Podcast
Questions and Answers
What is the typical distance between the well-defined alveolar crest and the CEJ in a healthy periodontium, as observed radiographically?
What is the typical distance between the well-defined alveolar crest and the CEJ in a healthy periodontium, as observed radiographically?
- 3-4mm
- 1-2mm (correct)
- 0.1-0.5mm
- 5-6mm
Which radiographic characteristic is commonly associated with periodontal disease?
Which radiographic characteristic is commonly associated with periodontal disease?
- Fuzzy or absent lamina dura (correct)
- Uniform periodontal ligament space
- Well-defined alveolar crest
- Intact lamina dura
What is the primary orientation of bone loss in horizontal bone loss?
What is the primary orientation of bone loss in horizontal bone loss?
- Irregular and jagged
- Uniform and parallel to the CEJ (correct)
- Angular and diagonal to the CEJ
- Vertical and isolated to one tooth
In the context of furcation involvement, which instrument is specifically designed for clinical assessment?
In the context of furcation involvement, which instrument is specifically designed for clinical assessment?
Which of the following is considered a limitation of using radiographs for periodontal evaluation?
Which of the following is considered a limitation of using radiographs for periodontal evaluation?
Which type of radiograph is best for detecting interproximal bone loss?
Which type of radiograph is best for detecting interproximal bone loss?
What is a key radiographic feature of a healthy dental implant?
What is a key radiographic feature of a healthy dental implant?
Overlapping contacts on a radiograph can lead to which of the following issues?
Overlapping contacts on a radiograph can lead to which of the following issues?
Which of the following best describes the radiographic appearance of vertical bone loss?
Which of the following best describes the radiographic appearance of vertical bone loss?
In the context of radiographic interpretation, what does 'lamina dura' refer to?
In the context of radiographic interpretation, what does 'lamina dura' refer to?
What is the term for the distance between the base of the gingival sulcus to the alveolar crest?
What is the term for the distance between the base of the gingival sulcus to the alveolar crest?
Radiographically, what would be the primary distinguishing feature of a periodontal abscess compared to a periapical abscess?
Radiographically, what would be the primary distinguishing feature of a periodontal abscess compared to a periapical abscess?
Which radiographic modality provides 3D imaging for advanced assessment of periodontal structures and is useful in implant planning?
Which radiographic modality provides 3D imaging for advanced assessment of periodontal structures and is useful in implant planning?
According to Glickman's classification, what characterizes Class II furcation involvement?
According to Glickman's classification, what characterizes Class II furcation involvement?
What radiographic finding is often associated with occlusal trauma?
What radiographic finding is often associated with occlusal trauma?
Which of these is most likely the cause for a primary endodontic lesion? (Vitality is tested with a cold test using Endo-Ice)
Which of these is most likely the cause for a primary endodontic lesion? (Vitality is tested with a cold test using Endo-Ice)
When evaluating dental radiographs for periodontal disease indicators, what does a clinician look for to assess the 'root to crown ratio'?
When evaluating dental radiographs for periodontal disease indicators, what does a clinician look for to assess the 'root to crown ratio'?
What is peri-implant mucositis?
What is peri-implant mucositis?
A failure to thrive is one of the symptoms for aggressive periodontitis. Which one is MOST LIKELY to show Grade C Molar-Incisor Pattern periodontitis (aggressive periodontitis)
A failure to thrive is one of the symptoms for aggressive periodontitis. Which one is MOST LIKELY to show Grade C Molar-Incisor Pattern periodontitis (aggressive periodontitis)
What is NOT part of the periodontium?
What is NOT part of the periodontium?
Which of the following is NOT a radiographic feature of healthy periodontium?
Which of the following is NOT a radiographic feature of healthy periodontium?
What is the main difference between peri-implant mucositis and peri-implantitis?
What is the main difference between peri-implant mucositis and peri-implantitis?
Which of the following is NOT a common finding associated with bone loss?
Which of the following is NOT a common finding associated with bone loss?
What is the primary characteristic of circumferential bone loss?
What is the primary characteristic of circumferential bone loss?
Which of the following best describes a 'three-wall bony defect'?
Which of the following best describes a 'three-wall bony defect'?
What is the anticipated radiographic outcome following successful regenerative periodontal treatment?
What is the anticipated radiographic outcome following successful regenerative periodontal treatment?
You notice a radiolucent lesion that appears to be adjacent to the root surface of a vital mandibular premolar. What is the MOST LIKELY diagnosis?
You notice a radiolucent lesion that appears to be adjacent to the root surface of a vital mandibular premolar. What is the MOST LIKELY diagnosis?
Radiographically, what is the MOST reliable indicator of successful osseointegration of a dental implant?
Radiographically, what is the MOST reliable indicator of successful osseointegration of a dental implant?
