Radiographic Interpretation of Bone/Periodontal Disease

Which type of bone is the dense, outer layer that appears radiopaque?

cortical (compact) bone

Which type of bone is located between the two layers of cortical bone, and has mixed radiolucent and opaque areas?

cancellous (spongy) bone

What is the lamina dura?

thin layer of dense cortical bone that lines the sockets of teeth

• radiopaque line

• break in the line could indicate periodontal condition

What is the alveolar crest?

the most coronal portion of the alveolar process

• appears radiopaque

• typically located 1.5-2.0mm below the CEJ

What is the periodontal ligament space?

the space between the root of the tooth and the lamina dura

• appears radiolucent

What is the periodontium?

tissues that support the teeth such as the:

• alveolar bone

• gingiva

• periodontal ligament

_____ is the inflammation of the gingiva.

Gingivitis

____ is the destruction of the bone and PDL space.

Periodontitis

In order to detect periodontal disease, you must have both _______.

clinical and radiographic examination

Radiographs show the amount of ___ present.

bone

Radiographs show the ___, ___, and ___ of bone loss.

pattern, distribution, and severity

Radiographs can be used to identify _____ to periodontal disease.

predisposing factors such as: calculus, poor margins on restorations, breaking down of old restorations

Readiographs serve as a _____ of the bone at a specific point in time.

permanent record

In which part of treatment can radiographs be used?

pre-treatment, during treatment, and post-treatment

Which type of radiograph is best suited for the evaluation of bone loss?

the periapical

• because both the root and the crown of the tooth are visible

Why does the ______ has limited use in the evaluation of bone loss.

horizontal bitewing because you cannot see bone levels in moderate/severe bone loss pts

What can vertical bitewings be used for?

evaluation of bone loss

• especially helpful for post-treatment and follow up

Which type of radiograph has little diagnostic value and is not recommended for bone loss evaluation?

the panoramic

How do you describe the pattern of bone loss?

either horizontal or vertical

What is horizontal bone loss?

bone loss that occurs parallel to the CEJ

• use the CEJ as a reference point

What is vertical bone loss?

a severe drop in bone level from CEJ towards the apex of the tooth

• use the CEJ as a reference point

How do you describe the distribution of bone loss?

either localized or generalized

What is localized bone loss?

bone loss that occurs in an isolated area within the maxilla or mandible

What is generalized bone loss?

bone loss that occurs evenly in more than 30% of the maxilla and mandible

How do you describe severity of bone loss?

either slight, moderate, or severe

• uses CAL: measurement from CEJ to base of periodontal pocket

What is slight bone loss?

1-2mm

What is moderate bone loss?

3-4mm

What is severe bone loss?

5mm or greater

What are some radiographic appearances during early bone loss?

• crestal bone irregularities

• indistinct outline of interdental alveolar crest

• lamina dura is unclear

What are some radiographic appearances of moderate to severe bone loss?

• Horizontal or vertical bone loss may be present

• May be localized or generalized

• Possible furcation involvement

Bone loss seen radiographically is an indicator of _____.

previous disease activity

Bone levels (will/will not) increase after treatment.

will not

What must ALWAYS occur to determine current disease status?

clinical examination