Radiographs And Bone loss

Question 1

Radiographs are especially helpful in evaluation of the following points:

Answer 1

Amount of bone present

Condition of the alveolar crests

Bone loss in the furcation areas

Width of the PDL space

Question 2

Local factors which can cause or intensify periodontal disease

Answer 2

1.Caries
2.Calculus
3.Overhanging restorations

Question 3

Normal crown to root ratio is

Answer 3

1:2

Question 4

Anatomical crown always starts from ——–

Answer 4

cej

Question 5

Clinical crown is the visible portion of the crown in oral cavity so its not necessarily starts from ——

Answer 5

cej

Question 6

Interdental bone is always spine like T/F

Answer 6

FaLSE Because it follows the level of cej and convexity of proximal tooth surface so its not necessary

Question 7

Periapical radiograph shows

Answer 7

Either maxilla or mandible but along with periapical area

Question 8

Bitewing radiograph shows

Answer 8

both maxilla and mandible but not periapical area

Question 9

If assessing bone loss is not possible radiographically then?

Answer 9

we will raise flap

Question 10

2 types of bone loss pattern

Answer 10

1.Horizontal
2.Vertical

Question 11

This pattern of bone loss is Most common and mostly occuring mandibular anterior teeth?

Answer 11

Horizontal

Question 12

Unlike horizontal bone loss its very difficult to detect vertical bone loss why?

Answer 12

Because other surfaces (unresorbed) may superimposed over a resorbed one

Question 13

Only ——— sides vertical bone loss can be diagnosed properly

Answer 13

Mesial and Distal

Question 14

Why in furcation defect Endodontic treatment is preferred first?

Answer 14

Because most of the times root is also infected in furcation defect

Question 15

Second Molar is a good candidate for RSR T/F

Answer 15

F, As it doesnt have good visibility and accessibility

Question 16

The facio-lingual diameter of the bone is related to the ——–

Answer 16

width of the proximal root surface.

Question 17

Classify radiographs in dentistry?

Answer 17

Intra- Oral Radiograph
Periapical view
Bite wing
Occlusal View

Extra- Oral Radiographs
OPG
Lat: Ceph
Anterio- Posterior view
Posterio- Anterior View
Lateral Oblique View
Oxipito- Mental view.

Question 18

Proper Radiographic technique

Answer 18

The x-ray beam must be perpendicular to the long axes of
the teeth and the plane of the image receptor.

The image receptor must be parallel to the long axes of the
teeth.

Question 19

Radiographs commonly used in periodontology?

Answer 19

In conventional radiographs,

periapical

bite-wing projections

Both offer the most diagnostic information and are most commonly used in the evaluation of periodontal disease.

Rarely

OPG (Orthopantomagram)

Question 20

Prichard put forward the following four criteria for the determination of adequate angulation of periapical radiographs:

Answer 20

1.The periapical radiograph should have the ability to show the cusps of molars with apical surface.

2. Enamel and pulp chambers should be seen and distinct.
3. Open interproximal spaces.

4.Contacts between the adjacent teeth should not overlap unless teeth are out of line.

Question 21

Exostosis?

Answer 21

Overgrowths of bone
They can occur as small or large nodules, sharp ridges , spike-like projections.

Question 22

Explain fenestration and dehiscence

Answer 22

Fenestrationis the condition, in which the bony coverage of the root surface is lost, and the root surface is only covered by the periosteum and gingiva. In such lesions, marginal bone is intact. When this bone defect spreads toward the marginal bone, it is calledDehiscence.

Question 23

Causes of bone destruction?

Answer 23

(i) Extension of gingival inflammation

(ii) Trauma from occlusion

(iii) Systemic disorders

Question 24

Systemic disorders causing bone destruction?

Answer 24

1.Leukemia
2.Hyperparathyroidism
3.Langerhan cell histiocytosis

Question 25

Bone Destruction patterns (All)

Answer 25

Horizontal bone loss Vertical or angular defects Osseous craters Bulbous bone contours Ledges Furcation involvement

Question 26

Horizontal bone loss

Answer 26

Most common pattern Bone is reduced in such a way that the bone margin is approximately perpendicular to the teeth surface Inter-dental septa and facial and lingual plates of bone are affected, but necessarily to an equal degree around the same tooth.

Question 27

Vertical bone loss?

