2024 BOH1 Radiology and Periodontal Patterns of Bone Loss (PDF)

The University of Sydney  We acknowledge the tradition of custodianship and law of the Country on which the University of Sydney campuses stand. We pay our respects to those who...

The University of Sydney  We acknowledge the tradition of custodianship and law of the Country on which the University of Sydney campuses stand. We pay our respects to those who have cared and continue to care for Country. The University of Sydney  2024 BOH1 Radiology and Periodontal Patterns of Bone Loss Eduardo Delamare BDS, MSc (DMFR) [email protected] Contributions by Dr Antonia Scott and Dr Malcolm I Coombs The University of Sydney The Adult Patient - Complete a thorough history and clinical examination, including the tooth-bearing areas before taking any radiographs. - Seek originals or copies of radiographs taken elsewhere if they are relevant. - DON’T carry out 'screening' radiographs or take radiographs as 'routine’. - DON’T take a new radiograph without examining existing radiographs. - DON’T take panoramic radiographs for all patients. - DON’T use a single protocol for all patients. Main Reference: Selection Criteria for Dental Radiography Standards (3rd Edition) Keith Horner, Kenneth Eaton FGDP (UK) 2015 6 Reading the radiographic image 1. Angulation 2. Orientation 3. Soft Tissue Shadows 4. Magnification The University of Sydney 7 Angulation Horizontal The University of Sydney 8 Angulation Vertical The University of Sydney 9 Orientation The University of Sydney 10 Soft Tissue Shadows The University of Sydney 11 Periodontal Conditions The University of Sydney 12 Periodontal Conditions § Indications for intraoral radiographs § Assessment of bone levels § Poorly contoured or overextended restorations § Condition of the alveolar crests § Analysis of root length and morphology and crown-to-root ratios § Bone loss in the furcation areas § Open interproximal contacts, which may be sites § Width of the periodontal ligament space for food impaction § Local irritating factors that increase the risk of § Anatomic considerations periodontal disease § Position of the maxillary sinus in relation to a § Calculus periodontal deformity The University of Sydney 13 Periodontal Patterns of Bone Loss § Prescription of radiographs: Bisecting vs paralleling in Perio The University of Sydney 14 Periodontal Patterns of Bone Loss § Prescription of radiographs: Bisecting vs paralleling in Perio The University of Sydney 15 Periodontal Patterns of Bone Loss The University of Sydney  Periodontal Conditions § Recommendations Generalized pocketing of Generalized pocketing up to 6mm or more 4-5mm (BPE of max. 3) (BPE of 4) - Horizontal - Periapicals with paralleling technique Bitewings (or vertical BWs) The University of Sydney 17 Periodontal Patterns of Bone Loss § Health § Affected The University of Sydney 18 Periodontal Patterns of Bone Loss § Health § Affected The University of Sydney 19 Periodontal Patterns of Bone Loss § Localized § Generalized The University of Sydney  Periodontal Patterns of Bone Loss § Types § Horizontal bone loss § Vertical bone defects § Furcation involvement The University of Sydney  Periodontal Patterns of Bone Loss § Horizontal Bone Loss Extension: - Coronal 1/3 (of root length) - Mid 1/3 - Apical 1/3 The University of Sydney 22 Periodontal Patterns of Bone Loss § Horizontal bone loss - Health - Coronal 1/3 The University of Sydney 23 Periodontal Patterns of Bone Loss § Horizontal bone loss - Coronal/ Mid 1/3 - Mid/ Apical 1/3 The University of Sydney  Periodontal Patterns of Bone Loss § Vertical Bone Loss Extension: Estimation of number of walls: - Coronal 1/3 (of root length) § Three-walled § Two-walled § One-walled - Mid 1/3 - Apical 1/3 The University of Sydney 25 Periodontal Patterns of Bone Loss § Vertical Bone Defects - Three-walled - Two-walled* * Also known as craters The University of Sydney 26 Periodontal Patterns of Bone Loss § Vertical Bone Defects * Also known as craters The University of Sydney 27 Periodontal Patterns of Bone Loss § Vertical Bone Loss - One walled The University of Sydney 28 Periodontal Patterns of Bone Loss § Furcation Involvement - Early The University of Sydney 29 Periodontal Patterns of Bone Loss § Furcation Involvement - Moderate/ Severe The University of Sydney 30 Periodontal Patterns of Bone Loss § Local irritating factors - Calculus The University of Sydney 31 Periodontal Patterns of Bone Loss § Local irritating factors - Defective restorations The University of Sydney 32 Periodontal Conditions § Prescription of Diagnostic Imaging - Bitewings Mild/ moderate bone loss - Vertical bitewings Moderate/ severe bone loss (not realistic for molars) - Periapical – paralleling Moderate/ severe bone loss - OPG’s Generalized conditions (but difficult to assess premolars) - CBCT Great for higher complexity as (cone beam CT) overcomes the 2D limitation of conventional radiographs (such as the determination of number of walls) The University of Sydney  Periodontal Conditions § Recommendations CBCT is not indicated as a routine method of imaging periodontal bone support. A periapical radiograph using a paralleling technique is indicated if a periodontal/endodontic lesion is suspected. Assessment of all teeth and their periodontal support can be achieved by an optimal-quality panoramic radiograph alone, a panoramic radiograph with supplementary periapical radiographs, or a complete series of periapical radiographs. The University of Sydney 34 Periodontal conditions § Prescription of Diagnostic Imaging The University of Sydney  Questions? The University of Sydney 36 References § White and Pharoah – Oral Radiology: Principles and Interpretation. 7th edition (chapters 10,16,18,19) § Ismail AI, Pitts NB, Tellez M. The International Caries Classification and Management System (ICCMSTM) An Example of a Caries Management Pathway. BMC Oral Health. 2015;15(Suppl 1):S9. doi:10.1186/1472-6831-15-S1-S9. § Alves, L. S., Fontanella, V., Damo, A. C., de Oliveira, E. F., & Maltz, M. (2010). Qualitative and quantitative radiographic assessment of sealed carious dentin: a 10- year prospective study. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 109(1), 135-141. § Selection Criteria for Dental Radiography Standards (3rd Edition) Keith Horner, Kenneth Eaton FGDP (UK) 2015 § Andrea G. Ferreira Zandona, Surgical Management of Caries Lesions: Selective Removal of Carious Tissues, Dental Clinics of North America, Volume 63, Issue 4, § E. Whaites - Essentials of Dental Radiography and Radiology. 4th edition (chapters17 & 23) The University of Sydney InsertTalk team/discipline to us: area/ First name Last name Position Eduardo Delamare +61 [email protected] XXXX XXXX [email protected] Shwetha Hegde sydney.edu.au/url [email protected] Insert social media handles The University of Sydney