Radiography of perio disease Flashcards
what are radiographs used for
to stage and grade periodontitis
what do we use to come to a diagnosis
history
examination and screening
BPE and assessment of historic periodontitis
radiographs can be used to determine the severity and the rate of progression of the disease
What 2 features do we use in the mouth to see if the periodontium is healthy
the relationship between the crestal bone margin and the cemento-enamel junction (CEJ)
what are the features of a healthy periodontium
if the distance is 2mm-3mm and there is no clinical attachment loss then it is healthy
what are radiographic features of a healthy periodontium
Thin, even, pointed margins to the interdental bone in the anterior regions
(cortication is not always evident due to the small amount of bone between the teeth anteriorly)
what does the interdental crystal bone look like on a radiograph
is continuous with the lamina dura of the adjacent teeth. The junction of the two forms a sharp angle.
•Thin even width to the mesial and distal periodontal membrane spaces
what are the limitations of radiographs
• 2D view of 3D situation
• Bony defects maybe hidden
• Only interproximal bone seen clearly
• Radiographs underestimate bone destruction
• 30-50% of the bone mineral content must be lost
before changes are detected radiographically
• No information on soft tissues
what can we see on radiographs
- Bone loss
- Mobility
- Occlusal trauma
- Calculus and marginal overhangs • Crown-root ratios
- Sclerosis
how do we grade bone loss
% bone loss divided by patients age
in grade A,B,C
what is used to determine the severity of the disease
the inter proximal bone loss at the worst site is used for staging
what is the extent of bone loss measured by
% root length if apex can be measured- panoramic
mm loss if magnification is 1:1- bitewings
what do we measure bone loss in on a bitewing
mm
what do we measure bone loss in on a panoramic
% root length
what are the five patterns of bone loss
vertical horizontal furcation involvement localised generalised
where is bone loss when it is horizontal bone loss
Loss of buccal and lingual plates and intervening bone
Horizontal bone loss
where is bone loss when it is vertical bone loss
- When marked difference in degree of bone loss at 2 adjacent sites
- Might indicate rapid bone loss
- Can be due to anatomy
why might furcation involvement cause issues
can be a local plaque retention factor
how is furcation involvement detected
by probing
how does furcation show up on an x ray
radiolucency
how might a combined lesion arise
it involves bone loss from the apex and root face
may arise from a non vital tooth and discharge along periodontal membrane space
what does mobility involve
widening of the periodontal membrane space
how can we detect calculus
radiographs and more careful probing
what can be included in poorly contoured restorations
overhang amalgams
crown margins
pin perforation
what else do radiographs show
crown-root ratio, root length and morphology can be documented- FOR ENDO
what are the benefits of panoramic
show all the dentition on one film
lower patient dosage compared to PA
disadvantages of panoramic
overalapping of teeth in some areas
careful patient positioning
time efficiency
patient tolerance
benefits of bitewings
Positioning more likely to be reproducible so aids sequential radiographs
• Most likely will only be used for Code 3 if already have them – eg for caries diagnosis
disadvantages of bitewings
bone loss is estimated
what are the advantages of PAs
high quality and reproducible
disadvantages of PAs
can take time
need film holders and film holders
can expose patient to high doses of radiation
what 3 things can you estbalish with bone levels
extent
staging
grading
what is the extent
extent and pattern of bone loss
What is staging
severity of bone loss
USE WORST AFFECTED SITE
What is grading
rate of progression of disease
what can happen at sites where there is vertical bone loss
infrabony defect
perioendo lesion
what are the types of infrabony defects
three walled
two walled
one walled
what are the signs of occlusal trauma on a radiograph
marginal widening
angular defect
root resorption
hypercementosis
root fracture
loss/thickening of lamina dura
bone sclerosis
on a bpe, what does a score of 0,1,2,3,4 and * mean
0=no calculus, no BOP, no pockets, BB visible
1=no calculus, BOP, no pockets, BB visible
2=calculus, no pockets, BB visible
3=pocket (3.5-5.5mm), BB partially visible
4=pocket (>5.5mm), BB not visible
*= furcation involvement
before diagnosing, what 3 things should you carry out
history (historic pd)
clinical exam (BPE)
screening
On a BPE what does code 0, 1 and 2 mean
0= <10% BOP, therefore clinical gingival health
1= 10-30% BOP, therefore localised
2= >30% BOP, therefore generalised gingivitis
on a bpe, what does a code 3 mean
no recession
=> radiographic assessment
=> initial periodontitis therapy
=> review in 3 months w 6PPC
=> no pockets greater than or equal to 4mm and no radiographic bone loss -> move on to code 0,1 and 2 pathway
OR
=>pockets greater than or equal to 4mm and radiographic bone loss ->
move on to code 4 pathway
on a bpe what does a code 4 mean
no interdental recession
=> RG assessment
=> full radiogrpahic assessment with a 6PPC
=> molar-incisor pattern, therefore periodontitis molar-incisor
OR
=> <30% of teeth , therefore localised peridontitis
OR
=> >30% of teeth, therefore generalised periodontitis
with code 0,1,2 do you need RG
no
with code 3, do you need rg
use exisiting BWs or OPT/PAs
for code 4, do you need radiographs
OPT/PAs
what are the 4 stages for a radiographic assessment
1=early/mild (>15% or <2mm attatchment loss from CEJ)
2=moderate (coronal third of root)
3=severe (mid third of root)
4=v severe (apical third of root)
what are the 3 grades
A=slow rate of progression (<0.5)
B= moderate rate of progression (0.5-1)
C= rapid rate of progression (>1)
what are the 3 status’
Currently stable= BOP <10%, PPD less than or equal to 4mm, no BOP at 4mm sites
Currently in remission= BOP greater than or equal to 10%, PPD less than or equal to 4mm, no BOP at 4mm sites
Currently unstable= PPD greater than or equal to 5mm
OR
PPD greater than or equal to 4 and BOP
what order does a PD diagnosis statement go in
extent-peridontitis-stage-grade-stability-risk factors
what are the 3 image qualities of radiographs
grade 1/excellent- no erros in aptient prep, positioning, exposure, prcoessing or handling
grade 2/acceptable- some erros in above but radiograph can still be used for diagnostic purposes
grade 3/ unaccepetable- erros such that radiogrpah is undiagnostic and has to be repeated
all type of radiograph reports shsould start with what 3 things
type of radiograph
date
quality assessment
what order do you report a radiographic image in
UR
UL
LL
LR
what things do you report on a radiograph
-caries
-restorations (if recurrent caries, poorly contoured or have overhangs)
-quality of root fillings and the apical status of root filled and crowned teeth
-eruption status, impaction, root morphology and relationship to ID canal of wisdom teeth
-bone loss
-angular defects
-perioendo lesions
-furcation involvement
-calculus deposits
-any progression of disease since previous film
