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radiographic diagnosis of periodontal disease

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RADIOGRAPHIC DIAGNOSIS OF PERIODONTAL DISEASE FATHIMA SISINI The Role of Radiology in Assessment of Periodontal Disease Both clinical and radiographic data are essential for diagnosing the presence and extent of…
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  2. The Role of Radiology in Assessment of Periodontal Disease
    • Both clinical and radiographic data are essential
    • for diagnosing the presence and extent of periodontal disease.
    • Clinical information includes:
    • ? Bleeding indices
    • ? Probing Depths
    • ? Edema
    • ? Erythema
    • ? Gingival Architecture
  3. ? Radiographs are especially helpful in evaluation of:
    • ? Amount of bone present
    • ? Condition of the alveolar crests
    • ? Bone loss in the furcation areas
    • ? Width of the PDL space
    • ? Local factors which can cause or intensify periodontal disease
    • ? Root length and morphology
    • ? Crown to root ratio
    • ? Anatomic issues:
    • ? Maxillary sinus
    • ? Missing, supernumerary and impacted teeth
    • ? Contributing factors
    • ? Caries
    • ? Apical inflammatory lesions
    • ? Root resorption
  4. Limitations of Radiographs
    • Conventional radiographs provide a two dimensional image of complex, three
    • dimensional anatomy.
    • Due to superimposition,the details of the bony architecture may be lost
    • Radiographs do not demonstrate incipient
    • disease, as a minimum of 55-60%demineralization must occur before radiographic changes are apparent
    • Radiographs do not reliably demonstrate softtissue contours, and do not record changes inthe soft tissues of the periodontium. Therefore, only a careful clinical examination,combined with a proper radiographic diagnosing the presence and extent of periodontal disease. Since gingivitis is a lesion of soft tissue only, no radiographic changes willbe seen.
  5. Radiographic Technique
    • ? The optimal projections for periodontal
    • diagnosis in the posterior teeth are bitewing radiographs
    • If significant amounts of bone loss are
    • suspected (based on clinically assessment
    • including probing depths and gingival
    • recession), vertical bitewing radiographs
    • are indicated
  6. Radiographic Technique
    • ? In the anterior, anterior periapical
    • projections, exposed using the paralleling
    • technique, are adequate
    • ? Anterior bitewing projections are also used for assessing periodontal disease
  7. Radiographic Technique
    • ? Posterior periapical projections tend to
    • display somewhat foreshortened views ofthe maxillary molar teeth
    • ? The foreshortening of the image tends toproject the buccal plate of bone coronally. The resultant image displays greater bone height than actually exists
  8. Radiographic Technique
    • ? Exposure factors also play a role in increasing
    • the diagnostic yield from the radiographs
    • ? By using a higher kVp setting (90kVp), instead
    • of the customary 70 kVp, and reducing the mAs,
    • a radiograph with a wider gray scale will be
    • produced. This allows subtle changes in bone density, as well as soft tissue outlines, to be discerned.
  9. Radiographic Technique
    • ? The x-ray beam must be perpendicular tothe 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
  10. Normal Anatomy
    • ? The bone height is within 2 millimeters of the(CEJ)
    • ? The crestal bone is a continuation of the lamina
    • dura of the teeth, and is continuous from tooth
    • to tooth
    • ? Between the anterior teeth, the alveolar crest is
    • pointed
    • ? Between the posterior teeth, the lamina dura
    • and the crestal bone form a box, with sharp
    • angles
  11. Normal Anatomy
    • ? The periodontal ligament space varies along the length of the roots. It tends to be wider at the
    • apex and alveolar crest, and narrower in the midroot areas.
    • ? The joint between the tooth and alveolar bone is a gomphosis. The periodontal ligament allows movement around a center of rotation. The center of rotation is midroot. Therefore, the greatest movement will be at the apex and alveolar crest. As bone is lost, the center of rotation moves toward the apex
  12. Radiographic Changes seen in Periodontal Disease
    • ? Periodontal disease causes inflammatory lesions in the marginal bone
    • ? Both osteoblastic and osteoclastic activity is seen
    • ? Osteoclastic activity will cause changes in the
    • morphology of the crestal bone
    • ? Initial response is destruction of bone. Chronic
    • lesions will show some osteosclerosis
  13. Mild Marginal Periodontitis
    • ? Localized erosions of the marginal bone
    • ? Thinning of crestal lamina dura
    • ? Loss of sharp border with the lamina dura of the adjacent teeth
    • ? Loss of spiking in the anterior
    • ? Slight loss of bone height (<1/3)
  14. Moderate Marginal Periodontitis
    • ? Generalized form demonstrates horizontal
    • bone loss
    • ? Localized defects include vertical bone loss and loss of buccal and lingual cortices
    • ? Loss of buccal or lingual cortex is difficult to view radiographically. It may be seen as decreased density over the root surface(semicircular radio lucency with apex directed apically)
    • ? Horizontal bone loss refers to the loss in height of the crestal bone around the teeth.