Answer 27

An abnormal decrease in alveolar bone on one proximal surface of a tooth in comparison to the tooth on the adjacent side. This uneven reduction in the height of the alveolar bone is less common than horizontal bone loss and produces an infra-bony pocket.

Question 28

Angular defects classification is given by?

Answer 28

Depending on number of walls present , angular defects were classified by Goldman and Cohen (1958)

Question 29

Explain 3,2,1 wall oseous defect? (remember oseous crater and oseous defect are different)

Answer 29

When the soft tissue which lines the pocket is surrounded by three walls of bone, the defect is described as a three-wall defect. If the defect is lined by only two walls of bone, the defect is a two-wall defect.  If the defect is lined by only one wall of bone, then it is known as a one-wall defect.

Question 30

Angular defects of facial and lingual or palatal surfaces are not seen on radiographs Surgical exposure is the only way to determine the presence and configuration of vertical osseous defects T/F

Answer 30

T

Question 31

Common areas and age of vertical defects?

Answer 31

Radiographically detected defects appear most often on the distal and mesial surfaces However, three-wall defects are more frequently found on the mesial surfaces of upper and lower molars. Old age

Question 32

Osseous craters?

Answer 32

They are concavities in the crest of the interdental bone confined within the facial and lingual walls.

Question 33

Reasons of osseous craters?

Answer 33

(i) plaque accumulation and difficulty to clean. (ii) normal concavity in lower molars

Question 34

Bulbous Bone Contours?

Answer 34

Bulbous bone contours are bony enlargements caused by exostosis , adaptation to function, or buttressing bone formation. They are found more frequently in the maxilla than in the mandible.

Question 35

They can occur as small nodules, large nodules, sharp ridges, spike like projections, or any combination of these.

Answer 35

Exostoses

Question 36

Ledges?

Answer 36

Ledges are plateau like bone margins caused by resorption of thickened bony plates

Question 37

Grades Of furcation involvement?

Answer 37

(i) Grade 1 : incipient bone loss (ii) Grade 2 : partial bone loss (iii) Grade 3 : total bone loss with through and through opening of furcation (iv) Grade 4 : similar to grade 3,with gingival recession exposing the furcation to view.

Question 38

22 years young girl presented in clinic with the complain of spaces in mandibular anterior teeth, on investigation it revealed that she had orthodontic treatment one year back. On examination, mandibular left central incisor had grade 3 mobility. Question: Diagnose the case? Treatment plan?

Answer 38

Diagnosis The patient presents with severe periodontal bone loss and Grade 3 mobility in the mandibular left central incisor. Given the history of orthodontic treatment a year ago and the presence of spacing, the most likely diagnosis is: 🔹 Post-Orthodontic Periodontal Breakdown with Severe Periodontitis The clinical image shows gingival recession, alveolar bone loss, and increased spacing between mandibular anterior teeth. The radiograph reveals severe vertical bone loss, especially around the central incisors. Grade 3 mobility suggests complete loss of periodontal support, meaning the affected tooth is no longer stable. Treatment Plan 1️⃣ Phase 1: Periodontal Therapy (Initial Treatment) Oral hygiene instructions (OHI) Scaling and Root Planing (SRP) Adjunctive antibiotic therapy (if signs of active infection) Splinting of mobile teeth to provide stability Evaluate response after 4-6 weeks 2️⃣ Phase 2: Surgical Intervention (if required) Guided Tissue Regeneration (GTR) or Bone Grafting for bone defects Periodontal flap surgery if deep pockets persist 3️⃣ Phase 3: Prosthetic or Orthodontic Considerations If tooth cannot be saved, extraction may be required, followed by implant or prosthetic replacement Orthodontic retention to prevent further spacing and relapse 4️⃣ Phase 4: Maintenance & Long-Term Follow-up Regular periodontal maintenance visits every 3-6 months Patient compliance with oral hygiene is crucial to prevent recurrence

Question 39

How The transition from gingivitis to periodontitis is associated with changes in composition of bacterial plaque.

Answer 39

**Comparison Between Gingivitis and Periodontitis:** In **gingivitis**, the predominant bacteria are **coccoid rods and straight rods**, whereas in **periodontitis**, the primary bacterial type is **spirochetes**. The immune response also differs; **plasma cells** are more commonly found in **gingivitis**, while **PMNs (polymorphonuclear neutrophils)** dominate in **periodontitis**.