Perio Radiology

Question 1

What are three basic intraoral radiographic techniques to consider?

Answer 1

Horizontal bitewing

Vertical bitewing

Periapical

Question 2

When are horizontal bitewing ordered?

Answer 2

When the pt has SLIGHT TO MODERATE horizontal bone loss

Question 3

What 4 things do radiographs aid in?

Answer 3

Diagnosis of periodontal disease

Determination of the prognosis

Tx options

Evaluation of the outcome of treatment

Question 4

T/F - Radiographs are an adjunct to the clinical examination, NOT A SUBSTITUTE FOR IT.

Answer 4

TRUE

Question 5

W/o radiographic images, the clinician can not effectively evaluate what 4 things?

Answer 5

Alveolar crystal bone architecture

Crown-to-root ratio/calculus presence

Possible vertical or furcation defects

Amt of horizontal bone loss

Question 6

A properly positioned horizontal bitewing should show what 3 things?

Answer 6

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

Question 7

Vertical bitewings are useful when?

Answer 7

MODERATE TO SEVERE horizontal bone loss

Question 8

T/F - Generally, vertical bitewings are more informative than horizontal bitewings on detecting moderate to severe periodontal diseases.

Answer 8

TRUE

Question 9

T/F - An accurate assessment of bone height is essential to successful periodontal disease management.

Answer 9

TRUE

PAs have a tendency to distort the distance b/t the alveolar osseous crest and CEJ compared to a bitewing

Question 10

What technique is important for periapicals?

Answer 10

Paralleling technique

—X-ray beam head parallel to the film and tooth

Question 11

T/F - Paralleling technique is the most realistic image to evaluate level of alveolar bone similar to a proper bitewing radiograph.

Answer 11

TRUE

Question 12

PAs are essential for assessing what 4 things?

Answer 12

Crown-to-root ratio

Root morphology

PDL space

PA status

Question 13

Where is the normal interdental septum found?

Answer 13

B/t the roots of adj teeth

—Absence doesn’t mean diseased state

Question 14

How does the interdental septum appear on a radiograph?

Answer 14

Radiopaque border at alveolar crest

*Lamina dura

Question 15

The shape of the interdental septum is a fx of the __________ of the contiguous teeth.

Answer 15

MORPHOLOGY

Question 16

An apparent vertical defect in the interdental septum is really caused by what?

Answer 16

Tooth angulation/inclination

Question 17

In normal health, what is the approximate distance b/t the CEJ and the crest of bone at each tooth surface?

Answer 17

1.5 - 2.0 mm

Question 18

How can the PDL space be discerned on a radiograph?

Answer 18

Thin, radiolucent line b/t the root and the radiopaque lines that outlines the root

Question 19

Widening of the PDL space is seen with _______ _______ as well as vertical root fracture and progressive systemic sclerosis.

Answer 19

Occlusal trauma

Question 20

What is the normal thickness of the PDL?

Answer 20

0.1 - 0.25 mm

Question 21

When is the PDL the widest?

Answer 21

During heavy occlusion, and thinner in nonfunctional teeth

Question 22

What is the surface area of the socket wall?

Answer 22

150 - 275 sq mm - single root

450 sq mm for multirooted

Question 23

T/F - Bone loss is generally greater than it appears in the radiographs.

Answer 23

TRUE

Question 24

___% of bone mineral density is lost before it is detected radiographically.

Answer 24

30%

Question 25

Horizontal bone loss is what?

Answer 25

Symmetric loss of bone on both the mesial and distal surfaces of contiguous teeth —Bony architecture appears to be rather flat

Question 26

Tell me about vertical bone loss/defects.

Answer 26

FUNNEL-shaped appearance and plunge apical on ONE tooth surface —Little or no bone loss on the contiguous tooth

Question 27

Healthy bone loss is how much per year?

Answer 27

0.1 mm/year 1 mm/10 years

Question 28

Loss of bone in the furcation areas of molar teeth may occur as a result of what?

Answer 28

Periodontitis Endodontic infection Root perforation during dental procedures Occlusal trauma

Question 29

“Bone spurs” on a radiograph are indicative of what?

Answer 29

Heavy calculus

Question 30

Loss of bone in the mesial and distal furcations of maxillary molars may present as a _________ ________.

Answer 30

Furcation arrow

Question 31

What is a cervical enamel pearl (CEP)?

Answer 31

Dot of enamel More common for: maxillary third>second>first molars

Question 32

T/F - Close proximity of tooth roots will have thin interproximal septum which leads to an increased risk of bone loss and periodontal destruction.

Answer 32

TRUE

Question 33

T/F - The radiograph is NOT a sensitive indicator of calculus.

Answer 33

TRUE

Question 34

Tell me about periodontal abscesses.

Answer 34

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.

Question 35

What are 3 features of aggressive periodontitis?

Answer 35

Rapid rate of attachment and bone loss Minimal local factors Familial aggregation of diseased individuals (Genetics) *Common with 1st molars and incisors

Question 36

T/F - Bone loss happens faster w/ smoking.

Answer 36

TRUE

Question 37

T/F - The radiographs and the clinical periodontal exam complement each other, and neither is sufficient by itself.

Answer 37

TRUE -Provides a foundation for diagnosis, prognosis, and tx planning

Question 38

T/F - Actual clinical bone loss is more than radiographic bone loss. What percentage?

Answer 38

TRUE 30%