Radiographic Aids in the Diagnosis of Periodontal Disease

• The bone is reduced in height • Bone margin remains perpendicular to the tooth surface

Describe horizontal bone loss

• Concavities in the crest of the interdental bone within the Fa and Li walls (1/3 of all defects) • Are seen as irregular areas of reduced radiopacity on the alveolar bone crests • X-rays DO NOT accurately show morphology/depth of the craters

Describe interproximal craters (bone destruction pattern)

• Occur in an oblique direction along side the root surface • The base of the defect is located apical to the surrounding bone • Vertical defects may have one, two, or three walls

Describe vertical bone loss

• Grade I: Pocket formation, intact interradicular bone. • Grade II: Interradicular bone loss, pocket formation in the furca , not completely through to the opposite side of the tooth. • Grade III: Through and through lesion. • Grade IV: Same as grade III with gingival recession, furcation clearly visible in clinical examination.

What are the 4 furcation classifications?

Bitewing

What is the most diagnostically accurate radiograph?

An area of radiolucency along the lateral aspect of the root

What is the typical radiographic appearance of the periodontal abscess?

Horizontal bone loss

What kind of bone loss is the most common pattern of bone loss in periodontal disease?

On the side of the root; it is a radiolucent image bordered by a radiopaque line

Where is a lateral periodontal cyst located?

Placed in the Fa pocket

Where should you place your probe/ gutta percha in a radiograph to indicate bone loss?

Vertical bitewings

Which is more informative at detecting moderate to severe periodontal disease? Vertical or horizontal bitewings?

Greater than

Regarding bone loss: As a general rule, bone loss is always > or < than it appears on radiographs

• Is not • clinically

Regarding bone loss: Early destructive changes in bone is/is not captured in x-rays. Early signs of perio disease is detected ____.

• bone loss • single molar root

Regarding furcation involvement: Whenev there is _____ in relation to a _____ root, it may be assumed that the furcation is also involved

Biopsy

Regarding lateral periodontal cysts: Differential diagnosis may be difficult without what?

1. Lamina dura 2. Morphology of alveolar crest 3. Width of PDL 4. Density of surrounding cancellous bone **Indicative os tooth mobility, fremitus, or occlusal trauma

Regarding trauma from occlusion: Radiographically, we can have detectable changes in what 4 things?

Underestimates the amount of bone loss

Because of distortion, what do PA's have a tendency to do in terms of amount of bone loss?

2 wall defects

Interproximal craters are ___ wall defects

No — alveolar crest and CEJ between adjacent teeth are parallel

Is this showing vertical bone loss?