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CSA SR > Radiography of perio disease > Flashcards

Radiography of perio disease Flashcards

1
Q

what are radiographs used for

A

to stage and grade periodontitis

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2
Q

what do we use to come to a diagnosis

A

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

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3
Q

What 2 features do we use in the mouth to see if the periodontium is healthy

A

the relationship between the crestal bone margin and the cemento-enamel junction (CEJ)

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4
Q

what are the features of a healthy periodontium

A

if the distance is 2mm-3mm and there is no clinical attachment loss then it is healthy

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5
Q

what are radiographic features of a healthy periodontium

A

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)

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6
Q

what does the interdental crystal bone look like on a radiograph

A

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

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7
Q

what are the limitations of radiographs

A

• 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

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8
Q

what can we see on radiographs

A
  • Bone loss
  • Mobility
  • Occlusal trauma
  • Calculus and marginal overhangs • Crown-root ratios
  • Sclerosis
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9
Q

how do we grade bone loss

A

% bone loss divided by patients age

in grade A,B,C

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10
Q

what is used to determine the severity of the disease

A

the inter proximal bone loss at the worst site is used for staging

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11
Q

what is the extent of bone loss measured by

A

% root length if apex can be measured- panoramic

mm loss if magnification is 1:1- bitewings

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12
Q

what do we measure bone loss in on a bitewing

A

mm

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13
Q

what do we measure bone loss in on a panoramic

A

% root length

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14
Q

what are the five patterns of bone loss

A 
vertical 
horizontal 
furcation involvement
localised 
generalised
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15
Q

where is bone loss when it is horizontal bone loss

A

Loss of buccal and lingual plates and intervening bone

Horizontal bone loss

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16
Q

where is bone loss when it is vertical bone loss

A
  • When marked difference in degree of bone loss at 2 adjacent sites
  • Might indicate rapid bone loss
  • Can be due to anatomy
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17
Q

why might furcation involvement cause issues

A

can be a local plaque retention factor

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18
Q

how is furcation involvement detected

A

by probing

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19
Q

how does furcation show up on an x ray

A

radiolucency

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20
Q

how might a combined lesion arise

A

it involves bone loss from the apex and root face

may arise from a non vital tooth and discharge along periodontal membrane space

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21
Q

what does mobility involve

A

widening of the periodontal membrane space

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22
Q

how can we detect calculus

A

radiographs and more careful probing

23
Q

what can be included in poorly contoured restorations

A

overhang amalgams
crown margins
pin perforation

24
Q

what else do radiographs show

A

crown-root ratio, root length and morphology can be documented- FOR ENDO

25
Q

what are the benefits of panoramic

A

show all the dentition on one film

lower patient dosage compared to PA

26
Q

disadvantages of panoramic

A

overalapping of teeth in some areas
careful patient positioning
time efficiency
patient tolerance

27
Q

benefits of bitewings

A

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

28
Q

disadvantages of bitewings

A

bone loss is estimated

29
Q

what are the advantages of PAs

A

high quality and reproducible

30
Q

disadvantages of PAs

A

can take time
need film holders and film holders
can expose patient to high doses of radiation

31
Q

what 3 things can you estbalish with bone levels

A

extent
staging
grading

32
Q

what is the extent

A

extent and pattern of bone loss

33
Q

What is staging

A

severity of bone loss
USE WORST AFFECTED SITE

34
Q

What is grading

A

rate of progression of disease

35
Q

what can happen at sites where there is vertical bone loss

A

infrabony defect
perioendo lesion

36
Q

what are the types of infrabony defects

A

three walled
two walled
one walled

37
Q

what are the signs of occlusal trauma on a radiograph

A

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

38
Q

on a bpe, what does a score of 0,1,2,3,4 and * mean

A

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

39
Q

before diagnosing, what 3 things should you carry out

A

history (historic pd)
clinical exam (BPE)
screening

40
Q

On a BPE what does code 0, 1 and 2 mean

A

0= <10% BOP, therefore clinical gingival health

1= 10-30% BOP, therefore localised

2= >30% BOP, therefore generalised gingivitis

41
Q

on a bpe, what does a code 3 mean

A

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

42
Q

on a bpe what does a code 4 mean

A

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

43
Q

with code 0,1,2 do you need RG

A

no

44
Q

with code 3, do you need rg

A

use exisiting BWs or OPT/PAs

45
Q

for code 4, do you need radiographs

A

OPT/PAs

46
Q

what are the 4 stages for a radiographic assessment

A

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)

47
Q

what are the 3 grades

A

A=slow rate of progression (<0.5)
B= moderate rate of progression (0.5-1)
C= rapid rate of progression (>1)

48
Q

what are the 3 status’

A

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

49
Q

what order does a PD diagnosis statement go in

A

extent-peridontitis-stage-grade-stability-risk factors

50
Q

what are the 3 image qualities of radiographs

A

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

51
Q

all type of radiograph reports shsould start with what 3 things

A

type of radiograph
date
quality assessment

52
Q

what order do you report a radiographic image in

A

UR
UL
LL
LR

53
Q

what things do you report on a radiograph

A

-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

CSA SR (52 decks)

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