Radiology in Periodontology Flashcards
When should a radiograph be used?
To aid diagnosis and help determine the prognosis of specific teeth when taken together with a comprehensive clinical examination and patient history.
Important for treatment planning and in monitoring the long-term stability of periodontal health as well as information on other pathologies such as periapical pathology, pulpal/furcation involvements and caries.
What can radiology help determine?
Can help determine prognosis
Can help determine treatment
Can reveal alteration of calcified tissues
Can show past effects on bones
What are the limitations to radiology?
Adjunctive help but not substitute for clinical assessment. It doesnt reveal cellular activity.
Limited in what it shows in soft tissues.
How can number of radiographs be determined?
The number and type of radiographs will depend on clinical examination.
Which BPE codes will require radiographs to be taken?
3, 4 and * to assess the extent of bone loss.
What is the gold standard radiograph to use in perio? Why?
A periapical radiograph taken using a long-cone paralleling technique.
This is because visualizing root anatomy in its entirety can be useful in assessing bone levels in relation to total root length in:
Assessing prognosis
Helping to assess furcation involvements
Identifying possible endodontic complications
What can bitewings show us about bone loss?
They can provide early warning of localized bone loss, poorly contoured restorations, and subgingival calculus.
When should an OPG be used?
Only when there are a variety of concerns that need to be investigated.
What influences the decision of using an OPG vs a periapical radiograph?
Preference/availability: Patients can find a paralleling technique periapical very uncomfortable compared to panoramic techniques.
Collimation should be appropriate to reduce radiation dose.
What are the normal features of alveolar bone?
Interdental septa
alveolar crest 1.5 to 2mm to alveolar crest
Continuous white line
Variations can be adequately attributed to the x-ray beam angulation
Alveolar crest shape angle and width depend on proximal convexity CEJ level
Alveolar crest angulation parallel to CEJ projection
What should radiographs be assessed for periodontically?
Degree of bone loss (if apex is visible then bone loss should be measured and reported as a percentage)
Pattern or type of bone loss
Presence of furcation defects
Presence of subgingival calculus
Other features such as perio-endo lesions
How should the x-ray beam be angled in a periapical to be acceptable?
Show tip of molar cusps with little or no occlusal areas.
Enamel caps and pulp chambers should be distinct
Interproximal spaces should be open
Proximal contacts should no overlap
What features should be examined in radiographs?
Alveolar bone
Roots
Restorations
Calculus
Pulp
Furcations
Periodontal ligament
Associated structures
What are the radiographic signs of bone destruction?
Slight radiographic change means progression to early stages (earliest sign of CAL)
Interdental septa reduced in height: Indicates horizontal bone loss
Break in continuity of lamina dura (can be due to radiographic technique or x-ray source placement)
Presence of lamina dura indicates health but lack of lamina dura does not mean disease
Wedge shaped radiolucent area mesially or distally pointing towards the apex.
Destruction across the crest with reduced height
Finger like radiolucent projections
Height of interdental septum progresively reduced by bone resorption
Furcation involvement helps with detection
diminished radiolucency in furcation indicates disease
Any marked bone loss in a molar furcation in involved
Discrete lateral radiolucency can suggest a perio abscess
Does x-ray show more or less bone loss than reality?
X-ray shows more bone loss
