Radiography in Periodontics PDF

Radiography in Periodontics Dr Saad Al Bayatti B.D.S., M.Sc. Oral Radiology University of Sharjah\Faculty of Dentistry [email protected] Reference Textbook • Eric Whaites, Nicholas Drage: Essentials of Dental Radiography and Radiology, 5th Edition, 2013, Churchill Livingstone ISBN: 978-0-70...

Radiography in Periodontics Dr Saad Al Bayatti B.D.S., M.Sc. Oral Radiology University of Sharjah\Faculty of Dentistry [email protected] Reference Textbook • Eric Whaites, Nicholas Drage: Essentials of Dental Radiography and Radiology, 5th Edition, 2013, Churchill Livingstone ISBN: 978-0-7020-4599-8 9/15/2023 Oral Radiology 2 Objectives • This presentation discusses the following: • The importance of radiographic examination in periodontal practice • Types of radiographic examinations used in periodontal treatment • Limitations of radiographic examination • Methods of overcoming radiographic limitations • Radiographic signs of periodontal disease Q Whats the Role of Radiographs in Periodontics • • • • • • • • •o Correlate clinical examination with radiographic examination 0 Assess the general status and features of the periodontium Confirm/exclude the presence of pathology Identify the extent of destruction of alveolar bone Identify local contributing factors Evaluation of periodontal therapy Maintain a permanent record the periodontal status NEVER DISCARD A RADIOGRAPH IT IS A RECORD,, KEEP IT FOR THE RECORD Q 1 What a Radiograph Can Show 0.2 0.5mm normal • Width of the periodontal ligament space 2 • Amount of alveolar bone present 3 4 5 4 • Condition of the alveolar bone crests •4 Bone condition in the furcation areas if bifurcato 5 • Crown-to-root ratio ortrifurati inpost teeth • Root length and morphology • Local initiating/irritating factors Root length and morphology Crown-to-root ratio D normal ength of the root is twice that of thecrown CR 1 2 Floss Relatedto Restoration Q What Are Factors that will initiate T EE.tg.EE hatomy The disease n contact Poorly contoured restorations amulgum notcontoured overham Overhanging restorations floss Ac content of L plaquet disea progress to bone loss 3 Mal positioned teeth 4 Open contact points open contact t nitiating factor What a Radiograph Can Show cont’d helps diagnose • Anatomic considerations: diseases • Relation to adjacent teeth • Position of the maxillary sinus in relation to a periodontal deformity • Dental anomalies • Missing teeth • Impacted teeth • Pathologic conditions 6 • Caries • Periapical lesions 7g • Root resorption • Caries • Periapical lesions • Root resorption yarn 0 root resorption peri apical lesions Q What a Radiograph Fails to Show • Radiographs do not demonstrate the soft tissue to hard tissue relationships •1 Radiographs typically show less severe bone BCS why destruction than is actually present •2 The incipient mild destructive lesions in bone 00 do not cause a sufficient change in density to be detectable on radiograph What a Radiograph Fails to Show cont’d • Radiographs show a two-dimensional view of a three-dimensional situation • Depth is lost 3 Bone Loss On • Bony defects in the buccal and lingual surfaces may be hidden • Only the interproximal bone is clearly seen Radiographic Detection of Periodontal Disease • Should be done after careful examination thenradiograph clinical examination • Radiographs should be of proper quality • A good diagnostic radiograph should have the following criteria: • Good quality (density, contrast and sharpness) • The image of the object should have the same size and shape of the object • The whole area in question should be seen Look at the level of interseptal bone between the incisors how is it affected by level of crown So you can make a disease in an area by taking these kinds of images Elongation vs shortening View the radiograph in a dark area for better vision So our eyes are directed to the x ray image Examination of Intra Oral Radiographs • Radiographs are examined in a horizontal direction β to not miss anything • Each pathology is examined separately, i.e. caries, interproximal bone level, trabicules, apical area, etc.) way Looknottomy Findforcaries inorder 5 6 7etc she intend elmeaninglevel Nevercheck everything at same time always systeminting