New Classification of Periodontal Disease PDF

**Noha Kamal Mohammed Mansour** **The periodontium** is a connective tissue consisting of four components: cementum, the periodontal ligament (PDL), alveolar bone, and gingival tissue. **[Radiographic features of a normal, anatomically intact periodontium would include: ]** -An intact lamina dura...

**Noha Kamal Mohammed Mansour** **The periodontium** is a connective tissue consisting of four components: cementum, the periodontal ligament (PDL), alveolar bone, and gingival tissue. **[Radiographic features of a normal, anatomically intact periodontium would include: ]** -An intact lamina dura (both laterally and at the alveolar crest). -No evidence of bone loss in furcation areas. -A2 mm distance on average, from the most coronal portion of the alveolar bone crest (**AC**) to the cementoenamel junction (**CEJ**). -\[The distance from the CEJ to AC in healthy individuals can vary between 1.0 and 3.0 mm\]. -The inter-dental crestal bone is continuous with the lamina dura of the adjacent teeth. -Thin, even width of the mesial and distal periodontal ligament spaces. -The shape of the tooth creates the appearance of a double PDL space. **Periodontal diseases** are a set of conditions characterized by an inflammatory host response in the periodontal tissues with localized or generalized alterations in the soft tissues around the teeth, loss of supporting bone, and ultimately loss of the teeth. **Periodontitis** once periodontitis has developed, by definition, alveolar bone loss has occurred because of the inflammatory process and can result in tooth loss if not controlled. Thus, clinical periodontal health on a reduced periodontium cannot be determined using radiographs alone; they provide information regarding historical destruction and are of value for longitudinal determination of progressive bone loss. **[Clinical Examination]** -Performing periodontal probing (increase). - Identifying bleeding sites. -Measuring gingival recession. -Determining clinical attachment loss. -Tooth mobility. -Evaluating of the amount of attached gingiva. **[Role of radiograph in assessment of Periodontal Conditions:]** ### **Role of 2D Imaging in Periodontal Disease Diagnosis:** - **Assessment of Bone Levels**: 2D radiographs help in evaluating the extent of bone loss around teeth, which is crucial for diagnosing the severity of periodontal disease. - **Detection of Pathology**: They can reveal hidden issues such as subgingival calculus, root fractures, and other abnormalities that might not be visible during a clinical examination. - **Treatment Planning**: Radiographs assist in planning appropriate treatment by providing detailed information about the bone and tooth structures. - **Monitoring Progress**: They are used to monitor the progression of periodontal disease and the effectiveness of treatment over time. **[Anatomical appearance:]** Amount of bone present Condition of the alveolar crests Bone loss in the furcation areas Width of the periodontal ligament space Root length and crown to-root ratio Position of the maxillary sinus in relation to a periodontal deformity **[Local irritating factors:]** Calculus Poorly contoured Overextended restorations& open interproximal contacts **[Pathologic considerations:]** Caries Periapical lesions Root resorption In addition to clinical examination, bidimensional (2D) imaging modalities (e.g. periapical, bitewing, and panoramic radiographs) are the preferred diagnostic tools for both initial assessments and follow-up evaluations of clinical attachment loss and alveolar bone levels around dental roots. Several reasons support the preference for these imaging modalities, including their accessibility, affordability, and high-resolution capabilities.  **[Radiographic modalities used:]** **[\*Intraoral radiographs:]** Among ionizing imaging modalities, **intraoral radiographs**, including **periapical** and **bitewing** radiographs, serve as the most frequently employed techniques for evaluating teeth, surrounding alveolar bone, periodontal ligament space (PLS), and lamina dura (LD). **Advantages:** highest spatial and contrast resolution while maintaining low levels of radiation dose to the patients among the various radiographic imaging modalities. In the pursuit of minimizing radiation exposure, the incorporation of digital image receivers, such as phosphor storage plates (PSP) or solid-state detector, is indispensable. It has been shown that both digital image receptors can accurately measure periodontal bone levels, especially for the solid-state detector. Additionally, the use of rectangular collimators aids in precise X-ray beam focusing on the targeted area, effectively reducing patient radiation exposure by at least 40%. For patients with generalized periodontal pockets measuring **\