Interpretation of periodontal disease Flashcards
What is the definition of periodontal disease?
Destructive inflammatory disease affecting supporting structures of the teeth
What is gingivitis?
only the soft tissues are involved
What is periodontitis?
soft tissues and supporting bone affected
Periodontal disease is the major cause of tooth loss in patients over ___ years old
35
Severity of periodontal disease increases with…
- age
- amount of plaque
- amount of bacterial micro-flora
What are the different stages of periodontal disease?
- healthy teeth and gums
- gingivitis
- early periodontitis
- moderate periodontitis
- advanced periodontitis
What are the predisposing factors to periodontal disease?
- plaque
- salivary immune factors
- cell mediated hypersensitivity in crevicular plaque
- local dental factors (bad restorations, calculus, rotated teeth, thin bone)
What are local dental factors that can increase risk for periodontal disease?
- poor restorations
- Calculus (tartar)
- Tilted/rotated tooth
- Thin bone
What are the clinical signs of periodontal disease?
- Edema, erythema of the tissues
- Loss of epithelial attachment to tooth surface and pocket formation
- Bleeding on probing
- Purulence
early, mild periodontal changes
chronic periodontitis with favorable immune response
chronic advanced periodontal changes
What are the clinical signs of periodontal changes?
● Erythema
● Visible tissue recession
● Periodontal pocket depth (probing)
What do you examin on a radiograph if you suspect periodontal disease?
Bone
– quantity; relative to root length
- quantity; crestal evaluation
- quality; dense vs. sparse trabeculation
- furcation; susceptible to bone loss
- PDL space; widening
What do you look for when evaluating radiographic alveolar bone loss?
- GENERALIZED
- LOCALIZED
- HORIZONTAL
- VERTICAL
Generalized: > __% of existing dentition
75%
If bone loss is localized what should you do to diagnosing?
specifiy locations
What do you note when doing a radiographic examination on roots for periodontal disease?
● length
● shape – conical, diverging, curves, dilaceration, hypercementosis, etc…
● crown:root ratio
● Atypical multiple roots
● Proximity to adjacent roots
What is better for keeping teeth: long root or short roots?
long roots
What is better for retention of teeth: atypical multiple roots or normal amount?
atypical multiple roots
What is better for retention of teeth: crowding or normally spaced teeth?
normally spaced teeth
- crowding causes thin bone between roots
What is better for retention of teeth: diverging or converging?
diverging
What is dilaceration?
Abnormal angulation or bend in the root (and occasionally the crown) of a tooth
- Some related to trauma during odontogenesis
- idiopathic
Is dilaceration good or bad for retention of teeth?
GOOD
- bad if you need to root canal or extract
What are local factors to look for when doing a radiographic examination for periodontal disease?
- restorations
- calculus
- tilted rotated teeth (ie, uneven marginal ridges)
You can see radiographic calculus best with ______ densities
bright
What are the radiographic changes to notice in periodontal disease?
- Horizontal Bone Loss
- Vertical Bone Loss
- Furcation Involvement
- Large crown:root Ratio
What is the definition of horizontal bone loss?
Even/uniform apical movement of the alveolar crestal bone height along adjacent root surfaces between affected tooth/teeth
The alveolar crest establishes itself apical to the…
CEJ
- where the follicular sac attaches
physiologic bone height is <_____ mm from CEJs
2.0
What does the anterior alveolar bone look like in health?
- pointed, corticated crest
How long should the red line be?
2.0 mm
Incipient bone loss – slight crestal bone loss of <__________mm, but less than ____%
1.0 – 2.0 mm
20%
Moderate bone loss – evidence of ~_________% bone loss
20% up to 50%
Advanced bone loss – evidence of ___% or more of bone loss; evidence of vertical defects
50%
What is incipient bone loss?
- blunted, non-corticated crest
- bone level is apical to physiologic height
- <1.0 – 2.0mm, but less than 20%
What is moderate bone loss?
- blunted, non-corticated crest
- prominent loss of alveolar bone height; ~20-50%
What is advanced (severe) bone loss?
- blunted, non-corticated crest
- prominent loss of alveolar bone height; evidence of 50% or more of bone loss; evidence of vertical defects
- crown:root ratio > 1:2
Advanced (severe) Bone Loss
Moderate Bone Loss
Incipient bone loss
Moderate Bone Loss
Nutrient canals
Initial Incipient Changes
loss of cortication but minimal loss of height
Loss of cortication
Loss of bone height
What is vertical bone loss?
Angular bone loss along a root that more severely involves the affected tooth/teeth than the adjacent teeth
Vertical Bone Defects
Red - vertical bone loss
Blue - horizontal bone loss
Furcation with HBL
Furcation with VBL
What do you look for when doing a radiographic examination of furcation defects?
- Loss of bone in the furcation area of a multirooted tooth
- Can occur with HBL and VBL
What is the crown:root ratio?
- An index expressed as a ratio that gives an indication of a tooth’s prognosis
A crown:root ratio of more than ____ has a poor prognosis
1:2
(2:1 is bad)
(1:3 is even better than 1:2)
What are the limitations of radiographic examinations for periodontal disease?
- Accuracy: 40 - 50% demineralization necessary for radiographic changes
- 2-D Infra-bony defects difficult to observe
- Soft-tissue Changes edema, color, plaque
- No Information on relationship of soft tissue to hard tissue
- Difficult to assess disease on B and Li bone plates adjacent B and Li tooth surfaces
- Mobility
________% demineralization necessary for radiographic changes
40 - 50
What are the treatments for periodontal disease?
- Plaque control
- Antimicrobial agents
––– Topical
––– systemic - Professional Cleaning (scaling, root planning, curretage)
- Surgical techniques to re-establish physiologic contours
