Radiographic Interpretation of Periodontal Disease B Flashcards
AAP classification measured by
the clinical attachment loss (CAL)
from CEJ to base of the sulcus or periodontal pocket
AAP classification is classified as
gingivitis
stage 1
stage 2
stage 3
stage 4
classification of periodontal disease
based on the amount of bone loss
images detect contributing factors for perio disease: calculus, defective restorations
before radiographic change can be seen 30 to 50% loss of mineralization must occur
when analyzing a dental radiograph, the following are indicators of periodontal health
shape and character of the alveolar bone crest
presence of the lamina dura
gingivitis radiographically
no associated bone loss
no change is seen in bone when viewed on a dental image: crestal lamina dura is present, alveolar crest is ~ 1.5 to 2 mm apical to the CEJ
gingivitis clinically
gingiva: inflammatory process
red
swollen
bleeding
no clinical attachment loss
what radiographic images should be taken for a new patient with gingivitis
pan and bitewings
what radiographic images should be taken for a recall patient with gingivitis
bitewings
AAP periodontitis: staging
classifies the severity and extent of a patient’s disease based on the measurable amount of destroyed and/or damaged tissue as a result of periodontitis and to assess the specific factors that may attribute to the complexity of long-term case management
if CAL is not available to determine initial stage what can be used instead
radiographic bone loss should be used
stage 1: radiographic findings
bone loss: coronal third <15%
crestal interdental alveolar bone becomes unclear and fuzzy and no longer appears to be a continuous radiopaque line
widening of the PDL at crestal margin (Triangulation)
what type of bone loss is more often seen
horizontal
stage 1 clinical findings
BOP
probing less than or equal to 4
CAL 1-2 mm
may have localized areas of slight recession
no tooth lost due to periodontitis
stage 1 triangulation
widening of the PDL space
caused by resorption of bone along either the mesial or distal aspect of the interseptal crestal bone
pointed triangular appearance
stage 1 radiographs new patient
pan and 4 bitewings
stage 2: radiographic findings
coronal third: 15% to 33% bone loss
mostly horizontal may have slight vertical
distribution may be localized or generalized
stage 2: clinical findings
perio probing depths evident
probing depths greater than or equal to 5mm
CAL loss 3 to 4 mm
BOP
recession may be present
no tooth loss due to perio
class 1 furcation
early furcation
radiograph indicates early furcation - use furcation probe
radiograph has bone loss on maxilla - should have taken a vertical bitewing
stage 2 radiographs new patient
pan and vertical bitewings or selective periapical
stage 3 radiographic findings
associated with more severe bone loss
radiographic bone loss: extends to middle third of root and beyond greater than or equal to 34%
horizontal bone loss
vertical bone loss greater than or equal 3 mm
widened PDL
furcation involvement class II or III
osseous defects
stage 3: clinical findings
probing depth greater than or equal to 6 mm
CAL greater than or equal to 5
less than or equal to 4 teeth lost due to periodontal disease
class II or III furcation involvement
mobility
stage 3 radiographs new patient
pan and FMS and maybe selective periapical depends on if it is localized or generalized
stage 3 radiographs recall patient
vertical bitewings, >2mm probing depth change… selective PAs
stage 4
in addition to stage 3 findings it may include…
secondary occlusal trauma, tooth mobility greater than or equal to 2, less than or equal to 5 teeth lost due to perio disease
