Radiography of PD Flashcards
how would you go about to diagnose whether or not a patient has PD?
- patient history and examination
- BPE (screening NOT a diganosis). If score is 0/1 = no radiograph. if code 3/4= radiographic assessment required (BSP guidelines)
- assess if the patient has historic periodontitis (shown by inter-dental recession).
we determine the severity and rate of progression using the radiograph.
explain this using the BSP guidelines
severity = STAGING. this is determined using the ‘inter-proximal bone loss’ aka the distance from the crestal bone margin to the CEJ + is recorded from the worst site. e.g. if you measure less than 2mm of inter-proximal bone loss at the worst site= then stage 1 perio.
rate of progression = GRADING= determined using the formula: ‘ %bone loss/ patient age ‘ recorded from the worst site.
what are the radiographic features of a HEALTHY periodontium?
you would see a thin, smooth, evenly corticated crestal bone margin.
the distance between the crestal bone margin and the CEJ is approx 2mm and there is NO CAL.
the interdental crestal bone is continous with the lamina dura of the adjacent teeth,
what are the limitations of using a radiograph to diagnose PD?
- 2d image of a 3d situation=superimposition=details of bony architecture lost/ hidden
- will always underestimate the bone destruction.
- does not give any information on bone loss.
what IS a radiograph able to show?
mobility
bone levels/loss and the TYPE of bone loss
occlusal trauma (might see sclerosis in affected area)
calculus/ marginal overhangs
crown-root ratios (ONLY a radiograph can be used to examine the root morphology, workout the crown-root ratio etc).
scelorsis (this is when new bone is laid down as a response to injury therefore we see a radiopaque region not a luscent one.
what are the types of bone loss
horizontal
vertical (you would need to see a marked difference in the degree of bone loss at 2 different sites!)
furcation (between roots of multirooted molars). on upper molars see a triangle shape defect and on lowers =radiolucency.
vertical bone loss is seen when….
there is RAPID bone loss due to SEVERE perio
give examples of vertical bone loss?
angular defect
perio/endo lesion also called a combined lesion (here the bone loss extends into the root)
what are the 2 reasons for a patient having a combined lesion (vertical bone loss)
- rapid bone loss due to severe perio
2. a non-vital tooth= pulp necrosis= inflammation= bone loss on root
how can we see mobility on radiograph?
if wehave a mobile tooth, not always shown on radiograph, but can be shown via a WIDER PDL rather than a narrow one
how can we see calculus on radiograph?
it is better to probe for calculus than look for it on a radiograph but if see it will be radiopaque deposits usually on the side of the crown
what is the gold standard radiograph type to examine PD?
panoramic! it used to be bitewings but not anymore
why panoramic for PD?
show the whole dentition at lower dose, even though need to position pt. correctly, once you have, it is time efficient, and pt. tolerates it more.
it will also show the apices of teeth and from panoramic we can determine bone loss directly (% root length)
but can have overlapping teeth in some areas