ng we takeintraoral xrays 1 Views Taken Bite-wing radiographs: • The view of choice to to see demonstrate incipient lesions affecting alveolar crestsQ.IE JIas.nniq • The parallel technique is applied in this view even when film holders are not used QWhattype of to radiographs are taken examinetheperiodontium Parallel Technique using a film holder Bitewing tech Views Taken cont’d Parallel log Intra oral periapical radiographs: • The parallel technique is superior to the angle bisecting technique because the X-ray beam is perpendicular on the tooth and the film which minimizes superimposition structures through which the X-ray passes. Paralleltechniquerequires a sensorholder whichprevent formingshadows anglebisectingtechnique Parallel Technique thisislingually why lingual X-ray Root anything closerto the filmappears sharper morgadiopoge Single shadow of the alveolar crest IF parallel techniquerequires a sensor holder whichprevent formingshadows Film Tooth Double shadows of the alveolar crest É Angle bisector Root Film Angle bisecting Technique Views Taken cont’d Panoramic view: • Useful for general assessment of the teeth and their supporting structures • General assessment of jaw bones • Not indicated for detection of incipient alveolar crest lesions due to: • Decreased image resolution • Inherent overlapping of upper premolars appng I in the panoramic O G What the Normal Periodontium in the Anterior Radiograph Posterior In the Anterior Region • • • • • Alveolar crests are seen: Thin Smooth Pointed sharpknife edge Variations in the X-ray beam angulation can cause changes in the height of the alveolar bone Anterior Region itmorethen • 1.5 mm means bone lost • The distance II any between two parallel lines connecting the CEJ of two adjacent teeth and the crest of the alveolar bone between the aleneourcrest f 1.5 mm VET Anterior Region KEXQ • Even thickness of the PDL from the alveolar crest to the apex repress t.ekst etj.mn • A well-mineralized cortical toApex outline of the alveolar crest • A well-mineralized cortical outline of the alveolar crest indicates the absence of periodontitis activity É super imposed blunt rounded Posterior Region • 1.5 mm • 2 The distance between two parallel lines connecting the CEJ of two adjacent teeth and the crest of the alveolar bone •3 Even thickness of the PDL from the • alveolar crest to the apex • Alveolar crests are seen: • Relatively thick • Smooth • Flat to rounded Ib 1.5 mm É trapthey not I be L I Tom Parallel to HEES É the to CE t beparallel 05246 w Q. How many types of periodontal diseases do we have? ◦Chronic: slowly forms with horizontal bone loss and thick crest margins ◦Acute : advances fast with vertical/angular bone loss and irregular crest margin Q. How many types of bone loss do we have? ◦horizontal ◦Vertical ( angular) Radiographic Signs of Periodontal Disease Q HowToKnow If There's PerioDisease theressomethingcalledangularboneloss its the first we periodontaldisease of sign will see of t.sk ngofaipyyon2widening PDL β no boneloss r firstsign ofperiodontal disease bone Angular bone loss 0 loss firstsign slanting loss widening of bone Differentiate 1 194gal Buccal bone b ess sharp than alatal bone B Bone is less sharpthan L Bone Palatal bone sharper moreradiopaque adi I bet Exam Q For PeriotCaries Early angular bone loss is als called (triangulation) trianglelocated between cementum falveolar Farm L Angular bone loss (triangulation) 0 Normal bone level CALCULUS • Chronic periodontists occurs to those who neglect oral hygiene so = food or plaque accumulation calcify • Calci cation causes calculus ◦Q. What is teh most common area for calci cation? Molars since theres an opening to saliva • Q. How is calculus seen on x ray? ◦Triangular radio- opaque areas located EACTLY under CEJ must be attched to the tooth no cal Horizontal chronic bone loss up 0 Fidgeting saga 00 Calculus faiththat calcified ftp.ffaymm Horizontal chronic bone loss Man quality bone outney 2am left radiograp overhomy 3hm Calculus calculus Heavy I Ee.is fa Q.wnattypeit.E iPe Acute irregular bone loss ◦Look at area of overhang, the bone quality is irregular because theres an irritating factor which is the overhang Q Bone IsIrregular atcrestmeaning wfnngth.IE I Small regions