rad appearance of PD Flashcards
3 parts of the periodontal assessment
- Clinical assessment
PD, BOP, Loss of attachment, furcation, mobility, IAG. - Visual assessment
- Radiographic assessment
Comparisons over time
radiographs: diagnostic ______ for periodontal disease
Periodontal ________: alveolar bone, ___, root topography, teeth position within bone, ______, periapical lesions
Snapshot in time: does not show _______ disease, shows past ______
________ to clinical data; record of past cellular activity; permanent record
Basis for ______
__-dimensional representation of a ___ object, causes _______, _________ impacts that obscure bone levels or decay
_______ component in perio assessment: should still be going back to assess that axium matches/includes radiographic findings
radiographs: diagnostic baseline for periodontal disease
Periodontal roadmap: alveolar bone, PDL, root topography, teeth position within bone, furcations, periapical lesions
Snapshot in time: does not show active disease, shows past destruction
adjunct to clinical data; record of past cellular activity; permanent record
Basis for comparison
Two-dimensional representation of a 3D object, causes superimposition, angulation impacts that obscure bone levels or decay
Final component in perio assessment: should still be going back to assess that axium matches/includes radiographic findings
They show the _____ of the disease.
NOT _____ disease.
Radiographic examination is never a satisfactory substitute for a ___________
They show the effects of the disease.
NOT current disease.
Radiographic examination is never a satisfactory substitute for a clinical periodontal assessment. (must detect active disease clinically)
what types of rads are best
gold standard:
what are periapicals for
would a PANO be sufficient
FMS with vertical BWX is the gold standard
PAs are required to calculate %bone loss/age
Panos would not be able to reveal early bone loss, just severe
angulation of rads
can change the _____ and ____ of tooth roots
can change the _____ and ____ of bone levels
_______ may have huge implications for resulting bone levels in images
Can change the shape and position of tooth roots
Can change width and shape of bone levels
Vertical angulation may have huge implications for resulting bone levels in images
in health describe:
- distance from CEJ-crest
- lamina dura appearance
- bone appearance
what is attacked first in periodontitis, how does it appear
- 1.5-2mm below CEJ
- apical continuation of alveolar crest and forms the wall of the tooth socket
- no changes in appearance of the bone
the socket is attacked first, youll see fuzziness/discontinuation of the lamina dura and the PDL widens
alveolar crest
Should follow the pattern of the ___ between teeth
Draw a _______ line between ____ and ________
When teeth are slanted or erupted to different levels the bone crest will be _______ to ______ the different crown levels
Only if the distance between the adjacent CEJ and bone crest is greater than __ mm would this indicate bone loss
When crest to CEJ difference is greater than __ mm, bone loss has occurred
Research shows __% loss before truly visible readily on x-rays
Should follow the pattern of the CEJ between teeth
Draw a parallel line between CEJs and alveolar crests
When teeth are slanted or erupted to different levels the bone crest will be slanted to match the different crown levels
Only if the distance between the adjacent CEJ and bone crest is greater than 2 mm would this indicate bone loss
When crest is CEJ difference is greater than 3 mm, bone loss has occurred (hard to detect less than this on rads)
Research shows 30% loss before truly visible readily on x-rays
earliest radiographic changes
Limited to ______ bone
________ and break in continuity of _________ and bone crest
Results from the extension of ______ into bone
Reduction of _________ and break in ______ crestal plate
Widened PDL space (_____, ______)
Limited to crestal bone
Fuzziness and break in continuity of lamina dura and bone crest
Results from the extension of inflammation into bone
Reduction of calcified tissue and break in cortical crestal plate
Widened PDL space (triangulation, funneling)
know how to score bone loss
score 0 = not readily seen
score 1 = no measurable bone loss, may see triangulation
score 2 = moderate
score 3 = severe
destruction spreads across lamina dura
______ cells proliferate deeper into ___ resulting in a finger like projection
Increase in _______
PDL space continues to widen ______ with ______ of alveolar crest continuing
Periodontal _____ develops
______ in the crest of interdental bone; widening of the ____; radiolucent lines in the _______ bone
inflammatory cells proliferate deeper into CT resulting in a finger like projection
Increase in bone resorption
PDL space continues to widen apically with erosion of alveolar crest continuing
Periodontal pocket develops
fuzziness in the crest of interdental bone; widening of the PDLs; radiolucent lines in the interseptal bone
bone loss in stages:
Stage 1: may not see ______ on radiographs because still in _____ third
Stage II: see more readily on radiographs, _______ bone loss evident
Stage III and IV: ______ see on radiographs without even having to ______; _______ may also be seen radiographically
