Periodontal Diseases

Question 1

main components of the periodontium

Answer 1

1. PDL
2. alveolar bone
3. cementum
4. gingiva
5. alveolar mucosa

Question 2

alveolar crest location in normal health

Answer 2

0. 5-2mm apical to CEJ

- distinct feature in anterior (more of a peak) vs posterior (flattened portin)

Question 3

do we see clinical manifestations onto radiogrpahs in perio disease?

Answer 3

NO – atleast not right away
- not seeing gingivitis/ swelling, edema, erythema, etc

takes aboiut 3% bone loss to first see any signs on radiograph as well

Question 4

slight, moderate, and severe radiographic findings with determining severity of periodontitis?

Answer 4

slight
- up to 15% of root length or greater than 2mm but less than/equal to 3mm

moderate
- 16% to 30% with greater then 3mm or less than/ equal to 5mm

severe/advanved
- more than 30% or greater than 5mm

Question 5

radiographic changes are occuring when?

Answer 5

BEHIND THE DISEASE PROCESS

- taking longer to develop onto the image

Question 6

local irritating factors that increase the risk of periodontal disease

Answer 6

calculus

poorly contoured or over extended restorations

Question 7

implication of open contacts

Answer 7

could be an area for food impaction and could contribute to the liklihood/ be a factor in perio disease

Question 8

anatomic considerations when looking at perio disease

Answer 8

position of the maxillary sinus in relation to a periodontal deformity (could get super-imposition)

missing, supernumerary, impacted, and tipped teeth

Question 9

other pathologial considerations with perio disease

Answer 9

caries

periapical lesions

root resoprtion

Question 10

limitations to radiographs in terms of perio disease

Answer 10

they DO NOT depict soft tissue - to hard tissue relationships and thus provide NO INFORMATION about the depth of soft tissue pockets

bone level measured from CEJ but often this can be skewed in patients with overerruption or passive eruption or in patients with severe attrition

Question 11

parallel technique

Answer 11

one we try an use always

sensor is parallel to long axis of the tooth so the central ray is perpendicular to both the senor and the tooth

• minimize distortion

Question 12

old technique used to look at changes over time

brief description

Answer 12

subtraction radiography
- using superimposition of a pre-op and then six month later post op radiograph

can try and see if there is increases in density

Question 13

use of pano in perio?

Answer 13

not diagnosing with this but can be used when severe/ rampant and see the extent of the bone loss

Question 14

take CBCT for perio indication?

Answer 14

NO
not standard of care (can see the changes)

standard of care is bitewings and peri-apical s

Question 15

describe changes to internal aspect of bone with acute and chronic periodontal lesions

Answer 15

acute –> radiolucent (appears darker- like black lines)

chonic –> tend to be SCLEROTIC (more opaque)
- radio-opacitities will change throughout the disease process

Question 16

what does cortication tell you when looking at the height of the alveolar bone?

Answer 16

cortication still present? –> disease process may have stopped

loss of cortication –> disease is still present and ongoing

Question 17

early bone changes in perio

Answer 17

localized erosion, blunting or slight loss of alveolar crest

Question 18

horizontal vs vertical bone loss looks like?

Answer 18

angular bony defects where as horizontal is occuring in a parrallel manner when looking at adacent teeth and their CEJ and crest

Question 19

interdental craters are what type of defect? describe the likely appearance on a radiograph

Answer 19

circumferential defect
- there is usually TWO DIFFERENT bone heights so then we see a more radio-opaque part closer to the apex region and more radiolucent towards crown aspect

CIRCUMFERENTIAL

Question 20

T/F the buccal and lingual plates can resorb at different rates?

Answer 20

YES

- why we can see two different levels of bone and two different radio-opacities in the bone

Question 21

determining the durcation involvement of mandibular vs. maxillary dentition

what can you do to help?

Answer 21

maxillary is harder to distinguish because there can be SUPERIMPOSITION of the palatal root into the furcation region of the MB andDB root

look at the lamina dura around the tooth and determine if there is bone loss

Question 22

T/F if crestal bone is in tact there can be no perio lesion?

Answer 22

false – can see in an example there is a perio abscess and even though the crestal bone is showing all underneath and adjacent teeth showing radio-lucent lesion

Question 23

what to think about in terms of aggressive perio bone loss

Answer 23

will likely be in a A SPECIFIC REGION (more localized)

Question 24

major dental conditions associated with perio disease

Answer 24

1. occlusal trauma
   - can see widening of PDL space
2. tooth mobility
3. open contacts
   - food impaction and effecting the surrounding tissue
4. local irritating factors
   - like overhanging restoration as example

Question 25

differential diagnosis with Perio disease

3 she discussed in this lecture

Answer 25

1. squamous cell carcinoma
   - will be more localized and apparent changes on the radiographs with irregular bone destruction
2. malignant tumor
   - may see loss of floor of the macillary sinus and no cortical outline or radiolucent ai filled space with irregular widening of the PDL in that region
3. Langerhan’s cell histocytosis
   - bone destruction with epicenter in the midroot region

Question 26

major systemic factors that affect perio disease

Answer 26

1. diabetes mellitus
2. acquired immunodeficiency syndrome
3. radiation therapy