Advanced disease:
with Horizontalyou may not be able to see the aveolar crest.
What are the downsides to using a vertical bitewing?
You may need to take 2 projections per side.
Radiographs are especially helpful in evalutation of these 9 factors:
- Amount of bone present.
- Condition of alveolar crests
- Bone loss in furcation areas
- Width of peridontal ligament space
- Local irritating factors that increase Periodontal Disease
- Calculus
- poorly contoured or overextented restoration
- Root Length and Morphology
- Open interproximal contacts (potential for food impaction)
- Anatomic considerations
- position of maxillary sinus in relation to peridontal deformity
- Missing, supernumerary, impacted and tipped teeth
- Pathologic considerations
- Caries
- Periapical lesions
- Root resorption
What is Gingivitis?
Gingivitis is a disease of chronic inflammation of the gingiva due to microbes from plaque on the teeth which lead to the development of pockets.
What distinguishes gingivitis from peridontitis?
In gingivitis the gums are only inflammed but there is no loss of connective tissue attachment
In periodontitis the gingiva starts to recede apically onto the root surface with loss of connective tissue AND bone loss!
How can you determine someone has Severe/Advanced Periodontitis?
In end state of the disease dark triangles can be seen in between teeth interproximally, there will be increased mobility of the teeth, recessesed gums and bone resorption.
We need to measure pocket depths and recession!
How does gingivitis appear on a radiograph?
TRICK QUESTION! in gingivitis are no evidence on a radiograph because no bone is missing.
When do you start to see evidence of periodontitis on a radiograph?
You will not be able to identify periodontitis in the early stages due to how bone loss develops.
You only start to see radiographic evidence of periodontitis in the moderate stage where bone loss has occured, and bone will be below the CEJ.
IN ADVANCED PERIODONTITIS ALWAYS LOOK FOR FURCATION INVOLVEMENT.
What defines Localized Aggressive Periodontitis?
- Molar, incisor involvement
- Can begin in teenagers
- Rapid attachment ( bone loss in a few months)
- Often associated with certain
bacteria (Aggregatibacter actinomycetemcomitans) - Plaque/calculus levels often not extreme
- Often associated with pmn (polymorphonuclear lymphocytes) deficiencies
what does Horizontal Bone Loss refer to in Periodontitis?
Horizontal bone loss – loss of both buccal and lingual cortical plates of bone and everything in between.
What does Vertical Bone Loss refer to in Periodontitis?
VERTICAL BONE LOSS (Angular bone loss)
Early angular bone loss may be seen as widening of the PDL Angular bone loss is a “v” shaped defect in the alveolus.Vertical defects may actually have 3 walls, 2 walls or one wall.
REMEMBER though in health the Alveolar Crest is parallel to the line that joinsadjacent CEJs
what are the 4 different types of pockets?
A. Three-wall
B. Two-wall
C. One-wall
D. Combined (crater like resorption/ “cup”)
What is an Interdental Crater?
An interdental crater is a 2 wall defect between two teeth where the buccal and lingual corical plates are intact but there is a loss of trabecular bone between.
On radiographs these are usually seen at the alveolar crest and are more common in the posterior parts of the mouth since the bone is much wider.
(but you might not see these at all on radiographs)
What periodontal defect can be seen on the mandibular molar?
This is an example of FURCATION INVOLVEMENT because there is clearly a radiolucency in the furcation indicating increased bone loss.
why is furcation involvement difficult to assess in maxillary molars?
It is difficult to assess because there is overlap from the palatal root.
(remember maxillary molars have 3 roots, 2 buccal 1 lingual/palatal)
alveolar crest
-where is it?
what is best xray to see it?
- 5-2mm from te CEJ in normal anatomy
- best seen using a bitewing
what typ of bitewing should you use to evaluate the periodontal condition properly?
in horizontal you may not be able to see the crest in advanced disease and may not see the root trunks, this is why you would need a vertical in more advanced disease
a bunch of situations where radiographs are especially helpful….
localized aggressive periodontitis (AKA localized juvenile periodontitis)
13 things a complete exam consists of (good luck remembering these)
3 limits of radiographs
periodontal disease in radiographs:
horizontal bone loss
periodontal disease in radiographs:
vertical bone loss
interdental craters
furcation arrow in mx molars?
crown to root ratio
Crown-to-root-ratio is the ratio of the length of the part of a tooth that appears above the alveolar bone versus what lies below it.[1] It is an important consideration in the diagnosis, treatment planning and restoration of teeth, one that hopefully guides the plan of treatment to the proper end result.
