Radiographic Examination

Question 1

what are some radiographic features that can be seen?

Answer 1

crestal lamina dura
furcation
CEJ
periodontal ligament space
apex
radicular lamina dura (aka alveolar bone proper)

Question 2

Are radiographs diagnostic of periodontal disease?

Answer 2

NO
- correlate with clinical attachment level (CAL/PD)
Percentage Severity CAL correlate Prognosis
_ 50 severe >_ 5 mm Poor to Hopeless

Question 3

What are some radiographic assessments of periodontal conditions?

Answer 3

• assessing bone loss (amount of bone loss)
• condition of the alveolar crests
• pattern of bone loss
• bone loss in the furcation areas
• width of the PDL space
• trabecular pattern and gradient
• vessels within interdental bone
• anatomic considerations: maxillary sinus; tori; mental foramen
• root proximity and C/R ratio
• local initiating factors - calculus; defective restorations/overhanging
• pathologic considerations: caries; periapical radiolucency; root resorptions

Question 4

How do you assess bone loss?

Answer 4

Bone loss % = CEJ to crest - 2mm / CEJ to apex - 2mm
4-2=2/14-2=12 = 16.67 %

Bone loss % = 17%
(slight or mild bone loss)

Question 5

What are the levels of bone loss?

Answer 5

mild bone loss = _50%

Question 6

What’s normal height of alveolar crest?

Answer 6

The height of the crest lies at a level approximately 2 mm below the level of the CEJs of adjacent teeth

Question 7

What’s the association between Crestal lamina dura and periodontal status

Answer 7

the integrity of the crystal lamina dura, evaluated on either PA or bite-wing radiographs, doesn’t seem to be related to the presence or absence of visual inflammation, BOP, periodontal pocketing or loss of connective tissue attachment in the corresponding interdental area. Using integrity of crystal lamina dura as an indicator for the need of periodontal treatment is not appropriate.

Question 8

What are the 2 patterns of bone loss?

Answer 8

1) horizontal bone loss (when bone resorption is equal on mesial and distal surfaces of the tooth)
2) angular (Vertical) bone loss (when bone resorption is unequal around the tooth)

Question 9

What is an osseous defect?

Answer 9

bone loss causes by periodontal disease results in osseous defects. These defects can occur in a horizontal or vertical dimension.
Can have a one wall (where only only bony wall is present ), two wall or three wall osseous defect

Question 10

What defect can occur in a one or two walled angular defect?

Answer 10

Hemiseptal defect: a vertical defect in the presence of adjacent roots; thus half of a septum remains on one tooth, AKA one-walled defect

Question 11

what’s an osseous crater?

Answer 11

this is a cup or bowl shaped defect in the intralveolar bone.
This happens within the buccal and lingual walls and is a two walled defect
- craters show up on periapical film

Question 12

what’s a moat-like defect?

Answer 12

an intrabony resorptive lesion involving one or more surfaces of supporting bone.

Question 13

What’s bone loss in furcation areas?

Answer 13

pathologic resorption of bone within a furcation

shows up radiographically as radiolucency (periapical radiograph - 2D and CBCT- 3D) - furcation radiolucency

Question 14

How can you detect furcation involvement on x-ray film?

Answer 14

by Gutta-Purcha point

Question 15

What’s normal PDL space?

Answer 15

the space between the tooth root and alveolar bone containing the periodontal ligament. The PDL appears as the PDL space of 0.4 to 1.5 mm on radiographs. It tends to be wider at the apex and alveolar crest, and narrow in the mid-root areas.

Question 16

What is thickened radicular lamina dura caused by?

Answer 16

occlusal trauma

Question 17

How do vessels appear on the x-ray within interdental bone?

Answer 17

they appear as radiolucent lines bordered by thin radiopaque lines

Question 18

Can the position of the maxillary sinus hinder treatment of periodontal problems?

Answer 18

if the maxillary sinus is close to or has invaginated among the roots of the maxillary teeth, there may be difficulties with surgical treatment of the periodontal problems.

Question 19

What’s the mandibular tori?

Answer 19

a bony exostosis on the lingual aspect of the mandible, generally in the premolar-molar region; commonly bilateral

Question 20

Where can you see the mental foramen on t

Answer 20

the mental Forman can be seen as far forward as the distal of the first premolar and as far posteriorly as the mesial of the first molar.

Question 21

what’s root proximity?

Answer 21

if the roots are less than 2.5mm apart

periodontal bone loss will affect the entire inter proximal

Question 22

what’s the crown to tooth ratio (C:R)?

Answer 22

the crown to root ratio, C:R refers to the ratio of the length of the tooth outside of bone to the length of tooth in bone. It is a linear measurement, and doesn’t take into account other morphologic factors, such as root number and shape, into account.

Question 23

what’s internal resorption?

Answer 23

tooth resorption beginning from within the pulp

Question 24

what’s external resorption?

Answer 24

resorption of tooth structure beginning on the external surface