    • ? Horizontal bone loss may be:
    • ? Mild
    • ? Moderate
    • ? Severe
    • ? Crest remains generally horizontal
    • ? Bone loss seen on radiographs is an
    • indicator of past disease activity
    • ? Once periodontal treatment is initiated
    • and the disease is in remission, bone levels will not increase.
    • ? Therefore, clinical examination is necessary to determine the current disease status of the periodontium
  16. Severe Marginal Periodontitis
    • ? Patient may have horizontal or vertical bone
    • loss, or a combination of generalized horizontal
    • bone loss with localized vertical defects
    • ? Bone level is in the apical 1/3 of the root
    • ? Clinically, the teeth may be shifting, tipping, or
    • drifting
    • ? Bone loss may be more extensive than is
    • apparent on the radiographs
  17. Vertical Bone Loss
    • Usually localized to one or two teeth. May be several areas of vertical bone loss throughout the mouth
    • two types
    • 1) Interproximal crater;-small sausage shaped bony defect at crest of interdental bone
    • 2)Infrabony defect;-Vertical Defect along root of tooth
    • Initial appearance is widened periodontal ligament space
    • ?May be one, two, or three walled, based on loss of the cortices
  19. Furcation Bone Loss
    • ? Bone loss from periodontal disease may
    • extend into the furcations of multirooted
    • teeth (Molars and Premolars)
    • ? Initially seen as widening of the
    • periodontal ligament space at the crest of
    • the furcation
    • ? As lesion progresses, the bone loss progresses apically
  20. Furcation Bone Loss
    • ? May initiate from the buccal or lingual
    • cortex
    • ? Root anatomy may make radiographic
    • detection of furcation bone loss difficult.
    • Three rooted teeth, incorrect horizontal
    • angulation of the radiograph, and
    • overlying structures may interfere with detection
  21. Periodontal abscess
    • Rapidly progressing destructive disease originate from soft tissue pocket
    • Acute lesions cannt view through radiograph
    • Chronic-radiolucent lesion superimposed over root, surrounded by bony rarefactions
  22. Aggressive Periodontitis
    • ? Patients <30 years
    • ? Exaggerated reaction to minimal plaque
    • accumulation
    • ? May result in early tooth loss
    • ? Localized or generalized
    • ? Localized form is also called Localized
    • Juvenile Periodontitis (LJP)
  23. Localized Juvenile Periodontitis
    • ? Seen in second decade
    • ? Primarily involves first molars and central incisors (teeth that erupt first)
    • ? Rapid bone loss
    • ? Minimal amounts of plaque
    • ? Over time, other teeth are involved
    • Drifting and mobile incisors,early loss of first molars
  24. Localized Juvenile Periodontitis
    • Deep vertical bony defect commonly around maxillary molars and incisors which is bilaterally symmetrical
  25. Generalized aggressive periodontitis
    • Affect variable number of teeth
    • Gingiva may be normal or have exuberant inflammatory response
    • Premature loss of deciduous teeth and early loss of permanent teeth
    • Horizontal or vertical bone loss arround many teeth
  26. Dental conditions associated with periodontal disease
    • 1)occlusal trauma
    • Primary;- due to fault occlusion, occlusal pre maturities,bruxism
    • Secondary:-normal occlusal force overloaded on periodontally compromised teeth
    • Widening of pdl space, thickening of lamina dura ,bone loss, increase in number and size of bony trabeculae
    • Hyper cementosis and root fractures
  27. 2)Tooth mobility
    • Widening of pdl
    • Single rooted teeth-socket may be hour glass shaped
    • Multi rooted teeth;-widening of pdl at apex and at furcations
    • Lamina dura may be broad,hazy and increased density
  28. 3)Open contacts
    • Tapped food in b/w these contacts initiate local inflammation then to periodontitis
  29. 4)Local irritating factors
    • Calculus
    • Over hanging restoration
    • Poorly contoured margins
    • Foreign bodies
  30. Evaluation of periodontal therapy
    • Radiographs used to detect the periodontal treatment prognosis
    • Reformation of inter proximal cortex and sharp angles b/w cortex and lamina dura
    • Radiolucent areas become more sclerotic
    • Decrease in crown root ratio
    • radiographs are not 100% reliable prognosis detection aid due various exposure and examination variables
  31. Differential diagnosis
    • 1)Squamous cell carcinoma:- extensive bone destruction in localized area with invasion, not respond to normal periodontal therapy
    • Lesions are with ill defined borders and lack of peripheral sclerosis
    • 2)langerhans cell histiocytosis :- single or multiple regions of bone destruction similar to LJP.but pattern of bone lose from the mid root region gives an ice-scoop shaped bony deformity. alveolar crest is intact
    • Other diseses include:-
    • Diabetes mellitus
    • Lukaaemia, hemophilia,polycythemia etc
    • Papillon lefevere syndrome,down syndrome,hyphophosphatemia etc
    • These diseases distinguished by clinical and histopathological examinations along with radiographic diagnosis
  32. bibliography
    • Text book of radiology-white and pharow
    • Text book of periodontology-carranza
  33. thank you......

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