Radiographs in periodontal disease Flashcards
How do radiographs help in diagnosis?
They help in staging and grading at worst bone loss site. Stage (severity)
Grading (rate of progression)
Extent
What do we use to diagnose periodontitis?
History, examination and screening, BPE and assessment of periodontits (recession)
Severity and rate of progression on radiograph
What defines a healthy periodontium?
Relationship between crestal bone margin and CEJ should be 2-3mm and if there is no clinical signs of attachment loss then no periodontitis.
How should bone look on radiographs?
Thin, smooth corticated margins to interdental crestal bone in posterior regions, should be radiodense. Not always in cortical bone as it is thinner so will not be as radiodense.
What should the interdental crestal bone be continuous with?
Lamina dura of adjacent teeth, junction forms at a sharp angle.
What are the limitations of radiographs?
2D view of 3D situation Bony defects may be hidden Only interproximal bone seen clearly Underestimate bone destruction - 30-50% bone must be lost before detected No information on soft tissues
What do radiographs identify?
Bone loss, mobility, occlusal trauma, calculus and overhangs, crown-root ratios and sclerosis
Root length and morphology
How do we grade bone loss?
%bone loss/age
What are the patterns of bone loss?
Horizontal, vertical, generalised, localised, furcation
What is horizontal bone loss?
Bone loss where crest is horizontal to occlusal plane but apical to normal level.
Loss of buccal and lingual plates and bone
What is 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 infrabony pocket.
How many walls can a infrabony defect have?
One, two or three
What are triangular bone loss in upper furcation lesions?
Angular defects
How do we detect furcations and why are they significant?
Local PRF’s
May be detectable by probing or radiolucency at furcation, look for arrowheads in upper molars.
What is a combined lesion?
Bone loss involving apex and root face
May arise from a non vital tooth and discharge
Extensive bone loss that involves apex and tooth becomes non vital
What is mobillity?
Widening of the PD membrane space
What are examples of occlusal trauma?
Marginal widening, angular defect, root resorption, hypercementosis, root fracture, loss/thickening of lamina dura, bone sclerosis
What is sclerosis in response to?
Thickening of trabeculae in response to chronic inflammation
Why are bitewings not as useful as other methods in perio?
As apex is not seen, bone loss is estimated
Vertical bitewings show more root length that horizontal but not all
What do you need for periapicals?
Film holders and parallelling technique
What radiographs do we use for code 3?
Use existing BW’s or OPT/PA’s
What radiographs do we use for code 4?
OPT/PA
What are the different stages of bone loss?
1 - <15% bone loss (<2mm attachment loss from the CEJ)
2- Coronal third of the root
3- Mid third
4- Apical third
What are the different grades of bone loss?
A <0.5 slow
B 0.5-1
C >1 rapid
How do we report radiographs?
Report chronologically
Check orientation, name and date
What do we assess radiographs by?
Excellent - no errors in prep, positioning, handling, exposure, processing
Acceptable - some errors but can be used for diagnostic purposes
Unacceptable - errors and is undiagnostic, repeat
What do you report on radiographs?
Report caries, only report restorations if there are recurrent caries, poorly contoured or have overhangs.
Comment on quality of root fillings and apical status of root filled and crowned teeth
Wisdom teeth - comment on eruption status, impaction, bone morphology and relationship to IA canal
Bone loss is it generalised or localised
Angular defects
Perio endo lesions
Furcation involvements
Calculus deposits on multiple teeth
Any progression from previous films.
Start with: date, type and quality
