SlideShare a Scribd company logo
RADIOGRAPHIC AIDS IN
THE DIAGNOSIS OF
PERIODONTAL DISEASES
GROUP A
Course outline
1.Introduction
2. Diagnostic Requirements of
Radiographs
3. Radiographic Techniques for
Assessing Periodontal Diseases
4. Radiographic Features of Healthy
Periodontium • Alveolar Bone •
Interdental Septa • Periodontal
Ligament Space
5. Radiographic Changes in Various
Periodontal Conditions
• Osseous Defects • Chronic
Periodontitis • Aggressive
Periodontitis • Furcation Defects
• Periodontal Abscesses •
Conditions Associated with
Periodontal Diseases
• 6. Skeletal Disturbances
Manifested in the Jaws
• 7. Limitations of Conventional
Radiographs
• 8. Advanced Radiographic Aids
INTRODUCTION
• Radiographs are an integral component of a periodontal assessment
for those with clinical evidence of periodontal destruction
• Radiographs are considered as a valuable adjunct to the clinical
examination, because essential information is provided about the
bony tissues covered by the gingiva that cannot be diagnosed by
clinical inspection alone.
• Radiographic image formation is based on the principle of projecting
a 3-D object onto a 2-D image plane, and therefore this technique
also has limitations.
DIAGNOSTIC REQUIREMENTS OF
RADIOGRAPHS
1. Radiographs should only be considered following a full clinical examination.
2. A provisional diagnosis should be made with the choice of radiographs based
on the type, severity and distribution of disease.
3. Radiographs taken for reasons other than periodontal disease (e.g. horizontal
bitewings for caries diagnosis) will often provide useful information and should
be examined before further radiographs are requested
4. Prichard established the following four criteria to determine the adequate
angulation of periapical radiographs:
• The radiographs should show the tips of molar cusps with little or none of the
occlusal surface
• Enamel caps and pulp chambers should be distinct
• Interproximal spaces should be open
• Proximal contacts should not overlap unless teeth are out of line anatomically.
RADIOGRAPHIC TECHNIQUES
A) Panoramic radiographs:
• Panoramic radiographs provide a general view of the oral structures,
and are useful for screening bone loss patterns in general.
• They are not suitable for accurate assessment of the degree of bone
loss associated with individual teeth, as there is severe distortion and
the outline of the bone margin is often unclear due to
superimposition of intervening structures.
• Panoramic view is useful when assessing generalized periodontitis,
where large areas of jaws have to be viewed.
B) Periapical
radiographs
• Frequently used not only to aid the
differential diagnosis of patient’s
presenting symptoms, but also to
screen for otherwise undetected
pathological processes of the teeth
and surrounding alveolar bone.
• In the diagnosis of periodontal
diseases, periapical radiographs can
provide useful information that
cannot be obtained through
examination of the soft tissues
alone.
C) Bitewing Radiographs
• These are taken to show the proximal surfaces of the teeth and the crest
of the alveolar bone of both the maxilla and the mandible on the same
film.
• While they are used primarily to detect interproximal decay, they can also
provide some information on the patient’s periodontal status.
• The height of the interproximal alveolar bone margin relative to the CEJ
can be observed.
• Also, deposits of subgingival calculus may be detected.
• Limitation- Only the coronal sections of the roots of the teeth are
observed, and they are limited to the molar-premolar regions.
• The posterior bitewing projection offers both optimal geometry and the
fine detail of intraoral radiography for patients with small amounts of
uniform bone loss
RADIOGRAPHIC FEATURES OF HEALTHY
PERIODONTIUM
A) ALVEOLAR BONE
• The dense cortical alveolar bone forming the wall of the socket of
tooth appears radiographically as a distinct, opaque, uninterrupted,
white line parallel to the tooth root known as the lamina dura.
• The lamina dura is a continuation of the jawbone cortex, which
encases the root in a socket of cortical bone.
• The alveolar crest in a young individual is close to the CEJ. The
alveolar crests are situated approximately 2 to 3 mm apical to the CEJ
of the teeth. The shape of the alveolar crest may vary from rounded
to flat
Cont’d
• Between incisor teeth, the alveolar crest will usually appear pointed.
• Between premolar and molar teeth the alveolar crest will be parallel to a
line between the adjacent CEJs, where the enamel thins and disappears.
The alveolar crest will be continuous with the lamina dura of the adjacent
teeth.
• When viewing the lamina dura and the periodontal ligament, only the
interproximal portions are visible. The buccal and lingual areas are not seen
in the radiograph.
• Widening of the periodontal ligament space and loss of lamina dura can be
interpreted as resorption of the alveolar bone.
• The trabecular pattern of interdental bone is distinct and fills the inter-
radicular space
B) INTERDENTAL SEPTA
• The interdental septum, or septal bone, is located between the roots
of adjacent teeth.
• It is therefore more clearly visualized than bone that is located on the
buccal or lingual aspect of the tooth.
• The shape of the interdental septum is a function of the morphology
of the contiguous teeth
C) PDL SPACE
• The periodontal ligament is composed of
connective tissue which appears as a
fine, black, radiolucent line next to the
root surface.
• The radiolucent image between the
lamina dura and tooth is the periodontal
space and is known radiographically as
the lamina lucida.
• With disease, the periodontal ligament
space may appear at varying thicknesses.
• A widened periodontal space is
considered to be a sign of chronic
inflammation.
• However, it varies.
USES OF RADIOGRAPHIC ASSESSMENT
Radiographs are helpful in evaluation of the following:
1. Amount of bone present
2. Condition of the alveolar crests
3. Bone loss in the furcation areas
4. Width of the periodontal ligament
RADIOGRAPHIC CHANGES IN VARIOUS
PERIODONTAL CONDITIONS
• OSSEOUS DEFECTS
• Horizontal bone loss
• Clinically, horizontal bone loss is seen in suprabony pocket.
• Radiographically, horizontal bone loss appears as decreased alveolar
marginal bone around adjacent teeth. Normally, the crestal bone is
located 1-2 mm apical to the cementoenamel junction.
• With horizontal bone loss, both the buccal and lingual plates of bone,
as well as interdental bone resorbs. The remaining bone margin is
roughly perpendicular to long axis of tooth, which occurs when the
epithelial attachment is coronal to the bony defect
Furcation defects
• The furcation is where multiple tooth roots divide at the trunk of the tooth.
It is usually filled with bone. Furcation exposure results from intra-radicular
bone loss due to advanced periodontal disease
• In class I furcation involvement of the furcation shows that there is
decreased density of bone at the furcation area.
• In class II bone loss may or may not be seen in the furcation area.
• In class III there is complete bone loss visible in the radiograph.
• In the maxillary molars, the palatal roots’ superimposition makes the
furcation of the mesial and distal roots and is presented as arrows
radiolucency. The furcation btwn the mesial and palatal roots is clearly
seen
Horizontal and vertical bone loss
Vertical bone loss:
• Clinically, vertical bone loss is
seen in infrabony pocket which
occurs when the walls of the
pocket are within a bony
housing.
• Radiographically, vertical bone
defects are generally V shaped
and re sharply outlined.
Interdental craters:
• seen as irregular areas of reduced radiopacity on the alveolar bone
crests. They are generally not sharply demarcated from the rest of the
bone, with which they blend gradually.
• