Pdl

907 views

Published on

0 Comments
5 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
907
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
23
Comments
0
Likes
5
Embeds 0
No embeds

No notes for slide

Pdl

  1. 1. Periodontal Disease Islam Kassem Consultant oral & maxillofacial surgeon ikassem@dr.com
  2. 2. Periodontal DiseasePeriodontal ligament attachment andalveolar bony support of the tooth havebeen lost.Junctional epithelium migrates apical tothe CEJ.
  3. 3. Periodontal DiseaseBitewings best for diagnosis. Some feelthat paralleling PA’s are best.Higher kVp recommended (long scale, lowcontrast).Compare images from differentvisits (using same technique).
  4. 4. Limitation of Radiographs• Two-dimensional representation of a 3-D anatomic structure.• Superimposition of the bone and tooth structures* Relationship of hard to soft tissues not evident
  5. 5. Limitation of Radiographs* Presence or absence of periodontalpockets.* Early bone loss (<3mm) is not evident.* Early furcation involvement is notevident.
  6. 6. Limitation of Radiographs* PA: X-ray beam alignment willobliterate the presence of extent offurcation involvement.* Facial and lingual aspects of alveolarbone will be superimposed over thefurcation.
  7. 7. BenefitsEarly radiographic changes:1. Crestal irregularities.2. Triangulation3. Interdental septal bone changes
  8. 8. PeriodontitisInvolvement:LocalizedGeneralized
  9. 9. PeriodontitisNormal Anatomy:Alveolar crest corticated1-1.5 mm from crest to CEJParallel to line between CEJ’sCrest is pointed anteriorly
  10. 10. Corticated alveolar crests
  11. 11. CEJ 1-1.5 mm
  12. 12. Alveolar crests morepointed anteriorly
  13. 13. Contributing Factors• Occlusal trauma• Open contacts• Overhangs, poor contours• Calculus• Post-extraction defects• Systemic involvement (diabetes, blood disorders, hormonal changes, stress, AIDS)
  14. 14. Horizontal bone loss: Parallel to linedrawn between adjacent CEJ’sVertical (Angular) bone loss: Morebone destruction on interproximalaspect of one tooth than on theadjacent tooth
  15. 15. Gingivitis No bone lossNo radiographic signs
  16. 16. Mild Adult PeriodontitisLoss of cortical densityRounding off of junctionbetween alveolar crest andlamina duraBlunting of crest anteriorly
  17. 17. Mild adult periodontitis
  18. 18. Moderate Adult PeriodontitisHorizontal bone loss or verticalosseous defectsTotal extent of bone loss not evidentMay have slight mobility
  19. 19. Moderate adult periodontitis (red arrows point to calculus)
  20. 20. Moderate adult periodontitis
  21. 21. Severe Adult Periodontitis Tooth mobility Extensive horizontal bone loss or vertical osseous defects Furcation involvement
  22. 22. Severe adult periodontitis
  23. 23. Severe adultperiodontitis
  24. 24. Severe adult periodontitis
  25. 25. Restorative MaterialsRadiopaque: Structures with higher objectdensity, such as amalgam, gold, silverpoints, pins, gutta percha, porcelain.Radiolucent: Structures with lower objectdensity, such as older composites andbonding agents.
  26. 26. Gold crowns, amalgams
  27. 27. Retention pins
  28. 28. porcelain crownsCeramic Crowns
  29. 29. crown crown amalgamcast post gutta percha silver points
  30. 30. Red arrows point to basesGreen arrow indicates recurrent caries withfractured restoration
  31. 31. old Composites new
  32. 32. Thank you ikassem@dr.com

×