Radiographic Interpretation of Periodontal Disease A Flashcards
periodontium
the tissues that invest and support the teeth
gingiva and alveolar bone
anatomic landmarks of alveolar bone
lamina dura
alveolar crest
PDL
periodontium: alveolar crest health
1.5-2 mm below CEJ
periodontium: alveolar crest health anterior region
pointed and sharp
very radiopaque
periodontium: alveolar crest health posterior
flat and smooth
parallel to a line between adjacent CEJ
less radiopaque than anterior region
periodontium: lamina dura
health: dense radiopaque line around roots
perforated by numerous small foramina
traversed by blood vessels, lymphatics and nerves, which pass between the PDL and bone
changes in the angulation of the x-ray beam can alter its appearance
periodontium: PDL space
a thin radiolucent line between the root of teeth and the lamina dura
continuous around the root structure and of uniform thickness in healthy teeth
description of perio disease
alveolar crest: greater 1.5-2 mm below AC, bone loss
no longer radiopaque
appears indistinct
difficult to detect bone loss <3mm on radiograph
detection of perio disease
both clinical and dental image examination
info about soft tissue and info about bone
clinical examination
must be performed
evaluation of soft tissue for signs of inflammation such as redness, bleeding, swelling, exudate
thorough clinical assessment must include perio probing
dental image examination
provides an overview of the amount of bone present
indicates the pattern, distribution and severity of bone loss
documents periodontal disease at specific points in time
paralleling
preferred method
height of crestal bone is accurately recorded in relation to the tooth root
bisecting
dimensional distortion due to errors in vertical angulation
images may appear to show less bone loss than is present
horizontal bite-wing
limited value in the detection of periodontal disease
severe interproximal bone loss cannot be adequately visualized on horizontal bite-wing images
vertical bite-wing
can be used to examine bone levels
best for post-treatment and follow-up purposes
panoramic image
minimal diagnostic value in the detection of periodontal disease
furcation area on radiographic examination
between the roots of multirooted teeth
may not be detected on a dental image because of the superimposition of buccal and lingual bone
especially max molars
what areas may be difficult to evaluate during radiographic examination
buccal and lingual
detecting periodontitis
very earliest signs must be detected clinically, not radiographically
by the time it is detected radiographically it has progressed past early stage
a radiograph cannot accurately display the shape of bone deformities because it is not
3D
a radiograph with poor technique and excessive angulation can obscure
bone loss
bone loss can be estimated as
the difference between the physiologic bone level and the height of remaining bone
recorded in percentage of bone loss not on amount remaining
pattern, distribution, severity of loss
bone loss pattern: horizontal
most common bone loss pattern
fairly even, overall reduction in height of the alveolar bone
alveolar bone reduced in height but the margin of the alveolar crest remains, more or less, perpendicular to the long axis of the tooth
occurs in a plane parallel to the CEJs of adjacent teeth
normal alveolar bone height
1.5 to 2 mm below and parallel to the CEJ
horizontal crest contour
crest of the interproximal bone will have a horizontal contour when the CEJs of the adjacent teeth are at the same level
horizontal bone loss results in bone levels that are
approximately at the same height on adjacent tooth roots
on a radiograph, if an imaginary line drawn between the CEJs of adjacent teeth is
approximately parallel, then the bone loss is described as horizontal bone loss
bone loss pattern: vertical
angular bone loss
does not occur in a plane parallel to the CEJs of adjacent teeth
uneven reduction in the height of the alveolar bone
resorption progresses rapidly in the bone next to the root surface
leaves a trench-like area of missing bone alongside the root
vertical bone loss results in
an uneven reduction in bone height on adjacent tooth roots
on a radiograph, if an imaginary line drawn between the CEJs of adjacent teeth is not parallel then the bone loss is described as
vertical bone loss
normal vertical contour
crest of the interproximal bone will have a vertical contour when one of the adjacent teeth is tilted or erupted to a different height
bone loss distribution: localized
occurs in isolated areas, less than 30% teeth involved have attachment and bone loss
bone loss distribution: generalized
occurs evenly throughout the dental arches
more than 30% of the teeth involved and occurs evenly throughout the dental arches
