Radiographic Interpretation of Periodontal Disease Part 1

8/10/2019 Radiographic Interpretation of Periodontal Disease Part 1

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RADIOGRAPHIC

INTERPRETATION OF

PERIODONTAL DISEASES

drg. SHANTY CHAIRANI, M. Si.



Radiographs are used in the evaluation

of periodontal disease in the following:

Determination of the condition from the

affected teeth such as : clinical crown-root

ration, shape and size of the crown and root,position of roots of multirooted teeth and

position of a tooth in relation to adjacent

teeth

Identification of predisposing factors such as

calculus, the contour and status of

restorations (overhangs or poor contours)



Identification of early bone changes

Evaluation of the amount and location of

bone loss

Determination of the prognosis of affected

teeth through radiographic examination of

the width of the periodontal ligament space

and the continuity of the lamina dura

Evaluation of posttreatment results



The characteristic radiographic

appearance of the alveolar crestal bone

The alveolar crest will appear radiopaqueon a radiograph and is located 0.5 to 2mm below the CEJ.

The alveolar crests have a variety ofshapes: flat and wide; narrow androunded; angulated. The approximatelevels of adjacent CEJ's and the convexityof the proximal surfaces of the teeth are acouple of factors that may determine theshape of the alveolar crests.



Between the anterior teeth theradiopaque alveolar crest will usuallyappear pointed whereas between theposterior the crests are usually flat.

The alveolar crest is continuous withthe lamina dura of adjacent teeth.

In the absence of disease, the bony junction between the alveolar crest andthe lamina dura will be seen to form asharp angle adjacent to the root tooth



Radiograph of normal periodontal tissue



Bone level determined

Using a probe or millimeter marked

ruler place the tip of the probe or end

of the ruler at the cementoenamel

junction (CEJ) and note the distancebetween the CEJ and alveolar crest.

If the distance is more than 2

millimeters, there is bone loss.



Early Bone Changes

The early lesions of chronic periodontitis

appear as areas of localized erosion of the

interproximal alveolar bone crest

The anterior regions show blunting of the

alveolar crests and slight loss of alveolar

bone height. The posterior regions may

also show a loss of the normally sharpangle between the lamina dura and

alveolar crest



Early Bone Changes

In early periodontal disease, this angle may lose its

normal cortical surface (margin) and appear rounded off,

having an irregular and diffuse border.

Significant loss of attachment must be present for 6 to 8months before radiographic evidence of bone loss

appears.

Variations in angle of projection of the x-ray beam can

cause a slight change in the apparent height of the

alveolar bone.

Small regions of bone loss on the buccal or lingual

aspects of the teeth are much more difficult to detect.



Initial periodontal disease is seen as a loss of cortical density and arounding of the junction between the alveolar crest and

the lamina dura (arrow).



Horizontal Bone Loss

Horizontal bone loss is a term used to describe

the radiographic appearance of loss in height of

the alveolar bone where the crest is still

horizontal (i.e., parallel to an imagined line joining the CEJs of adjacent teeth) but is

positioned apically more than a couple of

millimeters from the CEJs.

Horizontal bone loss may be mild, moderate, orsevere, depending on its extent.



Horizontal Bone Loss

Mild bone loss may be defined as approximately

a 1- to 2-mm loss of the supporting bone

Moderate loss is anything greater than 2 mm

up to loss of half the supporting bone height. Severe loss is anything beyond this point.

In horizontal bone loss, the crest of the buccal

and lingual cortical plates and the interveninginterdental bone have been resorbed



Vertical Bone Defects

The term vertical (or angular) osseous defectdescribes a bony lesion that is localized to a

single tooth, although an individual may have

multiple vertical osseous defects.

The radiographic presentation is a verticaldeformity within the alveolus that extends

apically along the root of the affected tooth from

the alveolar crest.

The outline of the remaining alveolar bone

typically displays an oblique angulation to an

imaginary line connecting the CEJ of the

affected tooth to the neighboring tooth.



Vertical Bone Defects

In its early form, a vertical defect appears

as abnormal widening of the PDL space at

the alveolar crest.

The vertical defect is described as

three walled (surrounded by three bony walls)

when both buccal and lingual cortical plates

remaintwo walled when one of these plates has been

resorbed and as one walled when both plates

have been lost



Interdental Craters

The interproximal crater is a two-walled,troughlike depression that forms in the crest of

the interdental bone between adjacent teeth.

The buccal and lingual outer cortical walls of the

interproximal bone extend further coronally thandoes the cancellous bone between them, which

has been resorbed.

Radiographically this presents as a bandlike or

irregular region of bone with less density at the

crest, immediately adjacent to the more dense

normal bone apical to the base of the crater



Buccal or Lingual Cortical Plate Loss

The buccal or lingual cortical plate adjacent to the teeth

may resorb.

Loss of a cortical plate may occur alone or with another

type of bone loss such as horizontal bone loss. This type

of loss is indicated by an increase in the radiolucency of

the root of the tooth near the alveolar crest.

The shape seen usually is a semicircular shadow with

the apex of the radiolucency directed apically in relation

to the tooth

Lack of bone loss at the interproximal region of the tooth

may make this kind of defect difficult to detect.



Furcation Involvement

The term furcation involvement describes the

radiographic appearance of bone loss in the

furcation area of the roots which is evidence of

advanced disease in this zone. Although central furcation involvements are

seen more readily in mandibular molars, they

can also be seen in maxillary molars despite the

superimposed shadow of the overlying palatalroot.



Diagrams illustrating the radiographic appearances of

varying degrees of furcation involvement in lower molars

(arrowed). A Very early involvement showing widening ofthe furcation periodontal ligament shadow. B Moderate

involvement. C Severe involvement.



very early furcation involvement

Radiographic Interpretation of Periodontal Disease Part 1

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