Interpretation of periodontal disease Flashcards
Destructive inflammatory disease affecting supporting structures of the teeth:
Periodontal disease
Destructive inflammatory disease affecting only the soft tissues:
gingivitis
Destructive inflammatory disease affecting soft tissues and bone:
Periodontitis
Extend of periodontal disease is based on:
How apically alveolar bone moves
How would you describe these images?
healthy teeth & gums
How would you describe these images?
gingivitis
How would you describe these images?
Early periodontitis
How would you describe these images?
Moderate periodontitis
How would you describe these images?
Advanced periodontitis
The major cause of tooth loss in patients greater than 35 years of age:
Periodontal disease
Severity of periodontal disease increases with: (3)
- age
- amount of plaque
- amount of bacterial micro-flora
Predisposing factors for periodontal disease include: (4)
- plaque
- salivary immune factors
- cell mediated hypersensitivity in crevicular plaque
- local dental factors
T/F: Immune response to the bacteria in the oral cavity can have negative effects on the periodontal tissues
True
What are some local factors that are deemed predisposing factors for periodontal disease? (4)
- poor restorations
- calculus (tartar)
- tilted/rotated tooth
- thin bone
Clinical signs of periodontal DISEASE include: (4)
- edema & erythema of tissues
- loss of epithelial attachment to tooth surface & pocket formation
- bleeding on probing
- purulence
What can be seen in this image?
Early, mild periodontal changes
What can be seen in these images?
Chronic periodontitis with a favorable immune response
What can be seen in this image?
Inflammatory periodontal changes
What can be seen in this image?
Advanced periodontal changes
What can be seen in this image?
Advanced periodontal changes
Clinical signs of periodontal CHANGES include:
- erythema
- visible tissue recession
- periodontal pocket depth (probing)
During radiographic examination of the bone what should be evaluated?
- bone quantity; relative to root length
- bone quantity; crestal evaluation
- bone quality (how dense-trabecular pattern)
- furcation
- PDL space
When bone loss affects furcation this =
furcation defet
What is more critical?
-bone loss with longer roots
-bone loss with shorter roots
bone loss with shorter roots
What do radiographs allow us to visualize in regards to alveolar bone?
Alveolar bone level
What are the types of alveolar bone loss categorized as?
- generalized
- localized
- horizontal
- vertical
Alveolar bone loss is considered _____ when there is greater than 75% of existing dentition affected
generalized
Specific locations of alveolar bone loss such as “around #7D & #30MD” is considered:
localized
What must be done with localized alveolar bone loss?
Specify locations
When radiographically examining the roots, we should evaluate the: (5)
- length
- shape
- crown:root ratio
- proximity to adjacent roots
- atypical/multiple roots
When using terms such as conical, diverging, curves or dilacerations, we are describing the _____ of the root
shape
What is the concern with roots being closer together in periodontal disease?
If roots are closer together than the bone is more thin in between and disease can advance quicker
What can be seen in this image? How does this affect the prognosis?
Third lingual root; helps anchor tooth
What can be seen in this image? How does this affect the prognosis?
short roots; bad prognosis
What can be seen in this image? How does this affect the prognosis?
long roots; good prognosis
Describe this image:
Red= thinner bone (disease advances faster)
Green= nice spacing (better prognosis)
Yellow= plaque trap due to impaction
How would we describe the root in this image? How does this affect prognosis
Converging; less anchorage
How would we describe the root in this image? How does this affect prognosis?
Dilacerating; good prognosis
How would we describe the root in this image? How does this affect prognosis?
Diverging; good prognosis
Abnormal angulation or bend in the root (and occasionally the crown) of a tooth:
Dilaceration
Some dilacerations are related to:
- trauma during odontogenesis
- idiopathic
Describe the roots in this image:
dilacerated
What can be seen in the following image?
Hypercementosis
How would you describe the roots in this image?
Dilacerated
List some local factors we should be locking for during radiographic examination:
- restorations
- calculus
- tilted/rotated teeth
How would you determine if a tooth on a radiograph is tilted/rotated?
Uneven marginal ridges
What type of bone loss are we seeing in this image?
Vertical bone defect
What is a main concern looking at this radiograph?
