perio dx interpretation Flashcards
Periodontal Disease def
Destructive inflammatory disease affecting supporting structures of the teeth
forms of perio dx
❑Gingivitis: only the soft tissues are involved
❑Periodontitis: soft tissues and supporting bone affected
progression of perio dx
Major cause of tooth loss in
patients > 35 years
perio dx
Severity of perio disease increases with
*Age
*Amount of plaque
*Amount of bacterial micro-flora
Periodontal Disease
Predisposing Factors
A) Plaque retention
B) Salivary Immune Factors
C) Cell mediated hypersensitivity in crevicular plaque
D) Local dental factors
- poor restorations, Calculus (tartar), Tilted/rotated tooth= plaque traps
- Thin bone more sus to destruction
Periodontal disease
Clinical Signs
- Edema, erythema of the tissues
- Loss of epithelial attachment to
tooth surface and pocket formation - Bleeding on probing
- Purulence
Radiographic Examination of perio dx bone
–quantity; relative to root length
- quantity; crestal evaluation
- quality
- furcation involvment as plaque trap
- PDL space
forms of alveolar bone loss
- GENERALIZED
- LOCALIZED
- HORIZONTAL
- VERTICAL
generalized vs localized bone loss
Generalized: > 75 % of existing dentition
Localized: Specify locations i.e. #7-D,
#30-M,D
Radiographic Examination aspects of Roots in perio dx
- length
- shape –conical, diverging, curves,
dilaceration, etc… - crown:root ratio
if roots are in close proximity what is the effect?
thinner bone btwn them: more sus to destruction
coverging/diverging roots and effects
converging roots are nt as supported whereas the diverging roots are more supported
Radiographic examination of
ROOT ANATOMY factors
- Length
- Atypical multiple roots
- Proximity to adjacent roots
- Shape (Conical, Curves (accentuated or “S”), Dilaceration, Diverging vs. converging, Hypercementosis)
Dilaceration
causes?
- Abnormal angulation or bend in the root (and occasionally the crown) of a tooth
- Some related to trauma during odontogenesis
- idiopathic
- can increase perio support of tooth
root?
dilaceration
dilaceration
local predisposing factors of perio dx
- restorations
- calculus
- tilted rotated teeth: ie, uneven marginal
ridges
calculus
how can we best demonstrate calculus
demonstrate best with “bright” densities (lighten the image)
Radiographic Changes in
Periodontal Disease
- Horizontal Bone Loss
- Vertical Bone Loss
- Furcation Involvement
- Large crown:root Ratio
Definition of Horizontal Bone Loss:
Even/uniform apical movement of the alveolar crestal bone height along adjacent root surfaces between affected tooth/teeth
SLOW ADVANCING FRONT
around tooth?
follicular space
what is the follicular space significance
this is where the bone will attatch to the tooth establishing horizontal level
always apical to the CEJ (1.3-1.5mm)
around teeth
follicular space
Posterior Dentition in
Health
- shape/crest?
- physiologic bone height?
- flat (plateau), corticated crest
- physiologic bone height is
<2.0mm from CEJs
Anterior Dentition in
Health
shape/crest?
bone height?
- pointed, corticated crest
- physiologic height is <2.0mm from CEJs
health?
healthy?
healthy?
yes
Radiographic Description of
Periodontal Bone Loss classes
- Incipient bone loss –slight crestal bone loss of < 1.0 –2.0mm, but less than 20%
- Moderate bone loss –evidence of ~20% up to 50% bone loss
- Advanced bone loss –evidence of 50% or more of bone loss; evidence of vertical defects
Incipient bone loss
- shape/crest?
- bone level to physiologic height?
- mm?, but less than %?
- blunted, non-corticated crest
- bone level is apical to
physiologic height - < 1.0 – 2.0mm, but less than
20%
bone loss?
incipient bone loss
Moderate Bone Loss
- shape of crest
- prominent loss of?
blunted, non-corticated crest
- prominent loss of alveolar bone height
bone loss?
moderate bone loss
Moderate vs. Advanced Bone Loss
-shape of crest
- prominent loss of?
- blunted, non-corticated crest
- prominent loss of alveolar bone height
Advanced (severe)Bone Loss
-shape of crest
- prominent loss of? %? evidence of what defects?
- crown:root ratio ?
- prominent loss of alveolar bone height; evidence of 50% or more of bone loss; evidence of vertical defects
- crown:root ratio > 1:2
bone?
advanced bone loss
bone loss
advanced
is this bone loss?
no WNL
initial changes of perio dx in posterior
Loss of cortication but minimal loss of height
what is happening?
loss of cortication and height of bone
Definition of Vertical Bone Loss:
Angular bone loss along a root that more severely involves the affected tooth/teeth than the adjacent teeth
what is happening at the mesial
vertical bone loss
what bony defect is this?
vertical bone defect
RADIOGRAPHIC EXAMINATION OF FURCATIONS
loss of?
can occur with?
- Loss of bone in the furcation area of a multi-rooted tooth
- Can occur with HBL and VBL
what is happening at the molar?
furcation involvement with HBL/VBL (M)
furcation involvemwnt with VBL
Crown:Root Ratio
* Defined as?
* gives an indication of?
* poor prognosis with?
- Defined as: Length of radiographic crown Length of radiographic root
- An index expressed as a ratio that givesan indication of a tooth’s prognosis
- A ratio of more than (>) 1:2 has a poor prognosis
radiographic crown
all of the crown above the alveolar crest
radiographic root
root below the alveolar crest
Radiographic examination
limitations
* Accuracy requires what % demin?
* 2-D Infra-bony defects?
* Soft-tissue?
* No Information on?
* Difficult to assess disease where?
* Mobility?
- 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 i.e., pocketing
- Difficult to assess disease on B and Li bone plates adjacent B and Li tooth surfaces
- Mobility
Periodontal Disease Treatment
- Plaque control
- Antimicrobial agents
– Topical
– systemic
- Antimicrobial agents
- 3.Professional Cleaning, scaling, root planning, curretage
- 4.Surgical techniques to re-establish physiologic contours
which is moderate loss? which is advanced?
L: moderate
R: advanced
what is the follicular space significance
this is where the bone will attatch to the tooth establishing horizontal level
always apical to the CEJ (1.3-1.5mm)
how can an alveolar crest that is angled be healthy?
this can be angled so long as it is parallel to a plane formed by adjecent teeth CEJ
what anatomical strucutre becomes more prevalent with chronic bone loss?
nutrient canals
nutrient canals
loss of cortication
loss of cortication with horizontal bone loss
loss of cortication
what bone loss is present
horizontal but some veritcal at the 1st molar
H or V?
both are occuring
how are furcations involved with HBL/VBL
when these become involved with bone loss they can worsen the effects by acting as plaque traps
crown root ratio
2:1, bad prognosis
crown to root ratio
1:0 (infinity), bad prognosis
Crown root ratio
approx 6:1, bad
