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
how do we 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 is the pattern 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