Which statement best describes why early detection of furcation involvement is clinically challenging, even with radiographs?
Which statement best describes why early detection of furcation involvement is clinically challenging, even with radiographs?
What is the potential consequence of misdiagnosing normal anatomic variations as pathology on a radiograph?
What is the potential consequence of misdiagnosing normal anatomic variations as pathology on a radiograph?
Which anatomical landmark is used as a reference point when determining if bone loss is horizontal?
Which anatomical landmark is used as a reference point when determining if bone loss is horizontal?
On a radiograph, what appearance signifies 'Grade C' classification in molar-incisor pattern periodontitis?
On a radiograph, what appearance signifies 'Grade C' classification in molar-incisor pattern periodontitis?
Which radiographic change indicates that a periodontal disease has become stabilized?
Which radiographic change indicates that a periodontal disease has become stabilized?
What percentage of bone demineralization is generally required before radiographic changes become visible using conventional 2D radiography?
What percentage of bone demineralization is generally required before radiographic changes become visible using conventional 2D radiography?
A radiographic examination reveals a distinct radiolucency at the apex of a tooth with a non-vital pulp. What is the MOST probable diagnosis?
A radiographic examination reveals a distinct radiolucency at the apex of a tooth with a non-vital pulp. What is the MOST probable diagnosis?
What is an overhanging restoration margin and MOST associated problem with it?
What is an overhanging restoration margin and MOST associated problem with it?
What is the MOST typical finding associated with bone loss?
What is the MOST typical finding associated with bone loss?
Which is NOT considered a radiographic finding?
Which is NOT considered a radiographic finding?
Which is NOT type of root resportion?
Which is NOT type of root resportion?
During a routine dental examination, bitewing radiographs reveal that a patient has calculus deposits extending subgingivally. Which is MOST LIKELY the result?
During a routine dental examination, bitewing radiographs reveal that a patient has calculus deposits extending subgingivally. Which is MOST LIKELY the result?
Which radiographic modality is MOST suitable to evaluate and find out if there is a vertical root fracture on a tooth that had root canal treatment 10 years prior?
Which radiographic modality is MOST suitable to evaluate and find out if there is a vertical root fracture on a tooth that had root canal treatment 10 years prior?
An untreated periodontal disease can progress overtime. What is the MOST predictable result that is most relevant to radiographic evaluation?
An untreated periodontal disease can progress overtime. What is the MOST predictable result that is most relevant to radiographic evaluation?
A patient presents for a routine dental exam. What is the INITIAL step when evaluating for periodontal disease?
A patient presents for a routine dental exam. What is the INITIAL step when evaluating for periodontal disease?
Flashcards
Radiograph in Periodontics
Radiograph in Periodontics
A valuable aid in diagnosing periodontal disease, determining prognosis and evaluating treatment outcome.
Periodontium
Periodontium
The tissues that surround and support the teeth, including gingiva, cementum, periodontal ligament, and alveolar bone.
Cementoenamel junction (CEJ)
Cementoenamel junction (CEJ)
The interface where the enamel of the crown meets the cementum of the root.
Lamina dura
Lamina dura
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Periodontal Ligament Space (PDL)
Periodontal Ligament Space (PDL)
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Alveolar Crest
Alveolar Crest
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Radiographic Features of Healthy Periodontium
Radiographic Features of Healthy Periodontium
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Radiographic Features of Periodontal Disease
Radiographic Features of Periodontal Disease
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Horizontal bone loss
Horizontal bone loss
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Vertical bone loss
Vertical bone loss
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Furcation
Furcation
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Peri-implantitis
Peri-implantitis
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Bitewing Radiographs
Bitewing Radiographs
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Periapical Radiographs
Periapical Radiographs
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Panoramic Radiographs
Panoramic Radiographs
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Cone Beam CT (CBCT)
Cone Beam CT (CBCT)
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Limitations of radiographs
Limitations of radiographs
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Radiographic Pitfalls
Radiographic Pitfalls
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Common Findings Associated with Bone Loss
Common Findings Associated with Bone Loss
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Study Notes
Radiographic Evaluation
- Dental radiographs are a valuable aid in diagnosing periodontal disease
- Radiographs are valuable determination of prognosis and evaluation of treatment outcomes
