DHS- Radio- Periodontal Radiographs

Radiographic Examination in Periodontics

• Radiographs provide information on periodontal ligament space, alveolar bone condition, root length, and morphology
• Factors initiating periodontal disease include poorly-contoured restorations, malpositioned teeth, open contact points, and dental anomalies
• Radiographs show anatomic considerations, caries, periapical lesions, root resorption, but not soft tissue to hard tissue relationships
• They may not detect incipient bone lesions, and only show a two-dimensional view of a three-dimensional situation
• Radiographic detection of periodontal disease should follow careful clinical examination and meet specific criteria for quality
• Intraoral radiographs are examined horizontally and separately for each pathology, using bite-wing and periapical views
• The parallel technique is preferred for periodontal examination to minimize superimposition of structures
• Panoramic views are not suitable for detecting incipient alveolar crest lesions due to decreased resolution and overlapping
• Normal periodontium in radiographs shows thin, smooth, pointed alveolar crests in the anterior region
• In the posterior region, alveolar crests are relatively thick, smooth, and flat to rounded
• Chronic periodontal disease forms slowly with horizontal bone loss and thick crest margins, while acute disease advances rapidly with vertical/angular bone loss and irregular crest margins
• Angular bone loss is the first sign of periodontal disease

Periodontal Disease and Radiographic Interpretation

• Chronic periodontitis occurs due to neglect of oral hygiene, leading to calcification and calculus formation
• Most common area for calcification is the molars due to saliva access, seen as triangular radio-opaque areas on x-rays
• Acute irregular bone loss is caused by irritating factors like overhangs, leading to irregular bone quality
• Small regions of bone loss on buccal or lingual aspects of teeth are difficult to detect clinically, but can be identified on radiographs
• Initial periodontal disease is seen as a loss of cortical density and a rounding of the junction between alveolar crest and lamina dura
• The condition is not periodontitis, but rather alveolar bone loss if there is no teeth present
• Gingivitis, inflammation with no bone loss, does not show radiographic evidence of bone loss
• Radiographs may not show depth of soft tissue pockets, and features not well detected by radiographs are apparent clinically
• Horizontal bone loss can be mild, moderate, or severe, with different implications on attachment loss and furcation areas
• Widening of the periodontal ligament space at the apex indicates furcation involvement and potential endo-perio lesions
• Radiographs do not always provide a complete picture, and clinical examination should always be correlated with radiographic findings
• Systemic diseases like diabetes mellitus and Langerhans cell histiocytosis can have effects on the periodontium, which should be checked in the medical history