Radiographic Interpretation of Periodontal Disease B

Question 1

AAP classification measured by

Answer 1

the clinical attachment loss (CAL)
from CEJ to base of the sulcus or periodontal pocket

Question 2

AAP classification is classified as

Answer 2

gingivitis
stage 1
stage 2
stage 3
stage 4

Question 3

classification of periodontal disease

Answer 3

based on the amount of bone loss
images detect contributing factors for perio disease: calculus, defective restorations
before radiographic change can be seen 30 to 50% loss of mineralization must occur

Question 4

when analyzing a dental radiograph, the following are indicators of periodontal health

Answer 4

shape and character of the alveolar bone crest
presence of the lamina dura

Question 5

gingivitis radiographically

Answer 5

no associated bone loss
no change is seen in bone when viewed on a dental image: crestal lamina dura is present, alveolar crest is ~ 1.5 to 2 mm apical to the CEJ

Question 6

gingivitis clinically

Answer 6

gingiva: inflammatory process
red
swollen
bleeding
no clinical attachment loss

Question 7

what radiographic images should be taken for a new patient with gingivitis

Answer 7

pan and bitewings

Question 8

what radiographic images should be taken for a recall patient with gingivitis

Answer 8

bitewings

Question 9

AAP periodontitis: staging

Answer 9

classifies the severity and extent of a patient’s disease based on the measurable amount of destroyed and/or damaged tissue as a result of periodontitis and to assess the specific factors that may attribute to the complexity of long-term case management

Question 10

if CAL is not available to determine initial stage what can be used instead

Answer 10

radiographic bone loss should be used

Question 11

stage 1: radiographic findings

Answer 11

bone loss: coronal third <15%
crestal interdental alveolar bone becomes unclear and fuzzy and no longer appears to be a continuous radiopaque line
widening of the PDL at crestal margin (Triangulation)

Question 12

what type of bone loss is more often seen

Answer 12

horizontal

Question 13

stage 1 clinical findings

Answer 13

BOP
probing less than or equal to 4
CAL 1-2 mm
may have localized areas of slight recession
no tooth lost due to periodontitis

Question 14

stage 1 triangulation

Answer 14

widening of the PDL space
caused by resorption of bone along either the mesial or distal aspect of the interseptal crestal bone
pointed triangular appearance

Question 15

stage 1 radiographs new patient

Answer 15

pan and 4 bitewings

Question 16

stage 2: radiographic findings

Answer 16

coronal third: 15% to 33% bone loss
mostly horizontal may have slight vertical
distribution may be localized or generalized

Question 17

stage 2: clinical findings

Answer 17

perio probing depths evident
probing depths greater than or equal to 5mm
CAL loss 3 to 4 mm
BOP
recession may be present
no tooth loss due to perio
class 1 furcation

Question 18

early furcation

Answer 18

radiograph indicates early furcation - use furcation probe
radiograph has bone loss on maxilla - should have taken a vertical bitewing

Question 19

stage 2 radiographs new patient

Answer 19

pan and vertical bitewings or selective periapical

Question 20

stage 3 radiographic findings

Answer 20

associated with more severe bone loss
radiographic bone loss: extends to middle third of root and beyond greater than or equal to 34%
horizontal bone loss
vertical bone loss greater than or equal 3 mm
widened PDL
furcation involvement class II or III
osseous defects

Question 21

stage 3: clinical findings

Answer 21

probing depth greater than or equal to 6 mm
CAL greater than or equal to 5
less than or equal to 4 teeth lost due to periodontal disease
class II or III furcation involvement
mobility

Question 22

stage 3 radiographs new patient

Answer 22

pan and FMS and maybe selective periapical depends on if it is localized or generalized

Question 23

stage 3 radiographs recall patient

Answer 23

vertical bitewings, >2mm probing depth change… selective PAs

Question 24

stage 4

Answer 24

in addition to stage 3 findings it may include…
secondary occlusal trauma, tooth mobility greater than or equal to 2, less than or equal to 5 teeth lost due to perio disease

Question 25

reduced periodontium and radiographs

Answer 25

can not tell why bone loss has occurred, cannot tell if perio disease is active or inactive

Question 26

categories of periodontal health

Answer 26

intact periodontium
reduced periodontium on a successfully treated perio patient, where disease is stable/inactive
reduced periodontium in non-periodontitis patient

Question 27

clinical gingival health on an intact periodontium

Answer 27

bleeding on probing < 10%
pocket probing depths less than or equal to 3mm
no probing attachment loss
no radiological bone loss

Question 28

clinical gingival health on a reduced periodontium: stable periodontitis patient

Answer 28

bleeding on probing < 10%
pocket probing depths less than or equal 4mm
probing attachment loss - yes
radiological bone loss - yes

Question 29

clinical gingival health on a reduced periodontium: non-periodontitis patient

Answer 29

bleeding on probing < 10%
pocket probing depths less than or equal to 3mm
probing attachment loss - Yes
radiological bone loss - possible

Question 30

grading

Answer 30

aims to indicate the rate of periodontitis progression, responsiveness to standard therapy, and potential impact on systemic health
start with grade B and seek evidence to support Grade A or C
direct or indirect evidence

Question 31

use of radiographs and periodontal grading… compare current and previous radiographs to

Answer 31

look for changes in bone levels, local predisposing factors, signs of local functional factors, previous periodontal disease

Question 32

grade A: slow rate of progression

Answer 32

direct: no bone loss in 5 years
indirect: <0.25

Question 33

grade B: moderate rate

Answer 33

direct: <2 mm over 5 years
indirect: 0.25 to 1.0

Question 34

grade C

Answer 34

direct: greater than or equal to 2 mm over 5 years, if previous evidence, can look at the change directly
indirect: > 1.0, when there are no previous radiographs or probing depths

Question 35

grade modifiers for progression of periodontitis

Answer 35

smoking, diabetes

Question 36

periodontitis diagnosing

Answer 36

clinical exam, radio exam
consider: localized or generalized, gingivitis or periodontitis, is it a reduced periodontium?, stage and grade
localized periodontitis
generalized periodontitis