Medical History
- Medical history is important
- Dental history is important
- Radiographic evaluation is important
- Clinical examination is important
- Additional testing is important
Periodontium Components
- Gingiva
- Cementum
- Periodontal ligament
- Alveolar bone
Radiographic Landmarks in Periodontology
- Alveolar bone crest evaluation is important
- Periodontal ligament space (PDL) evaluation is important
- Lamina dura evaluation is important
- Cementoenamel junction (CEJ) evaluation is important
Radiographic Features of a Healthy Periodontium
- An intact lamina dura surrounds the roots of a tooth
- A well-defined alveolar crest is typically located 1-2mm apical to the CEJ
- A parallel relationship exists between the alveolar crest and CEJ
- A uniform periodontal ligament space is visable
Biological Width (Supracrestal Tissue Attachment)
- Biologic width is 2.04 mm
- Junctional epithelium is 0.97 mm
- Connective tissue attachment is 1.07 mm
- Gingival sulcus is 0.69 mm
Radiographic Features of Periodontal Disease
- Loss of alveolar bone height is a feature of periodontal disease
- Fuzzy or absent lamina dura is a feature of periodontal disease
- Widening of periodontal ligament space is a feature of periodontal disease
- Presence of furcation involvement is a feature of periodontal disease
- Bone loss (horizontal and vertical patterns)is a feature of periodontal disease
Types of Bone Loss
- Horizontal Bone Loss: Uniform loss parallel to CEJ
- Vertical Bone Loss: Angular bone loss affecting adjacent teeth differently
Grade C Molar-Incisor Pattern (Aggressive Periodontitis)
- This pattern is seen in aggressive periodontitis
Progression of Untreated Periodontal Disease
- Untreated periodontal disease will progress
Circumferential Bone Loss
- Circumferential bone loss will occur
Types of Bony Defects
- Three-wall bony defect
- Two-wall bony defect
- One-wall bony defect
Severity of Horizontal Bone Loss
- Mild bone loss is 1/3
- Moderate bone loss is 1/3 to 2/3
- Severe bone loss is 1/3 to 2/3
Furcation Involvement
- Nabers Probe is used to evaluate furcation involvement
- Anatomy of the furcation of maxillary first molars: measurements and location variations
- Anatomy of the furcation of maxillary first premolars: measurements and location variations
- Anatomy of the furcation of mandibular first molars: measurements and location variations
- Furcation Classification were classified in to 4 classes by Glickman in 1953
Periodontal Lesions
- Periodontal lesions and Endodontic Lesions have different causes
- Primary Endodontic Lesion: Non-Vital Tooth
- Primary Periodontic Lesion: Vital Tooth – Deep Pocket Depth
Periodontal Abscess
- Periodontal abscesses have different radiographic presentation from periapical abscess
Lateral Periodontal Cyst
- Non-inflammatory odontogenic cyst
- Adjacent to the root of vital tooth
- Usually found in Mandibular Premolars area
Periodontal Changes due to Occlusal Trauma
- Periodontal changes can occur due to occlusal trauma
Radiographic Modalities for Periodontal Evaluation
- Bitewing Radiographs are best for detecting interproximal bone loss
- Periapical Radiographs provide detailed view of individual teeth, PDL space and periapical pathology
- Panoramic Radiographs are useful for overall evaluation but less detailed
- CBCT (Cone Beam CT) provides 3D imaging for advanced periodontal assessment and implant planning
Examples of Radiographs
- Horizontal Bitewing
- Vertical Bitewing
- Panoramic image
- Cone beam CT/ Digital Implant Planning
Limitations of Radiographs
- Radiographs do not show soft tissue involvement
- Radiographs cannot distinguish between active and inactive disease
- Radiographs may underestimate bone loss due to 2D limitations
- 55-60% bone demineralization is required before changes become visible on 2D radiographs
Radiographic Features of Dental Implant
- Radiographs are essential in dental implant evaluation
Peri-Implant Health
- Healthy implants have specific radiographic signatures
Peri-Implant Mucositis
- Inflammatory Lesion of the soft tissues surrounding an implant in the absence of loss of supporting bone
Peri-Implantitis
- Destructive inflammatory process affecting the soft and hard tissues surrounding dental implants
Fractured Implant
- Implants can fracture
Periodontium Around Natural Tooth and Dental Implant
- There are differences in Periodontium around Natural Tooth and Dental Implant
Failed Dental Implant
- Dental Implant can fail Osseointegration
Effects of Periodontal Treatment on Radiographs
- Regenerative procedures may show bone fill on radiographs
- Stabilized periodontal disease will show maintained bone levels on radiographs
Guided Tissue Regeneration
- Guided Tissue Regeneration case will result in changes to the periodontium
Common Radiographic Pitfalls
- Overlapping contacts causing inaccurate bone level interpretation
- Distorted images due to incorrect angulation
- Misdiagnosing normal anatomic variations as pathology
Common Findings Associated with Bone Loss
- Open Contact can result in bone loss
- Overhanging Restorations can cause bone loss
- Calculus buildup can cause bone loss
- Loss of Mandibular Molar can result in bone loss
Other Radiographic Findings Related to Periodontium
- Horizontal and Vertical Root Fractures
- External and Internal Root resorption
- Root to Crown Ratio is useful in analysis
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