Radiographs And Bone loss Flashcards
Radiographs are especially helpful in evaluation of the following points:
Amount of bone present
Condition of the alveolar crests
Bone loss in the furcation areas
Width of the PDL space
Local factors which can cause or intensify periodontal disease
1.Caries
2.Calculus
3.Overhanging restorations
Normal crown to root ratio is
1:2
Anatomical crown always starts from ——–
cej
Clinical crown is the visible portion of the crown in oral cavity so its not necessarily starts from ——
cej
Interdental bone is always spine like T/F
FaLSE Because it follows the level of cej and convexity of proximal tooth surface so its not necessary
Periapical radiograph shows
Either maxilla or mandible but along with periapical area
Bitewing radiograph shows
both maxilla and mandible but not periapical area
If assessing bone loss is not possible radiographically then?
we will raise flap
2 types of bone loss pattern
1.Horizontal
2.Vertical
This pattern of bone loss is Most common and mostly occuring mandibular anterior teeth?
Horizontal
Unlike horizontal bone loss its very difficult to detect vertical bone loss why?
Because other surfaces (unresorbed) may superimposed over a resorbed one
Only ——— sides vertical bone loss can be diagnosed properly
Mesial and Distal
Why in furcation defect Endodontic treatment is preferred first?
Because most of the times root is also infected in furcation defect
Second Molar is a good candidate for RSR T/F
F, As it doesnt have good visibility and accessibility
The facio-lingual diameter of the bone is related to the ——–
width of the proximal root surface.
Classify radiographs in dentistry?
Intra- Oral Radiograph
Periapical view
Bite wing
Occlusal View
Extra- Oral Radiographs
OPG
Lat: Ceph
Anterio- Posterior view
Posterio- Anterior View
Lateral Oblique View
Oxipito- Mental view.
Proper Radiographic technique
The x-ray beam must be perpendicular to the long axes of
the teeth and the plane of the image receptor.
The image receptor must be parallel to the long axes of the
teeth.
Radiographs commonly used in periodontology?
In conventional radiographs,
periapical
bite-wing projections
Both offer the most diagnostic information and are most commonly used in the evaluation of periodontal disease.
Rarely
OPG (Orthopantomagram)
Prichard put forward the following four criteria for the determination of adequate angulation of periapical radiographs:
1.The periapical radiograph should have the ability to show the cusps of molars with apical surface.
- Enamel and pulp chambers should be seen and distinct.
- Open interproximal spaces.
4.Contacts between the adjacent teeth should not overlap unless teeth are out of line.
Exostosis?
Overgrowths of bone
They can occur as small or large nodules, sharp ridges , spike-like projections.
Explain fenestration and dehiscence
Fenestrationis the condition, in which the bony coverage of the root surface is lost, and the root surface is only covered by the periosteum and gingiva. In such lesions, marginal bone is intact. When this bone defect spreads toward the marginal bone, it is calledDehiscence.
Causes of bone destruction?
(i) Extension of gingival inflammation
(ii) Trauma from occlusion
(iii) Systemic disorders
Systemic disorders causing bone destruction?
1.Leukemia
2.Hyperparathyroidism
3.Langerhan cell histiocytosis
Bone Destruction patterns (All)
Horizontal bone loss
Vertical or angular defects
Osseous craters
Bulbous bone contours
Ledges
Furcation involvement
Horizontal bone loss
Most common pattern
Bone is reduced in such a way that the bone margin is approximately perpendicular to the teeth surface
Inter-dental septa and facial and lingual plates of bone are affected, but necessarily to an equal degree around the same tooth.
Vertical bone loss?
An abnormal decrease in alveolar bone on one proximal surface of a tooth in comparison to the tooth on the adjacent side. This uneven reduction in the height of the alveolar bone is less common than horizontal bone loss and produces an infra-bony pocket.
Angular defects classification is given by?
Depending on number of walls present ,
angular defects were classified by Goldman and Cohen (1958)
Explain 3,2,1 wall oseous defect?
(remember oseous crater and oseous defect are different)
When the soft tissue which lines the pocket is surrounded by three walls of bone, the defect is described as a three-wall defect.
If the defect is lined by only two walls of bone, the defect is a
two-wall defect.
If the defect is lined by only one wall of bone, then it is known as a one-wall defect.
Angular defects of facial and lingual or palatal surfaces are not seen on
radiographs
Surgical exposure is the only way to determine the presence and configuration of vertical osseous defects
T/F
T
Common areas and age of vertical defects?
Radiographically detected defects appear most often on the distal and mesial surfaces
However, three-wall defects are more frequently found on the mesial surfaces of upper and lower molars.
Old age
Osseous craters?
They are concavities in the crest of the interdental bone confined within the facial and lingual walls.
Reasons of osseous craters?
(i) plaque accumulation and difficulty to clean.
(ii) normal concavity in lower molars
Bulbous Bone Contours?
Bulbous bone contours are bony enlargements caused by exostosis ,
adaptation to function, or buttressing bone formation.
They are found more frequently in the maxilla than in the mandible.
They can occur as small nodules, large nodules, sharp ridges, spike like projections, or any combination of these.
Exostoses
Ledges?
Ledges are plateau like bone margins caused by resorption of thickened
bony plates
Grades Of furcation involvement?
(i) Grade 1 : incipient bone loss
(ii) Grade 2 : partial bone loss
(iii) Grade 3 : total bone loss with through and through opening of furcation
(iv) Grade 4 : similar to grade 3,with gingival recession exposing the furcation to view.
22 years young girl presented in clinic with the complain of spaces in mandibular anterior teeth, on investigation it revealed that she had orthodontic treatment one year back. On examination, mandibular left central incisor had grade 3 mobility.
Question:
Diagnose the case?
Treatment plan?
Diagnosis
The patient presents with severe periodontal bone loss and Grade 3 mobility in the mandibular left central incisor. Given the history of orthodontic treatment a year ago and the presence of spacing, the most likely diagnosis is:
🔹 Post-Orthodontic Periodontal Breakdown with Severe Periodontitis
The clinical image shows gingival recession, alveolar bone loss, and increased spacing between mandibular anterior teeth.
The radiograph reveals severe vertical bone loss, especially around the central incisors.
Grade 3 mobility suggests complete loss of periodontal support, meaning the affected tooth is no longer stable.
Treatment Plan
1️⃣ Phase 1: Periodontal Therapy (Initial Treatment)
Oral hygiene instructions (OHI)
Scaling and Root Planing (SRP)
Adjunctive antibiotic therapy (if signs of active infection)
Splinting of mobile teeth to provide stability
Evaluate response after 4-6 weeks
2️⃣ Phase 2: Surgical Intervention (if required)
Guided Tissue Regeneration (GTR) or Bone Grafting for bone defects
Periodontal flap surgery if deep pockets persist
3️⃣ Phase 3: Prosthetic or Orthodontic Considerations
If tooth cannot be saved, extraction may be required, followed by implant or prosthetic replacement
Orthodontic retention to prevent further spacing and relapse
4️⃣ Phase 4: Maintenance & Long-Term Follow-up
Regular periodontal maintenance visits every 3-6 months
Patient compliance with oral hygiene is crucial to prevent recurrence
How The transition from gingivitis to periodontitis is associated with changes in composition of bacterial plaque.
Comparison Between Gingivitis and Periodontitis:
In gingivitis, the predominant bacteria are coccoid rods and straight rods, whereas in periodontitis, the primary bacterial type is spirochetes.
The immune response also differs; plasma cells are more commonly found in gingivitis, while PMNs (polymorphonuclear neutrophils) dominate in periodontitis.
