radiographs in periodontal diseases

1. RADIOGRAPHIC AIDS
in the diagnosis of periodontal disease
Department of Periodontics
MGV Dental College

2. RADIOGRAPHS
 Valuable aid in
 Diagnosis of periodontal disease
 Determination of prognosis
 Evaluation of outcome of treatment
 Adjunct to clinical examination
 Reveals alterations in calcified tissue
 Bone and tooth
 Does not indicate current cellular activity
 Shows effect of past dental/periodontal disease
 On teeth and bones

3. NORMAL INTERDENTAL SEPTA
 Evaluation of bony changes in
periodontal disease are based
on the appearance of the inter-
dental septa
 Facial and lingual bony plates are
obscured by dense roots
 Thin radio-opaque line along the
PDL called as lamina dura
 Cribriform plate
 Width and shape of septum and
angle of the crest vary as per
 Convexity of proximal teeth
 Level of CEJ of proximal teeth

4. VARIATION OF X-RAY
TECHNIQUE
 Distortion limit the value of x-rays
 Factors modified by variation in technique
 Bone level and pattern of bone destruction
 Width of PDL, contour of interdental septum
 Radio-density of bone and trabacular pattern
 Factors causing variations in x-rays
 Exposure time
 Developing time
 Film type
 X-ray angulations

5. X-RAY TECHNIQUES
 Long cone paralleling
technique is the most
realistic technique
 Angle bisecting technique
makes the bone margin
appear closer to the tooth
 Mesial or distal cone shift
changes the following
 Width of PDL space
 Shape of interdental bone
 Appearance of lamina dura

6. CORRECT ANGULATION OF
IOPA X-RAYS
 Criteria
 X-ray should show the tips of
the molar cusps
 None of the occlusal surface
should be seen
 Enamel caps and pulp
chambers should be
distinctly visible
 Inter-proximal spaces should
be open
 Proximal contacts should not
overlap
 Unless teeth are
anatomically out of line

7. X-RAYS IN PERIODONTICS
 Bone destruction
 X-ray does not reveal
minor changes in alveolar
bone
 Image shows less severe
bone loss than actual
 Difference between
actual alveolar crest
height and radiographic
appearance is in the
range of 0 to 1.6 mm.
 Radiographic change
indicates that the disease
has already progressed

8. X-RAYS IN PERIODONTICS
 Factors to be seen in
radiographs
 Amount of bone loss
 Distribution of bone loss
 Pattern of bone destruction

9. AMOUNT OF BONE LOSS
 Indirect method of
assessing bone loss as it
shows amount of bone
present
 Bone loss determined by
the difference between
normal bone level and
actual level
 Expressed in percentage of
bone lost
 Mild, moderate, severe
 Distance between CEJ and
crest of bone is 2mm.

10. DISTRIBUTION OF BONE LOSS
 Important diagnostic criteria
 Indicates the location of
various destructive local
factors
 In different areas of the mouth
 In different areas of the tooth
 Can indicate if the nature of
the disease
 Localized
 Generalized

11. PATTERN OF BONE
DESTRUCTION
 The interdental septa
undergoes changes in
disease
 These changes affect
the following
 Lamina dura
 Crestal radio-density
 Size and shape of
medullary spaces
 Height of bone
 Contour of bone

12. PATTERN OF BONE
DESTRUCTION
 The height of the inter-dental
septum is reduced
 Crest perpendicular to the long
axis of the tooth
 Horizontal bone loss
 Crest angulated to the long
axis of the tooth
 Angular or vertical bone loss

13. PATTERN OF BONE
DESTRUCTION
 X-rays do not reveal the
following
 Topography of osseous craters
 Bone destruction of the facial
and/or lingual bony plates
 Obscured by the dense root
structure
 Bone destruction in the
intermediate cancellous bone
 Due to density of cortical bone
 Location of base of periodontal
pockets

14. PATTERN OF BONE
DESTRUCTION
 These short comings are
overcome by
 Trans-gingival probing or
sounding of the bone
 Use of radio-opaque
markers to determine
pocket base
 GP points
 Silver points
 Hirschfield's pointers

15. RADIOGRAPHIC CHANGES
IN PERIODONTITIS
 Fuzziness and break in continuity
of lamina dura
 Earliest radiographic change
 Occurs on the mesial/distal aspect of
interdental septum
 Results from
Extension of inflammation into bone
Causing widening of vessel channels
Reduced calcified tissue at the crest
 No correlation between lamina dura
changes and
Bleeding, pockets, attachment loss
Presence indicates health and absence
may not indicate disease

16. RADIOGRAPHIC CHANGES
IN PERIODONTITIS
 Formation of wedge shaped
radiolucent area
 Occurs on the mesial/distal aspect of
the crest of the septal bone
 Apex is directed towards the root
 Produced by resorbtion of bone
Along the lateral aspect of the septum
 Accompanied by widening of the
periodontal ligament space
 Reduced height of septal bone
 Deeper extension of inflammation
 Endosteal bone resorption

