Radiographic Interpretation of Periodontal Conditions Flashcards
Periodontal Diseases - Disease processes involving the __
periodontium
Supportive apparatus surrounding a tooth
Periodontium
The periodontal ligament is made of the
PDL space (radiolucent)
The alveolar bone consists of
alveolar crest
lamina dura
Know alveolar crest, lamina dura, periodontal ligament space, CEJ on a radiograph
look at pics in powerpoint
What is the distance between the alveolar crest and the CEJ
0.5-2 mm
Characterized by an inflammatory host response in the periodontal tissues that may lead to localized or generalized alterations in the supporting bone and soft tissues
Periodontal diseases
Dental __ play a primary role in periodontal disease
plaque biofilm
During the inflammatory response of periodontal disease, there is a release of inflammatory mediators. There is a loss of and apical migration of __
the junctional epithelium
With the loss of and apical migration of the junctional epithelium there is __ formation and further __
periodontal pocket
bacterial colonization
Inflammatory response of periodontal disease stimulates osteoclastic __
bone resorption
Diagnosis of periodontal diseases: First __
clinical examination
What is involved in the clinical examination of diagnosis of periodontal disease
Gingival index, periodontal probing (bleeding sites, gingival recession, clinical attachment loss), tooth mobility
For diagnosis of periodontal diseases radiographic examination is
complementary
What can be shown on the radiographs for periodontal disease
Extent of destruction of the alveolar process
Local irritating factors
Record of the course of the disease
What are the best exams for periodontal assessment
Bitewings (for posterior teeth)
When is a vertical bitewing indicated for assessment of periodontal disease
When the extent of bone loss cannot be depicted on a regular bitewing
This may show the overall status of the alveolar crests, but not the best image due to important limitations
Panoramic
What are 3 limitations with a panoramic x-ray for periodontal assessment
Superimpositions
Distortions
Lower resolution
What are 3 technical quality considerations when assessing periodontal health on a radiograph
Pt must bite down and bite block = centered
Correct horizontal angulation matters
Correct vertical angulation matters
(Can cause false effect of healthy bone levels)
What are some early bone changes we see on radiographs - very initial sign of perio disease
localized erosion of the inter-proximal alveolar crest
PIC IN POWERPOINT
- cortical surface of the alveolar crest may appear diffuse
- round appearance (loss of sharp inter-proximal angle)
This bone change seen on a radiograph is approximately parallel to an imaginary line between CEJ’s (first sign of bone loss)
Horizontal bone loss
PIC IN POWERPOINT
This bone change seen on a radiograph is oblique to imaginary line between CEJ’s. Angular or triangular shaped defects
Vertical bone defects
PIC IN POWERPOINT
Vertical bone defects are usually associated with
local exacerbating factors
Types of vertical bone defects
3 walled bone defect
2 walled bone defect
1 walled bone defect
(loss of all 4 walls is a horizontal defect)
PIC IN POWERPOINT
Horizontal bone loss is greater than __ mm
2
Resorption of cortical plate adjacent to the teeth
Buccal or lingual cortical plate loss
This bone loss may occur alone or in association with another type of bone loss
Buccal or lingual cortical plate loss
Most common type of bone loss, normally a generalized position
Horizontal bone loss
Other radiographic signs associated with periodontal disease
Changes to density and trabecular pattern of bone : A mixture of radiolucent and radiopaque patterns is common
What would be a radiopaque pattern seen radiographically with periodontal disease
sclerotic bone reaction –> thicker trabeculae
May extend some distance from the periodontal lesion
Local contributing factors to other radiographic signs associated with periodontal disease
Calculus
Defective restorations
Open inter-proximal spaces
A certain degree of calcification is required before __ is seen on a radiograph
calculus
Presence of calculus on a radiograph my be __
underestimated
Types of defective restorations seen on a radiograph
overhangs
Misfits / voids
(On a radiograph we can only asses cervical inter-proximal defects)
If there are open inter-proximal contacts, __ may facilitate the progression of PD
food impaction
Periodontal disease often progresses in
bursts
With the progression of periodontal disease there are __ periods of active inflammation and tissue destruction, followed by times of quiescence with no appreciable changes
Cyclic
The nature of bacterial pathogens and the host responses effects the progression of periodontal disease and the manifestation of it as mild, moderate or severe. What effects this
Oral hygiene practices
Age, stress, smoking, systemic diseases, hormonal changes
Mild vs moderate vs severe periodontal progression on a radiograph
Mild - cervical third of tooth showing
Moderate - middle third of tooth showing
severe - apical third of tooth showing
Widening of the PDL space at the apex of the interradicular bony crest
Furcation involvement
Periodontal lesion that extended to the apex causing secondary endodontic disease
Endodontic-Periodontic Lesions
Periapical inflammatory disease from endodontic origin extending coronally to alveolar crest
Endodontic-Periodontic Lesions
RBL for stage I-IV perio
Stage I: coronal third <15%
Stage II: coronal third 15-33%
Stage III and IV: middle third of root and beyond
Perio grade based off bone loss
Bone loss / age
= age = grade B
> age = grade C
Irreversible anatomical changes of residual ridges following dental extraction
Alveolar ridge atrophy
PIC in powerpoint
Is alveolar ridge atrophy related to periodontitis
No
The increased distance CEJ-AC is not necessarily the result of periodontal disease with
supraeruption
Radiographic signs of stabilization of the disease can be seen occasionally - interproximal cortex of the alveolar crest can reform after __
successful periodontal therapy
Malignant neoplasms that when involving the alveolar process may mimic the radiographic appearance of periodontitis
Squamous cell carcinoma
Squamous cell carcinoma is differentiated from periodontitis by
clinical appearance and failure to respond to treatment
(irregular widening of the PDL space along its entire length and destruction of the lamina dura are suggestive of infiltration by a malignancy rather than perio)
Intra oral radiographic evaluation: changes in bone levels around implants - images taken at baseline for future reference
Peri-implant conditions
Discriminate between health and disease states for peri-implant conditions
Absence of bone loss beyond bone level changes resulting from initial bone remodeling (bone loss should not exceed 2mm)