Stage 1: may not see readily on radiographs because still in coronal third
Stage II: see more readily on radiographs, horizontal bone loss evident
Stage III and IV: definitely see on radiographs without even having to measure; furcations may also be seen radiographically
grades:
A: __ progression, ___ loss over last 5-year comparison
B: _____ progression, ___ than __ mm loss over last 5 years
C: _____ progression, ___ than __ mm loss over last 5 years
on the grading chart, what is direct and indirect evidence
A: slow progression, no loss over last 5-year comparison
B: moderate progression, less than 2 mm loss over last 5 years
C: rapid progression, more than 2 mm loss over last 5 years
direct: radiographic bone loss or CAL
indirect: % bone loss/age or case phenotype
if we don’t have x-rays from 5 years ago to compare, what do we do
use indirect evidence to determine a grade
use current radiographs to determine %bone loss/age
compare the level of biofilm to the amount of destruction
INDIRECT evidence: ROOT bone loss
how to calculate bone loss as a function of age (% bone loss/age)
what tooth do we select
- % bone loss = attachment loss/total root length x 100
- Attachment loss = CEJ to height of alveolar crest bone
- EX: bone loss= 5.8 mm
- Total root length? CEJ to apex
- EX: root length= 16.5 mm
- 5.8/16.5=.35 (x100) =35% bone loss
- 70=patient age
- 35/70=0.5
- Grade B: 0.25 to 1.0
select the WORST affected tooth and get a PA of it
BONE LOSS DISTRIBUTION:
Important ______ sign
____ versus _____ bone loss (pattern)
Interproximal cratering: trough like ______ bordered on 2 sides by ___________ and on 2 sides by ___________
Facial OR lingual has bone loss, shows as a ________
Interproximal hemi-septa: ____ or ____ portion of interproximal bone _____ is resorbed
Vertical defect: ___ wall is missing and one or both of the _______ walls
Important diagnostic sign
Horizontal versus vertical bone loss (pattern)
Interproximal cratering-trough like depression bordered on 2 sides by roots of adjacent teeth and on 2 sides by facial and lingual cortical plates
Facial OR lingual has bone loss, shows as a radiolucent crest
Interproximal hemisepta-mesial or distal portion of interproximal bone septum is resorbed
Vertical defect-one wall is missing and one or both of the facial/lingual walls
One-Wall Defect: This type of defect occurs when only one wall of bone remains ______. These defects are often associated with _______ periodontal disease and can be challenging to treat due to limited support.
Two-Wall Defect: In a two-wall defect, there are ___ walls of bone remaining. This configuration offers a bit more support than a one-wall defect and can be more amenable to surgical treatments, such as bone grafting.
Three-Wall Defect: A three-wall defect has ____ walls of bone ______. This type of defect is generally more ____ and can provide a good environment for ______ procedures, such as guided tissue regeneration or bone grafts.
Four-Wall Defect: A four-wall defect is the ________ scenario, where all four walls of bone are present around the defect. This configuration is ideal for surgical interventions and has a _____ success rate for regeneration and healing.
- Combination: ____ wall is half the height of the ___ and ____ wall, this is an ____ defect with three walls in ____ half and two walls in the ____ half
One-Wall Defect: This type of defect occurs when only one wall of bone remains intact. These defects are often associated with advanced periodontal disease and can be challenging to treat due to limited support.
Two-Wall Defect: In a two-wall defect, there are two walls of bone remaining. This configuration offers a bit more support than a one-wall defect and can be more amenable to surgical treatments, such as bone grafting.
Three-Wall Defect: A three-wall defect has three walls of bone intact. This type of defect is generally more stable and can provide a good environment for regenerative procedures, such as guided tissue regeneration or bone grafts.
Four-Wall Defect: A four-wall defect is the most favorable scenario, where all four walls of bone are present around the defect. This configuration is ideal for surgical interventions and has a higher success rate for regeneration and healing.
- Combination: facial wall is half the height of the distal and lingual wall, this is an osseous defect with three walls in apical half and two walls in the occlusal half
limitations to radiographs -
we can’t see: (7)
internal bone morphology
depth of interdental defects
facial/lingual involvement
incipient bone loss
soft tissue
mobility
early furcations
ANATOMIC CONSIDERATIONS
Prognosis for periodontally involved teeth:
Root morphology
* Root length, _____ = ____ prognosis
* Dilaceration = _____ prognosis
* ___, ____ rooted = better prognosis
* ____, ____ roots = worse prognosis
Prognosis
* _________ ratio
* _______/progression of disease
Prognosis for periodontally involved teeth:
Root morphology
* Root length, longer better prognosis
* Dilaceration, better perio prognosis
* Wide, multi-rooted better prognosis
* Narrow, fused roots worse prognosis
Prognosis
* Root-to-crown ratio
* Documentation/progression of disease
