Radiographs in periodontal disease

Question 1

How do radiographs help in diagnosis?

Answer 1

They help in staging and grading at worst bone loss site. Stage (severity)
Grading (rate of progression)
Extent

Question 2

What do we use to diagnose periodontitis?

Answer 2

History, examination and screening, BPE and assessment of periodontits (recession)
Severity and rate of progression on radiograph

Question 3

What defines a healthy periodontium?

Answer 3

Relationship between crestal bone margin and CEJ should be 2-3mm and if there is no clinical signs of attachment loss then no periodontitis.

Question 4

How should bone look on radiographs?

Answer 4

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.

Question 5

What should the interdental crestal bone be continuous with?

Answer 5

Lamina dura of adjacent teeth, junction forms at a sharp angle.

Question 6

What are the limitations of radiographs?

Answer 6

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

Question 7

What do radiographs identify?

Answer 7

Bone loss, mobility, occlusal trauma, calculus and overhangs, crown-root ratios and sclerosis
Root length and morphology

Question 8

How do we grade bone loss?

Answer 8

%bone loss/age

Question 9

What are the patterns of bone loss?

Answer 9

Horizontal, vertical, generalised, localised, furcation

Question 10

What is horizontal bone loss?

Answer 10

Bone loss where crest is horizontal to occlusal plane but apical to normal level.
Loss of buccal and lingual plates and bone

Question 11

What is vertical bone loss?

Answer 11

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.

Question 12

How many walls can a infrabony defect have?

Answer 12

One, two or three

Question 13

What are triangular bone loss in upper furcation lesions?

Answer 13

Angular defects

Question 14

How do we detect furcations and why are they significant?

Answer 14

Local PRF’s

May be detectable by probing or radiolucency at furcation, look for arrowheads in upper molars.

Question 15

What is a combined lesion?

Answer 15

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

Question 16

What is mobillity?

Answer 16

Widening of the PD membrane space

Question 17

What are examples of occlusal trauma?

Answer 17

Marginal widening, angular defect, root resorption, hypercementosis, root fracture, loss/thickening of lamina dura, bone sclerosis

Question 18

What is sclerosis in response to?

Answer 18

Thickening of trabeculae in response to chronic inflammation

Question 19

Why are bitewings not as useful as other methods in perio?

Answer 19

As apex is not seen, bone loss is estimated

Vertical bitewings show more root length that horizontal but not all

Question 20

What do you need for periapicals?

Answer 20

Film holders and parallelling technique

Question 21

What radiographs do we use for code 3?

Answer 21

Use existing BW’s or OPT/PA’s

Question 22

What radiographs do we use for code 4?

Answer 22

OPT/PA

Question 23

What are the different stages of bone loss?

Answer 23

1 - <15% bone loss (<2mm attachment loss from the CEJ)
2- Coronal third of the root
3- Mid third
4- Apical third

Question 24

What are the different grades of bone loss?

Answer 24

A <0.5 slow
B 0.5-1
C >1 rapid

Question 25

How do we report radiographs?

Answer 25

Report chronologically

Check orientation, name and date

Question 26

What do we assess radiographs by?

Answer 26

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

Question 27

What do you report on radiographs?

Answer 27

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