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Radiology Chap 25
Terms in this set (41)
Periodontal Bone Changes Recorded by Radiographs
• Crestal irregularities
• Interdental alveolar bone changes • Pattern of bone loss (horizontal/vertical)
• Distribution of bone loss (localized/generalized) • Severity of bone loss (slight, moderate, advanced)
• Furcation involvement
Case Type I: Gingivitis
The alveolar crest is located 1.5 to 2.0 mm apical to the cementoenamel junctions CEJ of the teeth
-Anterior: Pointed Posterior: Flat, smooth
Case Type II: Slight Chronic Periodontitis
-Alveolar crest: Loss of density with slight radiolucencies evident; triangulation observed
-Anterior: Blunted Posterior: Fuzzy, cupping-out appearance
Case Type III: Moderate Chronic or Aggressive Periodontitis
-Alveolar crest: Level greater than 2.0 mm below the CEJ, indicating 30-50 percent bone loss Anterior and posterior: Horizontal and/or vertical patterns of bone loss observed
-Posterior: Furcation radiolucencies evident
Case Type VI: Advanced Chronic or Aggressive Periodontitis
Alveolar crest: Easily identified with level of bone loss greater than 50 percent Anterior and Posterior: Evidence of tooth position changes, drifting
vertical bitewing series
are most useful for examining the periodontium
Excessive vertical angulation
Excessive vertical angulation may not reveal bone loss, whereas inadequate vertical angulation may result in a radiographic image that falsely indicates bone loss when there is none
Correct vertical angulation
Correct vertical angulation accurately records crestal bone indicating no bone loss between the mandibular first and second molars.
Incorrect vertical angulation
produces a radiolucent, cupping-out appearance of the lamina dura falsely indicating bone loss between these same teeth
Incorrect horizontal angulation
results in overlapping of the contact areas between the teeth, making it impossible to determine the condition of interden- tal bone
Second, varying the horizontal angulation
slightly may actually increase the chances of imaging interdental defects and furcation
A higher setting, such as 90 kVp,
will result in an image that has a low constrast: black and white with many shades of gray in between.
Horizontal bone loss
describes height loss around adjacent teeth in a region. In horizontal bone loss, both buccal and lingual plates have been resorbed as well as the intervening interdental bone. Horizontal bone loss occurs in a plane parallel to the cementoenamel junctions (CEJ) of adjacent teeth
Vertical bone loss,
sometimes called angular bone loss, occurs in a vertical direction where the resorption of one tooth root sharing the interdental septum (bone between the teeth) is greater than the other tooth
dense cortical plate of the bony tooth socket
Name three local contributing factors for the development of periodontal diseases.
Amalgam overhangs, poorly contoured crown margins, and calculus. These factors act as traps that can lead to the buildup of bacterial pathogens that cause periodontal diseases.
Which periodontal disease case type demonstrates early bone loss, up to 30 percent?
II. The AAP classifies periodontal diseases based on etiologic factors of the disease and response to treatment. Four of these classifications are case type I (gingivitis), case type II (slight chronic periodontitis), case type III (moderate chronic or aggressive periodontitis) and case type IV (advanced chronic or aggressive periodontitis).
What is the radiographic appearance of the lamina dura when gingivitis is present?
The same as a healthy status. The lamina dura appears as an uninterrupted, continuous, dense radiopaque line around the roots of the teeth. As gingivitis is a disease of soft tissue only, there are no radiographic changes and the lamina dura appears the same as in a healthy periodontal status.
Describe the earliest radiographic evidence of periodontal disease.
A fuzzy, radiolucent cupping-out of the alveolar crest. In the anterior part of the dentition, the alveolar crest appears blunted. Triangulation or widening of the PDL is noted in the posterior regions.
What is triangulation?
A widening of the periodontal ligament space; bordered by the lamina dura and the root surface, with its base toward the crown of the tooth. In periodontal disease, the coronal portion of the PDL assumes the shape of a triangle. This triangle is bordered by the lamina dura and the tooth root, with the base of the triangle facing toward the crown.
What is the earliest case type of periodontal disease in which furcation involvement is seen radiographically?
Case type III (moderate chronic or aggressive periodontitis). Moderate (30-50%) bone loss may appear in both horizontal and vertical planes. Radiolucencies appear in furcations of posterior multi-rooted teeth, indicating bone loss in the furcas.
Radiographs are a two-dimensional image of three- dimensional objects.
Radiographs lack the third dimension of depth, which results in bone and tooth structures being superimposed over each other. This will often hide bone loss on the buccal and lingual surfaces and furcation area, espe- cially in the posterior region of the oral cavity.
Cannot distinguish treated versus untreated disease.
Radiographs do not indicate the presence or absence of active disease.
Actual destruction more advanced clinically
Radiographs cannot detect early signs of periodontal diseases. A significant loss of bone density must occur before radiographic changes are detected.
Bitewings, especially the vertical bitewing series of anterior and posterior radiographs
are most useful for examining the periodontium
Excessive vertical angulation
may not reveal bone loss,
inadequate vertical angulation may result in a radiographic image that
falsely indicates bone loss when there is none
Second, varying the horizontal angulation slightly may actually
increase the chances of imaging interdental defects and furcation
1. b 2. Usě box 25-1 to list uses 3. c 4. d 5. c 6. a 7. b 8. Use chapter information to list
limitations 9. d
10. c 11. a 12. b
Each of the following may be determined from a den- tal radiograph EXCEPT one. Which one is the EXCEPTION?
b. Pocket depth
List four uses of radiographs in the assessment of peri-
a. Note the alveolar bone height. Use the CEJ as a reference point. Measure with a probe as needed
b.Identify local contributing factors such as restoration overhangs and calculus.
Which of the following terms describes bone loss that occurs in a plane parallel to the cementoenamel junc- tion of adjacent teeth?
Significant bone loss that results in a radiolucency observed in the area between the roots of multirooted teeth is called
d. furcation involvement.
Radiographs may help to locate each of the following local contributing factors EXCEPT one. Which one is the EXCEPTION?
Excessive occlusal force may result in a widening of the periodontal ligament space.
Widening of the periodontal ligament space is called furcation involvement.
a. The first statement is true. The second statement is false.
Dental radiographs are important because they docu- ment the location and depths of periodontal pockets.
Dental radiographs may serve as a baseline and as a means for evaluating the outcomes of periodontal treatments.
b. The first statement is false. The second statement is true.
List four limitations of dental radiographs in the assess- ment of periodontal diseases.
Which of the following would be best for imaging a slight, but generalized periodontal status?
d. Posterior and anterior vertical bitewing radiographs.
Correct horizontal angulation is needed to accurately image interdental bone levels.
Altering the horizontal angulation can reveal additional information regarding interdental bone levels.
c. Both statements are true.
Alveolar crests pointed in the anterior region and a radiopaque flat, smooth lamina dura 1.5 to 2.0 mm below the CEJ in the posterior region describes
a. Case Type I: Gingivitis
12. Radiolucent changes observed on a radiograph such as a fuzzy, cupping-out of the crestal bone and a blunted appearance of the lamina dura in the anterior region describes
b. Case Type II: Slight Chronic Periodontitis
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