Plaque trap due to poor restorations
What stands out in the following image?
calculus
What stands out in the following image?
calculus
When evaluating a radiograph for calculus, what may be helpful?
lighten the image (calculus demonstrates best with “bright” densities)
What button would you use to adjust brightness to reveal calculus more easily on a radiograph?
Sun button
Radiographic changes seen in periodontal disease may include:
- horizontal bone loss
- vertical bone loss
- furcation involvement
- large crown:root ratio
Even/uniform apical moment of the alveolar crestal bone height along adjacent root surfaces between affected tooth/teeth:
horizontal bone loss (HBL)
T/F: the alveolar bone should be at the CEJ of the teeth
False- the alveolar bone is NEVER at the CEJ of teeth, there is a little space between the bone and the crest called the follicular space
The normal level is slightly ____ to the CEJ around ____ mm
apical; 1mm
What do we consider a healthy bone level?
within 2mm of CEJ
If there is more than a 2mm space between the bone level and CEJ this indicates:
bone loss
If the bone level is coronal to the CEJ, this indicates:
a neoplasm or something else wrong
Describe health in posterior bone levels:
- falt (plateau), corticated crest
- physiologic bone heigh is less than or equal to 2.0mm from CEJ
This measurement tool is being used to look at:
Bone level
Slight crestal bone loss of less than or equal to 1.0-2.00mm but less than 20%
Incipient bone loss
Evidence of around 20% and up to 50% of bone loss:
moderate bone loss
Evidence of 50% or more of bone loss; evidence of vertical defects:
advanced bone loss
-blunted, non-corticated crest
-bone level apical to physiologic height
-less than or equal to 1.0-2.0 mm of bone loss
-less than 20% of bone loss
incipient bone loss
What type of bone loss is seen in this radiograph?
Incipient bone loss
-blunted, non-corticated crest
-prominent loss of alveolar bone height
-less than 1/2 root length (no greater than 50%)
moderate bone loss
What type of bone loss is seen in this radiograph?
moderate bone loss
Determine which radiograph shows moderate bone loss & which shows advanced bone loss:
Left= moderate
Right= advanced
-blunted, non-corticated crest
-prominent loss of alveolar bone height
-crown:root ration > 1:2
Advanced bone loss
What characteristic can be seen with advanced bone loss?
Hyperplasia of nutrient canals
What can be seen in this image? What does this indicate?
Hyperplasia of nutrient canals; advanced bone loss
What is indicated in this image?
Follicular space
How can you tell when loss of cortication begins with periodontal disease?
Less of a well-defined line of alveolar bone (it gets kind of blurred)
Angular bone loss along a root that more severely involves the affected tooth/teeth than the adjacent teeth:
Vertical bone loss (VBL)
What type of bone loss is seen in these images? Why?
Vertical bone loss (VBL); more advanced in specific areas (not uniform)
What type of bone loss is seen in these images? Why?
Vertical bone loss; more advanced in specific areas (not uniform)
Loss of bone in the furcation area of multirooted teeth:
furcation defect
Furcation defects can occur with:
HBL & VBL
What can be seen in the following images?
Furcation defects
Diagnose the bone loss in this image:
Furcation defect with HBL
Diagnose the bone loss in these images:
Furcation defect with VBL
The crown:root ratio is an indicator of how much:
bone is supporting the tooth
Length of radiographic crown / Length of radiographic root:
crown:root ratio
An index expressed as a ratio that gives an indication of a tooth’s prognosis:
crown:root ratio
A crown:root ratio of more than ______ has a poor prognosis
1:2
What is worse:
Crown:root ratio of 2:1 or 1:2?
2:1 (if you actually divide, the one that results in a bigger number is worse)
Accuracy of _______ demineralization is necessary for radiographic changes
40-50%
_____ defects may be difficult to observe on a radiograph
2D infra-bony
In addition to a radiograph, what else needs to be examined? (4)
-soft tissue changes
-edema
-color
-plaque
A radiographic examination limitation is that there is no information on the relationship of:
soft tissue to hard tissue (i.e. pocketing)
It is especially difficult to assess disease on the _____ & ____ bone plates and adjacent ____ & ____ tooth surfaces
B; Li
B; Li
Can mobility be determined via radiograph?
No
What four facets are involvement in treatment of periodontal disease?
- plaque control
- antimicrobial agents (topical or systemic)
- professional cleaning (SRP)
- Surgical techniques to re-establish physiologic contours