17. RADIOGRAPHIC CHANGES
IN PERIODONTITIS
 Appearance of interdental craters
 Not depicted well on x-rays
 Irregular areas of reduced radio-opacity on
alveolar crest
 Appearance of periodontal abscess
 Discrete radiolucency on lateral aspect of the root
 May not be seen due to
 Stage of disease
 Extent and morphology of bone destruction
 Location of abscess
 Not seen when in soft tissue wall
 Only seen it present in interproximal area

18. RADIOGRAPHIC CHANGES
IN PERIODONTITIS
 Appearance of furcation
involvement
 Artifacts make it possible
for furcation involvements
to be present without x-ray
changes
 Definitive diagnosis made
by probing
 In horizontal direction
 Using Naber’s probe

19. RADIOGRAPHIC CHANGES
IN PERIODONTITIS
 Suggested diagnostic
criteria
 Slightest radiolucency in
furcation area to be evaluated
clinically
 Diminished radio density in
furcation area where bony
trabaculae are seen
 Marked bone loss in relation to
single molar root

20. RADIOGRAPHIC CHANGES
IN PERIODONTITIS
 Changes seen in Localized
Aggressive Periodontitis
 Vertical/angular bone loss with 1st.
molars/incisors
 Arc or saucer shaped bone loss
with 1st. molar
 From mesial aspect of 2nd. molar to
distal aspect of 2nd. premolar

21. RADIOGRAPHIC CHANGES IN
TRAUMA FROM OCCLUSION
 Changes are seen in the following structures
 Lamina dura
 Morphology of the alveolar crest
 Width of PDL space
 Density of surrounding cancellous bone
 Findings to be interpreted with clinical signs
 Mobility and pain
 Presence of wear facets
 Pocket depth and type
 Occlusal contacts and habits

22. RADIOGRAPHIC CHANGES IN
TRAUMA FROM OCCLUSION
 Traumatic lesions are more common in the
facial and lingual areas
 More stability in mesial/distal area due to intact
proximal contact
 Evidence of traumatic lesions in inter-dental
areas are suggestive of more trauma in
facial and lingual areas
 Areas which show evidence of TFO are
 Crest of interdental septa
 Furcation area
 Apical area

23. CHANGES IN VARIOUS
PHASES OF TFO
 Injury Phase
 Loss of lamina dura in crestal,
furcation & apex area
 Widening of PDL space
 Repair Phase
 Widening of PDL space,
thickening of lamina dura
 Condensation of perialveolar
cancellous bone

24. CHANGES IN VARIOUS
PHASES OF TFO
Remodeling Phase
 Angular or vertical bone loss
 Funnel shaped resorption of
the alveolar crest
 Widening of PDL space,
thickening of lamina dura

25. ADDITIONAL DIAGNOSTIC
CRITERIA
 Radio opaque horizontal line across roots
 Indicates destruction of facial/lingual plates
 Vessel canals in alveolar bone
 Linear, circular radiolucent areas
 Indicate source of vascular supply
 Normal structures may be confused with
radiolucency
 Mental foramen, naso palatine foramen

26. ADDITIONAL DIAGNOSTIC
CRITERIA
 Difference between treated/untreated case
 Normal, clear cut peripheral outline of septa
 Lamina dura surrounding the entire root

27. SKELETAL DISTURBANCES
MANIFESTED IN THE JAWS
 Osteitis fibrosa cystica
 Advanced primary/secondary
hyperparathyroidism
 Osteoclastic resorption of alveolar bone
 Cyst-like lesions with generalized loss of lamina dura
 Paget’s disease
 Normal trabacular pattern replaced by hazy,
diffuse meshwork of fine trabaculae
 Scattered radiolucent areas with irregular radio-
opaque zones
 Absence of lamina dura

28. SKELETAL DISTURBANCES
MANIFESTED IN THE JAWS
 Fibrous dysplasia
 Small to large radiolucent areas at root apex
 Enlargement of cancellous space and distortion
of trabacular pattern
 Ground glass appearance
 Loss of lamina dura
 Multiple myeloma
 Multiple radiolucencies
 Scleroderma
 Uniform widening of PDL space
 Osteopetrosis (Albers Schonberg's disease)

29. SKELETAL DISTURBANCES
MANIFESTED IN THE JAWS
 Langerhan's cell histiocytosis
 Disturbances in immunoregulation
 Different forms of disease formerly known as
 Hand-Schuler-Christian disease
 Letterer-Siwe disease
 Gaucher’s disease
 Eosinophilic granuloma
 Single or multiple radiolucencies
 Unrelated to the tooth
 Causing root resorption

30. THANKS
Dr. NITIN DANI