Radiography of perio disease

Question 1

what are radiographs used for

Answer 1

to stage and grade periodontitis

Question 2

what do we use to come to a diagnosis

Answer 2

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

Question 3

how do we see if the periodontium is healthy

Answer 3

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

Question 4

what are the features of a healthy periodontium

Answer 4

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

Question 5

what are radiographic features of a healthy periodontium

Answer 5

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)

Question 6

what does the interdental crystal bone look like on a radiograph

Answer 6

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

Question 7

what are the limitations of radiographs

Answer 7

• 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

Question 8

what can we see on radiographs

Answer 8

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

Question 9

how do we grade bone loss

Answer 9

% bone loss divided by patients age

in grade A,B,C

Question 10

what is used to determine the severity of the disease

Answer 10

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

Question 11

what is the extent of bone loss measured by

Answer 11

% root length if apex can be measured- panoramic

mm loss if magnification is 1:1- bitewings

Question 12

what do we measure bone loss in on a bitewing

Answer 12

mm

Question 13

what do we measure bone loss in on a panoramic

Answer 13

% root length

Question 14

what is the pattern of bone loss

Answer 14

vertical 
horizontal 
furcation involvement
localised 
generalised

Question 15

where is bone loss when it is horizontal bone loss

Answer 15

Loss of buccal and lingual plates and intervening bone

Horizontal bone loss

Question 16

where is bone loss when it is vertical bone loss

Answer 16

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

Question 17

why might furcation involvement cause issues

Answer 17

can be a local plaque retention factor

Question 18

how is furcation involvement detected

Answer 18

by probing

Question 19

how does furcation show up on an x ray

Answer 19

radiolucency

Question 20

how might a combined lesion arise

Answer 20

it involves bone loss from the apex and root face

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

Question 21

what does mobility involve

Answer 21

widening of the periodontal membrane space

Question 22

how can we detect calculus

Answer 22

radiographs and more careful probing

Question 23

what can be included in poorly contoured restorations

Answer 23

overhang amalgams
crown margins
pin perforation

Question 24

what else do radiographs show

Answer 24

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

Question 25

what are the benefits of panoramic

Answer 25

show all the dentition on one film

lower patient dosage compared to PA

Question 26

disadvantages of panoramic

Answer 26

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

Question 27

benefits of bitewings

Answer 27

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

Question 28

disadvantages of bitewings

Answer 28

bone loss is estimated

Question 29

what are the advantages of PAs

Answer 29

high quality and reproducible

Question 30

disadvantages of PAs

Answer 30

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