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23 Radiology > 11 - Periodontal Diseases > Flashcards

11 - Periodontal Diseases Flashcards

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1
Q

what is heterogenous collection of diseases affecting periodontium

A

periodontal disease

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2
Q

what is perio disease characterized by

A

inflammatory host response in periodontal tissues

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3
Q

resulting changes in perio disease may present how?

A

localized or generalized

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4
Q

in ___, resulting changes may be localized or generalized alterations in supporting bone and soft tissues around the teeth - ultimately loss of teeth

A

periodontal diseases

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5
Q

what is the disease pathway for perio disease

A
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6
Q

where does perio inflammatory destruction begin

A

gingival sulcus

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7
Q

where is bone loss in perio disease? what widens

A

loss of bone at alveolar crest and widening of periodontal ligament space

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8
Q

is perio purely horizontal or vertical bone loss?

A

combo of both

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9
Q

how is periodontal disease assessed

A
  1. Clinical examination is completed first
  2. Radiologic images are an adjunct
  3. Prescription of radiographic images are
    indicated when the clinical examination
    suggests periodontitis
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10
Q

what do you look for in radiographic assessment of periodontal conditions

A
  1. Amount of bone present
  2. Condition of alveolar crests
  3. Bone loss in the furcation areas
  4. Width of periodontal ligament space
  5. Local irritation factors that increase the risk of periodontal diseases (calculus, poorly contoured or overextended restorations, open interproximal contacts)
  6. Missing, supernumerary, impacted, and tipped teeth
  7. Root length and morphology and crown-to-root ratio
  8. Root Resorption
  9. Caries
  10. Periapical lesions
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11
Q

what are imaging modalities for perio disease

A
  1. intraoral imaging
  2. pano imaging
  3. CBCT
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12
Q

___ images should be considered the primary imaging
choice for characterizing periodontal diseases

A

Bitewing

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13
Q

what Accurately depict the distance between the CEJ and crest of
interradicular alveolar process

A

bW

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14
Q

what helps evaluate percentage of root affected by bone loss

A

PA imaging

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15
Q

T/F: in BW imaging, plane of the image receptor is parallel to long axis of tooth and X-ray beam is directed perpendicular to long axis of tooth

A

TRUE

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16
Q

the teeth are depicted in their correct position relative to alveolar process when:

A
  1. No overlapping of the interproximal contacts between the tooth
    crowns
  2. No overlapping of the roots of adjacent teeth
  3. Buccal and lingual cusps of the molars are superimposed over one
    another
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17
Q

who gets VERTICAL BW

A

In patients with moderate to severe clinical attachment
loss, horizontal bite wings may not depict alveolar crest
loss

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18
Q

how is vertical BW oriented

A

The receptor is reoriented at 90 degrees; same size 2
image receptors are used; oriented such that the long axis
of the receptor is in a vertical orientation

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19
Q

limintations of intraoral images

A
  1. 2 dimensional repregentatio of three dimensional anatomical structures (Where objects superimpose (maxillary molar root furcation, buccal lingual cortical plates) bone loss often not seen)
  2. 2D usually underestimate bone loss
  3. No soft tissue changes are seen
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20
Q

what xray

Relatively quick and easy to acquire
Provide an overview of teeth and jaws in a single image

A

pano

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21
Q

limitationons of pano

A
  1. 2 dimensional representation of three dimensional anatomical structures
  2. Superimpositions and distortion and lower resolution, especially in the anterior areas of jaws
  3. Discouraged to use it as a primary imaging tool for periodontal disease
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22
Q

what xray

Ability to 3D visualize oageous supporting structures of teeth from any angle
No anatomical superimposttion
Allows better visualization of periodontal defects
Complex vertical defects, craters, furcation, buccal and lingualcortical plate loss

A

CBCT

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23
Q

limitations of CBCT

A

Imaging artifacts by metallic restorations
Low contrast resolution than intraoral radiographs
Current evidence doed not slipcort the routine use of CBCT for imaging of the periodontium
Especially when cost and radiation dose is considered

