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Radiology > Interpretation of periodontal disease > Flashcards

Interpretation of periodontal disease Flashcards

1
Q

What is the definition of periodontal disease?

A

Destructive inflammatory disease affecting supporting structures of the teeth

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2
Q

What is gingivitis?

A

only the soft tissues are involved

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3
Q

What is periodontitis?

A

soft tissues and supporting bone affected

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4
Q

Periodontal disease is the major cause of tooth loss in patients over ___ years old

A

35

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5
Q

Severity of periodontal disease increases with…

A
  • age
  • amount of plaque
  • amount of bacterial micro-flora
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6
Q

What are the different stages of periodontal disease?

A
  1. healthy teeth and gums
  2. gingivitis
  3. early periodontitis
  4. moderate periodontitis
  5. advanced periodontitis
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7
Q

What are the predisposing factors to periodontal disease?

A
  • plaque
  • salivary immune factors
  • cell mediated hypersensitivity in crevicular plaque
  • local dental factors (bad restorations, calculus, rotated teeth, thin bone)
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8
Q

What are local dental factors that can increase risk for periodontal disease?

A
  • poor restorations
  • Calculus (tartar)
  • Tilted/rotated tooth
  • Thin bone
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9
Q

What are the clinical signs of periodontal disease?

A
  • Edema, erythema of the tissues
  • Loss of epithelial attachment to tooth surface and pocket formation
  • Bleeding on probing
  • Purulence
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10
Q
A

early, mild periodontal changes

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11
Q
A

chronic periodontitis with favorable immune response

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12
Q
A

chronic advanced periodontal changes

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13
Q

What are the clinical signs of periodontal changes?

A

● Erythema
● Visible tissue recession
● Periodontal pocket depth (probing)

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14
Q

What do you examin on a radiograph if you suspect periodontal disease?

A

Bone
– quantity; relative to root length
- quantity; crestal evaluation
- quality; dense vs. sparse trabeculation
- furcation; susceptible to bone loss
- PDL space; widening

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15
Q

What do you look for when evaluating radiographic alveolar bone loss?

A
  • GENERALIZED
  • LOCALIZED
  • HORIZONTAL
  • VERTICAL
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16
Q

Generalized: > __% of existing dentition

A

75%

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17
Q

If bone loss is localized what should you do to diagnosing?

A

specifiy locations

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18
Q

What do you note when doing a radiographic examination on roots for periodontal disease?

A

● length
● shape – conical, diverging, curves, dilaceration, hypercementosis, etc…
● crown:root ratio
● Atypical multiple roots
● Proximity to adjacent roots

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19
Q

What is better for keeping teeth: long root or short roots?

A

long roots

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20
Q

What is better for retention of teeth: atypical multiple roots or normal amount?

A

atypical multiple roots

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21
Q

What is better for retention of teeth: crowding or normally spaced teeth?

A

normally spaced teeth
- crowding causes thin bone between roots

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22
Q

What is better for retention of teeth: diverging or converging?

A

diverging

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23
Q

What is dilaceration?

A

Abnormal angulation or bend in the root (and occasionally the crown) of a tooth

  • Some related to trauma during odontogenesis
  • idiopathic
24
Q

Is dilaceration good or bad for retention of teeth?

A

GOOD
- bad if you need to root canal or extract

25
Q

What are local factors to look for when doing a radiographic examination for periodontal disease?

A
  • restorations
  • calculus
  • tilted rotated teeth (ie, uneven marginal ridges)
26
Q

You can see radiographic calculus best with ______ densities

A

bright

27
Q

What are the radiographic changes to notice in periodontal disease?

A
  1. Horizontal Bone Loss
  2. Vertical Bone Loss
  3. Furcation Involvement
  4. Large crown:root Ratio
28
Q

What is the definition of horizontal bone loss?

A

Even/uniform apical movement of the alveolar crestal bone height along adjacent root surfaces between affected tooth/teeth

29
Q

The alveolar crest establishes itself apical to the…

A

CEJ
- where the follicular sac attaches

30
Q

physiologic bone height is <_____ mm from CEJs

A

2.0

31
Q

What does the anterior alveolar bone look like in health?

A
  • pointed, corticated crest
32
Q

How long should the red line be?

A

2.0 mm

33
Q

Incipient bone loss – slight crestal bone loss of <__________mm, but less than ____%

A

1.0 – 2.0 mm
20%

34
Q

Moderate bone loss – evidence of ~_________% bone loss

A

20% up to 50%

35
Q

Advanced bone loss – evidence of ___% or more of bone loss; evidence of vertical defects

A

50%

36
Q

What is incipient bone loss?

A
  • blunted, non-corticated crest
  • bone level is apical to physiologic height
  • <1.0 – 2.0mm, but less than 20%
37
Q

What is moderate bone loss?

A
  • blunted, non-corticated crest
  • prominent loss of alveolar bone height; ~20-50%
38
Q

What is advanced (severe) bone loss?

A
  • 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
39
Q
A

Advanced (severe) Bone Loss

40
Q
A

Moderate Bone Loss

41
Q
A

Incipient bone loss

42
Q
A

Moderate Bone Loss

43
Q
A

Nutrient canals

44
Q
A

Initial Incipient Changes

loss of cortication but minimal loss of height

45
Q
A

Loss of cortication
Loss of bone height

46
Q

What is vertical bone loss?

A

Angular bone loss along a root that more severely involves the affected tooth/teeth than the adjacent teeth

47
Q
A

Vertical Bone Defects

48
Q
A

Red - vertical bone loss
Blue - horizontal bone loss

49
Q
A

Furcation with HBL

50
Q
A

Furcation with VBL

51
Q

What do you look for when doing a radiographic examination of furcation defects?

A
  • Loss of bone in the furcation area of a multirooted tooth
  • Can occur with HBL and VBL
52
Q

What is the crown:root ratio?

A
  • An index expressed as a ratio that gives an indication of a tooth’s prognosis
53
Q

A crown:root ratio of more than ____ has a poor prognosis

A

1:2

(2:1 is bad)
(1:3 is even better than 1:2)

54
Q

What are the limitations of radiographic examinations for periodontal disease?

A
  • 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
55
Q

________% demineralization necessary for radiographic changes

A

40 - 50

56
Q

What are the treatments for periodontal disease?

A
  • Plaque control
  • Antimicrobial agents
    ––– Topical
    ––– systemic
  • Professional Cleaning (scaling, root planning, curretage)
  • Surgical techniques to re-establish physiologic contours

Radiology (35 decks)

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