Perio Radiology Flashcards
What are three basic intraoral radiographic techniques to consider?
Horizontal bitewing
Vertical bitewing
Periapical
When are horizontal bitewing ordered?
When the pt has SLIGHT TO MODERATE horizontal bone loss
What 4 things do radiographs aid in?
Diagnosis of periodontal disease
Determination of the prognosis
Tx options
Evaluation of the outcome of treatment
T/F - Radiographs are an adjunct to the clinical examination, NOT A SUBSTITUTE FOR IT.
TRUE
W/o radiographic images, the clinician can not effectively evaluate what 4 things?
Alveolar crystal bone architecture
Crown-to-root ratio/calculus presence
Possible vertical or furcation defects
Amt of horizontal bone loss
A properly positioned horizontal bitewing should show what 3 things?
Superimposition of buccal and lingual/palatal cusps
Sharp or well-defined alveolar crestal margin
No horizontal overlap b/t adj teeth
- Bony crest is visible in both arches, but it is close to the edge of the film b/t mandibular premolars
- Root trunks of the molar teeth are not entirely visible
Vertical bitewings are useful when?
MODERATE TO SEVERE horizontal bone loss
T/F - Generally, vertical bitewings are more informative than horizontal bitewings on detecting moderate to severe periodontal diseases.
TRUE
T/F - An accurate assessment of bone height is essential to successful periodontal disease management.
TRUE
PAs have a tendency to distort the distance b/t the alveolar osseous crest and CEJ compared to a bitewing
What technique is important for periapicals?
Paralleling technique
—X-ray beam head parallel to the film and tooth
T/F - Paralleling technique is the most realistic image to evaluate level of alveolar bone similar to a proper bitewing radiograph.
TRUE
PAs are essential for assessing what 4 things?
Crown-to-root ratio
Root morphology
PDL space
PA status
Where is the normal interdental septum found?
B/t the roots of adj teeth
—Absence doesn’t mean diseased state
How does the interdental septum appear on a radiograph?
Radiopaque border at alveolar crest
*Lamina dura
The shape of the interdental septum is a fx of the __________ of the contiguous teeth.
MORPHOLOGY
An apparent vertical defect in the interdental septum is really caused by what?
Tooth angulation/inclination
In normal health, what is the approximate distance b/t the CEJ and the crest of bone at each tooth surface?
1.5 - 2.0 mm
How can the PDL space be discerned on a radiograph?
Thin, radiolucent line b/t the root and the radiopaque lines that outlines the root
Widening of the PDL space is seen with _______ _______ as well as vertical root fracture and progressive systemic sclerosis.
Occlusal trauma
What is the normal thickness of the PDL?
0.1 - 0.25 mm
When is the PDL the widest?
During heavy occlusion, and thinner in nonfunctional teeth
What is the surface area of the socket wall?
150 - 275 sq mm - single root
450 sq mm for multirooted
T/F - Bone loss is generally greater than it appears in the radiographs.
TRUE
___% of bone mineral density is lost before it is detected radiographically.
30%
Horizontal bone loss is what?
Symmetric loss of bone on both the mesial and distal surfaces of contiguous teeth
—Bony architecture appears to be rather flat
Tell me about vertical bone loss/defects.
FUNNEL-shaped appearance and plunge apical on ONE tooth surface
—Little or no bone loss on the contiguous tooth
Healthy bone loss is how much per year?
0.1 mm/year 1 mm/10 years
Loss of bone in the furcation areas of molar teeth may occur as a result of what?
Periodontitis
Endodontic infection
Root perforation during dental procedures
Occlusal trauma
“Bone spurs” on a radiograph are indicative of what?
Heavy calculus
Loss of bone in the mesial and distal furcations of maxillary molars may present as a _________ ________.
Furcation arrow
What is a cervical enamel pearl (CEP)?
Dot of enamel
More common for: maxillary third>second>first molars
T/F - Close proximity of tooth roots will have thin interproximal septum which leads to an increased risk of bone loss and periodontal destruction.
TRUE
T/F - The radiograph is NOT a sensitive indicator of calculus.
TRUE
Tell me about periodontal abscesses.
Acute, destructive process in the periodontium from localized collection of suppurations communicating with the oral cavity thru the sulcus
- Generally a discrete area of radiolucency
- If a foreign body, remove it, and let the body take over from there.
What are 3 features of aggressive periodontitis?
Rapid rate of attachment and bone loss
Minimal local factors
Familial aggregation of diseased individuals (Genetics)
*Common with 1st molars and incisors
T/F - Bone loss happens faster w/ smoking.
TRUE
T/F - The radiographs and the clinical periodontal exam complement each other, and neither is sufficient by itself.
TRUE
-Provides a foundation for diagnosis, prognosis, and tx planning
T/F - Actual clinical bone loss is more than radiographic bone loss.
What percentage?
TRUE
30%
