Radiology6- Periodontal Disease and Radiographic Assessment

These flashcards cover key terms and concepts related to periodontal disease and its radiographic assessment, aiding in the understanding of diagnosis and classification.

Periodontium

Specialized support structures around the teeth, including periodontal ligament, cementum, gingiva, and alveolar bone.

Hesy-Re

The first recorded dentist from 2600 BC, known as the 'Great one of the ivory cutters'.

Radiographs

Imaging technique used in periodontal diagnosis to assess bone and tissue condition surrounding teeth.

Alveolar crest

The highest point of alveolar bone that supports the teeth, should be between 0.5 - 2 mm from the CEJ.

Staging and Grading of Periodontitis

Staging refers to the extent of disease, while grading refers to the progression of the disease over time.

Vertical bitewings

A type of dental radiograph better suited for evaluating moderate to severe bone loss.

Cortical outline of alveolar bone

The outer layer of the alveolar bone, which appears well-defined and radiopaque on radiographs.

Localized periodontitis

A form of periodontal disease involving less than 30% of teeth affected; may show vertical osseous defects.

Furcation involvement

An indication of periodontal disease where the bone loss occurs in the furcation area of multirooted teeth.

CAL

Clinical attachment level, used to measure the extent of periodontal disease.

Sclerotic bone

Bone that appears denser or radiopaque in chronic periodontitis, usually indicative of a chronic inflammatory response.

'Floating Tooth' appearance

A clinical presentation of a tooth that has lost significant support structure due to bone loss, giving the appearance of being suspended.

Primary criteria for grading

Includes direct evidence such as longitudinal data of radiographic bone loss or CAL.

Direct evidence of progression

Observable changes in clinical attachment level (CAL) over time or changes in radiographic bone loss.

Calculus

Tartar build-up on teeth, a local initiating factor that can contribute to periodontal disease.

Pathologic considerations in radiographs

Refers to potential issues like caries, periapical lesions, and root resorption, which can affect periodontal health.

Moderate chronic periodontitis

A clinical diagnosis may result in a variety of bone defects and shows horizontal bone loss.

Bone loss patterns

Classified as localized, generalized, or molar/incisor pattern based on the extent of the affected sites.

perio dontium

around teeth

radiographs purpose

permanent records of periodontium

Bitewings used for

interproximal caries and bone loss

used to view anterior crestal bone

normal PA, can take BW but not common

vertical bitewings 

used to view bone levels, 3 can be taken 

vertical angulation

separates tooth cusps and gives improper view of bone

Bitewings used to test bone

because of proper vertical angulation to view bone and interproximal spaces

Bitewings are more accurate than PAs 

due to lack of distortion by incorrect vertical angle

localized patterns of bone loss/change

<30% of teeth involved

generalized bone loss pattern

molar/incisor bone loss pattern

staging

extent of disease

grading

progression of disease over time

radiographs asses

bone in mm/%

alveolar crest health

bone loss at furcation

width of PDL

initiating factors (restorative overhang/calculus)

root length and morph

crown to root ratio

anatomical perio eval considerations

root proximity

proximity to maxillary sinus

missing, supernumerary and impacted teeth

pathologic considerations of perio eval

caries, lesions, root resorption

stages

1,2,3,4

grade

a,b,c

normal alveolar bone

normal alveolar bone

first sign of bone loss is loss of cortication of interproximal bone

local/initiating factor

calculus

limitations to radiographs 

two dimensions

underestimation of bone loss and caries

lacks soft tissue visibility 

periodontal disease is diagnosed

clinically not radiographically

horizontal bone loss

horizontal bone loss

parallel movement of alveolar crests towards the apex of the tooth 

mild horizontal bone loss

blunting of alveolar crests and slight loss of height

loss of height around multiple teeth may involve furcation

moderate horizontal bone loss

severe horizontal bone loss

vertical bone loss

vertical bone loss

vertical bone loss

seen on radiographs as a non parallel line of bone loss

bone loss with furcation involvment

first sign of vertical bone loss

PDL space widens towards the crest

first radiographic sign of furcation involvement

pdl widening at furcation

circumferential bone loss

known as cratering in a localized area around the tooth, indicating periodontal disease.

moderate to severe horizontal bone loss

moderate to severe horizontal bone loss

vertical bone loss M/D of #2

effects of bone loss on adjacent bone

inflammatory response to perio lesions and

more sclerotic/ radiolucent peripheral bone

sclerotic reaction of adjacent bone in perio

usually to chronic cases

radiolucent or lytic response of adjacent bone

more common in acute cases

condensing osteitis

sclerotic bone in areas of chronic periodontitis 

advanced stages of perio

extensive horizontal bone loss or extensive vertical defects

osseous defects in furcation of multirooted teeth 

floating tooth

bone scar after extraction

periodontal abscess

rapidly destructive lesion originating in deep soft tissue pocket

if acute=no radiographic signs

localized bone loss

less than 30% of sites effected

vertical osseous defects

severe and rapid loss

worse on incisors and first molars 

generalized bone loss 

more than 30% of sites affected

stage IV perio