of bone loss on the buccal or lingual aspects of the teeth are much more difficult to detect Meaning bone loss begin in proximal but that doesn’t mean theres isn’t in buccal and lingual surface You examine bone loss of buccal and lingual is by clinical examination with perio probe Features that the radiograph best demonstrates are difficult to identify and evaluate clinically mustpggi.EE xaimInat w Pt going into the acute processof Mdisease usuallypoint The anterior regions show blunting of the alveolar crests and slight loss of alveolar bone height Calculus Meaning teh sharp area is lost and start to resorb Initial periodontal disease is seen as a loss of cortical density and a rounding of the junction between the alveolar crest and the lamina dura Is this periodontist? No Then whats it callled? Alveolar bone loss Inorder to have periodntistis theres must be a teeth this is a ridge mow bone not seriodontitis be it then p Posterior regions may show a loss of the normally sharp angle between the lamina dura and alveolar crest teeth Normal gingiva? Plaque? Gingivitis? Plaque, food particles are not seen in radiograph unless tehy get calci ed No information about the depth of soft tissue pockets Gingivtis is in ammation of gingiva with NO bone loss on tray False pocket? bone Phi progresses When only gingivitis is present, the bone appears into Periodontitis normal radiographically Gingivitis shows no radiographic evidence of bone loss. Features that are not well detected by the radiograph are mostly apparent clinically I d calcified n Q. For bone loss to be seen in radiograph how much loss should it have? 30 -40 % of bone material is lost Normal or diseased? Gingiva ded w en my 1 me Q. What type of caries? Root caries Treaties b when there's boneloss so periodont Q. What are the degrees of HORIZONTAL bone loss? • Mild • Moderate • Severe 1.5mm Mild horizontal bone loss: more than 1 mm of the normal distance Loss of attachment may be present for 6 to 8 months before radiographic evidence of bone loss appears Moderate horizontal bone loss: more than 2 mm of the normal distance or involvement of furcation areas Q.. is this a chronic or acute periodontitis? Chronic since its horizontal Q. What is teh whihte line overlapping root? Teh bone socket chronic more than 2mm normed of distance f Dense alveolar cortex suggests the absence of active periodontitis bone loss below the middle I beroot Sever horizontal bone loss: bone level apical to midpoint of the length of the roots with involvement of furcation areas to r lose Pogition direction And also teh tooth starts to loose its position 4 5mm Horizontal vs. Vertical bone loss e angular v active bone a chromic loss bone I 051 Q. What is teh rst sign of bifurcation involvement? Is teh widening of PDL at bifurcation area level of bone loss is at furcation area so widening occurs there Widening of the periodontal ligament space at the apex of when the interradicular bony crest indicates furcation involvment. bone lost reaches the bifurcation area Furcation Involvement Q. What is this called ? Endo perio lesion Pus from ation due to periodontitis plus teh toxin coming from teh apex endoperio lesion re preys Yellow arrows represents the depth of teh pocket the depth of thepocket furcation involvement Periodontal abscess?? Endo-perio lesion?? 2 images are the same but it’s concealed since its on buccal side its not seen superimpose don root Look at the other we can see the GP and bone loss on buccal surafce Do not always trust a Radiograph!!! I bone is here lost from the burial surface not seen be superimposed not every widening of the ppl is due to periodontal ease BE AWARE OF THIS RADIOGRAPHIC APPEARANCE D Always correlate radiographic and clinical appearances m Plaque, calculus, gingivitis, periodontitis Consider effect of systemic diseases on the periodontium,,, CHECK MEDICAL HISTORY Diabetes Mellitus 17172 Langerhans Cell Histiocytosis Invaded Fahghrhans AIDS disease not Periodontitis This is a case of osteogenic sarcoma NOTE Not very PDL widening is related to periodontitis Underline the caption always corrrlate clinal exmianation with radiographic exmianation ◦PDL is invaded by langrahsn disease causes widening of PDL if so then tooth mobility