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24
Q

Thin layer of ___ often overlies the crest
of the alveolar process

A

radiopaque cortical bone

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25
Height of crest lies at a level that is approx. ___ mm apical to the levels of the CEJs of adjacent teeth
0.5 to 2.0 mm
26
Between posterior teeth, alveolar crest is oriented [parallel or perpendicular] to an imaginary line connecting adjacent CEJs
parallel
27
Between anterior teeth, the alveolar crest is a [line OR point] between the teeth that may have a well-defined cortex
point
28
alveolar crest should be continuous with what part of adjacent teeth
lamina dura
29
should the junction between lamina dura and alveolar crest be a SHARP or BLUNT angle
sharp
30
should PDL space be thick or thin
THIN
31
prominent vascular canals in xray are ofetn associated with what
perio disease
32
what are imaging features of perio disease
1. Changes in morphology of the supporting bone - Loss in interproximal crestal bone and bone overlying buccal and lingual surfaces 2. Changes to the trabecular density and pattern - Reduction or increase in bone trabeculation or both
33
what are early changes of alveolar process morphology
localized erosion of interproximal alveolar crest
34
what does anterior and posterior region look like in early changes of alveolar process
Anterior region: blunting of crest and slight loss of height Posterior region: Loss of normal acute angle between lamina dura and alveolar crest
35
how can alveolar process defects be described
Horizontal or vertical in nature Inter dental craters and furcation defects Loss of buccal or lingual cortical plates
36
what type of bone loss
horizontal
37
what type of bone loss
vertical
38
what bone loss: Loss of alveolar bone where the crest is still horizontal (crest more apical than 0.5-2 mm) - parallel to the line joining CEJ
horizontal bone loss
39
when CEJ of adjacent teeth are at diferent horizontal levels, what can the alveolar crest look like
may have an ANGLED appearance
40
crest distance for normal, minimal, moderate, and severe loss
normal: 0.5-2mm minimal: 2-4 mm moderate: 4-6 mm severe: >6 mm
41
what bone loss: Appearance of bone losd that is localized at one or both root surfaces of a single tooth An individual may have multiple osseous defects
vertical bone loss
42
what is vertical bone loss associated with
late stages of periodontitis
43
what bone loss: Radiographically, outline of the remaining alveolar process typically displays an angulation that is oblique to the imaginary line connecting the CEJ
vertical bone loss
44
what are two walled trough-like depression that develops in the crest of alveolar process between adjacent teeth
interdental craters
45
what causes interdental craters
cancellous bone between buccal and lingual plates is resorbed
46
what feature: Radiographically, it appear as a band-like or irregular region of bone with less density at crest, immediately adjacent to more dense normal bone apical to base of crater
interdental craters
47
are interdental craters more common in anterior or posterior region
posterior
48
what is this
interproximal craters
49
how to determine if buccal or lingual defect
use SLOB rule
50
progressive periodontal disease and associated bone loss may extend where
to furcation of multirooted teeth
51
what is strong evidence of furcation involvement in radiograph
widening of PDL space at the apex of interradicular bony crest
52
what is visible with a mandibular molar furcation
if sufficient loss of bone on lingual or buccal surface, radiolucent image of furcation becomes prominent
53
what is visible on maxillary molar furcation
not as sharply defined because palatal root is superimposed over defect (inverted J-shape R/L hook of J extends into trifurcation)
54
what is this
furcation bone loss
55
definitive diagnosis of complex furcation deformities requires what
careful clinical examination and sometimes surgical exploration
56
what is an important tool to identify potential involved sites of osseous deformaties in furcations
intraoral images
57
is perio disease capable of stimulating a reaction in adjacent surrounding bone
yesssir
58
what opacity reflects the loss of density and number of trabeculae
radiolucent change
59
what opacity changes due to the deposition of bone on existing trabeculae
radiopaque change
60
when there are changes in internal densities and trabecular pattern, does surrounding bone reaction usually have a mixture of bone loss and sclerosis
YES
61
what happened to the bone
resorption with no new bone
62
what happened to the bone
loss of upper alveolar bone but extensive diffuse sclerosis below
63
what can cause the widening of PDL, thickening of lamina dura, bone loss, and increase in number and size of trabeculae
occlusal trauma
64
what does the widening of PDL cause
tooth mobility
65
what does calculus and plaque formation and defective formation cause
local irritaitng factors
66
what is rapidly progressing, destructive lesion that usually originates in the deep soft tissue perio pocket
perioontal absecess
67
what results from occlusion of the coronal portion of perio pocket or lodging of foreign material between tooth and gingiva
perio abscess
68
what does perio abscess lesion look like if ACUTE
no radiographic change
69
what does perio abscess lesion look like if PERSISTENT
radiolucent region appears; may be a focal, round area of R/L with loss of lamina dura of involved root surface
70
what are the arrows
71
where do you most commonly see calc
mand incisors
72
what may be localized to any surface or generalized throughout the mouth
calculus
73
calccccy
74
T/F: Overhanging or poorly contoured margins can also lead to accumulation of plaque, where periodontal disease may develop.
TRUE
75
margin overhang ultimately causing perio problemas
76
what is deep angular bone defect extending to tooth apex communicating with PA rarefying osteitis
endo-perio lesions
77
what defect may slightly widen at alveolar crest creating FUNNEL LIKE SHAPE
endo-perio lesions
78
post perio therapy, do xrays ALWAYS show signs of sucessful tx
NO! occassionally does
79
what are indicators of stabile perio disease in radiograph? is this seen in all patients?
Reestablishment of interpro ciral crestal cortex and the sharp line angle between cortex and lamina dura are good indicators of stabilization of disease. These signs are not seen in all patients.
80
is perio disease healing best assessed clincially or thru radiograph
CLINICAL HEALING
81
what does this show
after successful perio tx, a corticated alveolar crest is formed
82
what are differental perio diagnoses
1. malignant neoplasms 2. LCH
83
what is this: Extensive bone desiruction of a localized area beyond periodontium Invasive characteristics Irregular widening of PDL space Ragged or regular periphery and destruction of lamina dura
malignant neoplasm
84
what problem
squamous cell carcinoma
85
what problem
Langerhans' cell histiocytosis (epicenter at middle of root instead of crest)
86
does LCH occur in single or multiple regions of bone around roots of tooth
BOTH! could be in single or multiple regions
87
what is appearance of teeth floating in air that are similar to severe periodonttitis
LCH
88
where is the epicenter of bone destruction in LCH
midroot level (not crest)
89
does 2D imaging show all bone loss
NO
90
T/F: it is very important to combine clinical and radiographic findings
TRUE
91
T/F: compare changes over time to determine activity
true
92
T/f: one set of images gives a history of all changes but not recent changes
true

23 Radiology (15 decks)

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