Radiographic Interpretation of Periodontal Conditions

Question 1

Periodontal Diseases - Disease processes involving the __

Answer 1

periodontium

Question 2

Supportive apparatus surrounding a tooth

Answer 2

Periodontium

Question 3

The periodontal ligament is made of the

Answer 3

PDL space (radiolucent)

Question 4

The alveolar bone consists of

Answer 4

alveolar crest
lamina dura

Question 5

Know alveolar crest, lamina dura, periodontal ligament space, CEJ on a radiograph

Answer 5

look at pics in powerpoint

Question 6

What is the distance between the alveolar crest and the CEJ

Answer 6

0.5-2 mm

Question 7

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

Answer 7

Periodontal diseases

Question 8

Dental __ play a primary role in periodontal disease

Answer 8

plaque biofilm

Question 9

During the inflammatory response of periodontal disease, there is a release of inflammatory mediators. There is a loss of and apical migration of __

Answer 9

the junctional epithelium

Question 10

With the loss of and apical migration of the junctional epithelium there is __ formation and further __

Answer 10

periodontal pocket
bacterial colonization

Question 11

Inflammatory response of periodontal disease stimulates osteoclastic __

Answer 11

bone resorption

Question 12

Diagnosis of periodontal diseases: First __

Answer 12

clinical examination

Question 13

What is involved in the clinical examination of diagnosis of periodontal disease

Answer 13

Gingival index, periodontal probing (bleeding sites, gingival recession, clinical attachment loss), tooth mobility

Question 14

For diagnosis of periodontal diseases radiographic examination is

Answer 14

complementary

Question 15

What can be shown on the radiographs for periodontal disease

Answer 15

Extent of destruction of the alveolar process
Local irritating factors
Record of the course of the disease

Question 16

What are the best exams for periodontal assessment

Answer 16

Bitewings (for posterior teeth)

Question 17

When is a vertical bitewing indicated for assessment of periodontal disease

Answer 17

When the extent of bone loss cannot be depicted on a regular bitewing

Question 18

This may show the overall status of the alveolar crests, but not the best image due to important limitations

Answer 18

Panoramic

Question 19

What are 3 limitations with a panoramic x-ray for periodontal assessment

Answer 19

Superimpositions
Distortions
Lower resolution

Question 20

What are 3 technical quality considerations when assessing periodontal health on a radiograph

Answer 20

Pt must bite down and bite block = centered
Correct horizontal angulation matters
Correct vertical angulation matters
(Can cause false effect of healthy bone levels)

Question 21

What are some early bone changes we see on radiographs - very initial sign of perio disease

Answer 21

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)

Question 22

This bone change seen on a radiograph is approximately parallel to an imaginary line between CEJ’s (first sign of bone loss)

Answer 22

Horizontal bone loss
PIC IN POWERPOINT

Question 23

This bone change seen on a radiograph is oblique to imaginary line between CEJ’s. Angular or triangular shaped defects

Answer 23

Vertical bone defects
PIC IN POWERPOINT

Question 24

Vertical bone defects are usually associated with

Answer 24

local exacerbating factors

Question 25

Types of vertical bone defects

Answer 25

3 walled bone defect 2 walled bone defect 1 walled bone defect (loss of all 4 walls is a horizontal defect) PIC IN POWERPOINT

Question 26

Horizontal bone loss is greater than __ mm

Answer 26

2

Question 27

Resorption of cortical plate adjacent to the teeth

Answer 27

Buccal or lingual cortical plate loss

Question 28

This bone loss may occur alone or in association with another type of bone loss

Answer 28

Buccal or lingual cortical plate loss

Question 29

Most common type of bone loss, normally a generalized position

Answer 29

Horizontal bone loss

Question 30

Other radiographic signs associated with periodontal disease

Answer 30

Changes to density and trabecular pattern of bone : A mixture of radiolucent and radiopaque patterns is common

Question 31

What would be a radiopaque pattern seen radiographically with periodontal disease

Answer 31

sclerotic bone reaction --> thicker trabeculae May extend some distance from the periodontal lesion

Question 32

Local contributing factors to other radiographic signs associated with periodontal disease

Answer 32

Calculus Defective restorations Open inter-proximal spaces

Question 33

A certain degree of calcification is required before __ is seen on a radiograph

Answer 33

calculus

Question 34

Presence of calculus on a radiograph my be __

Answer 34

underestimated

Question 35

Types of defective restorations seen on a radiograph

Answer 35

overhangs Misfits / voids (On a radiograph we can only asses cervical inter-proximal defects)

Question 36

If there are open inter-proximal contacts, __ may facilitate the progression of PD

Answer 36

food impaction

Question 37

Periodontal disease often progresses in

Answer 37

bursts

Question 38

With the progression of periodontal disease there are __ periods of active inflammation and tissue destruction, followed by times of quiescence with no appreciable changes

Answer 38

Cyclic

Question 39

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

Answer 39

Oral hygiene practices Age, stress, smoking, systemic diseases, hormonal changes

Question 40

Mild vs moderate vs severe periodontal progression on a radiograph

Answer 40

Mild - cervical third of tooth showing Moderate - middle third of tooth showing severe - apical third of tooth showing

Question 41

Widening of the PDL space at the apex of the interradicular bony crest

Answer 41

Furcation involvement

Question 42

Periodontal lesion that extended to the apex causing secondary endodontic disease

Answer 42

Endodontic-Periodontic Lesions

Question 43

Periapical inflammatory disease from endodontic origin extending coronally to alveolar crest

Answer 43

Endodontic-Periodontic Lesions

Question 44

RBL for stage I-IV perio

Answer 44

Stage I: coronal third <15% Stage II: coronal third 15-33% Stage III and IV: middle third of root and beyond

Question 45

Perio grade based off bone loss

Answer 45

Bone loss / age = age = grade B > age = grade C

Question 46

Irreversible anatomical changes of residual ridges following dental extraction

Answer 46

Alveolar ridge atrophy PIC in powerpoint

Question 47

Is alveolar ridge atrophy related to periodontitis

Answer 47

No

Question 48

The increased distance CEJ-AC is not necessarily the result of periodontal disease with

Answer 48

supraeruption

Question 49

Radiographic signs of stabilization of the disease can be seen occasionally - interproximal cortex of the alveolar crest can reform after __

Answer 49

successful periodontal therapy

Question 50

Malignant neoplasms that when involving the alveolar process may mimic the radiographic appearance of periodontitis

Answer 50

Squamous cell carcinoma

Question 51

Squamous cell carcinoma is differentiated from periodontitis by

Answer 51

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)

Question 52

Intra oral radiographic evaluation: changes in bone levels around implants - images taken at baseline for future reference

Answer 52

Peri-implant conditions

Question 53

Discriminate between health and disease states for peri-implant conditions

Answer 53

Absence of bone loss beyond bone level changes resulting from initial bone remodeling (bone loss should not exceed 2mm)