Radiography of periodontal disease Flashcards
(26 cards)
What 3 things do radiographs establish in periodontal disease?
- Stage (severity)
- Grade (rate of progression)
- Extent
How do we diagnose periodontal disease?
History
Examination
BPE
Evaluation for historic periodontitis (interdental recession)
When should radiographs be used?
Once presence of periodontal disease using has been established using the above methods
Radiographs can then determine severity and rate of progression of the disease
What is the only reliable feature of a healthy periodontium?
The relationship between the crestal bone margin (top of alveolar bone) and the cemento-enamel junction
If this distance is 2-3mm and there are no clinical signs of attachment loss, then there is no periodontitis
How will the margins appear in relation to the interdental crestal bone in posterior regions?
thin, smooth, evenly corticated
Why is the bone crest not always evident in radiographs?
due to bucco-lingual thin nature of bone in this region
How is the interdental crestal bone related to the lamina dura?
is continuous with the lamina dura of the adjacent teeth
The junction of the two forms a sharp angle.
There is a thin, even width to the mesial and distal periodontal membrane spaces
What information does radiographs give us?
Bone loss
Mobility
Occlusal trauma
Calculus and marginal overhangs
Crown-root ratios
Sclerosis
What are the patterns of bone loss for each individual tooth?
- Horizontal
- Vertical
- Furcation involvement
What are the patterns of bone loss for the overall dentition?
- Generalised
- Localised
- Molar-incisor pattern
What are the limitations of radiographs?
- 2D view of 3D situation
- Bony defects may be hidden
- Only interproximal bone seen clearly
- Radiographs underestimate bone destruction (30-50% of bone mineral content must be lost before changes are detected radiographically)
- No information on soft tissues
What happens in horizontal bone loss?
crest is horizontal relative to the occlusal plane and is positioned apical to the normal level
a loss of buccal and lingual cortices and intervening trabecular bone
What happens in vertical bone loss?
There is a discrepancy in degree of bone loss at 2 adjacent sites which may indicate rapid bone loss and can be due to anatomy
There may be an intrabony defect (3/2/1 walled) as well as combined lesions
There can also be angular defects
Can vertical and horizontal bone loss occur simultaneously?
yes
How is furcation involvement detected?
May be detectably by probing
On the radiograph, there is radiolucency where there is furcation
Furcation at the upper molars appear as radiolucent arrowhead
acts as PRF
What is included in combined lesions?
both periapical and periodontal bone loss legions
May be primarily periapical or primarily periodontal
How do we know if there is mobility from the radiograph?
widening of the periodontal membrane space – implying tooth mobility
teeth may be mobile without any radiographic changes
How does mobility occur?
when the normal occlusal forces overload the reduced periodontium leading to mobility
What are some consequences of occlusal trauma?
Marginal widening
Angular defect
Root resorption
Hypercementosis
Root fracture
Loss/thickening of lamina dura
Bone sclerosis
What 3 things control whether you can see calculus in a radiograph?
size, location, and degree of calcification deposit
However, careful probing is more accurate
In restorative dentistry, how are radiographs useful?
- Overhang amalgams
- Crown margins
- Occasional pin perforation
What does sclerosis osteitis indicate?
chronic osseous inflammation
What are the 3 types of radiographic views used?
panoramics
bitewings
periapicals
Describe panoramic radiographs
Show the entire dentition in one image
Contact points overlap
Is sensitive to patient positioning
More time efficient
Has lower dose vs full mouth periapicals
Are well tolerated by patients
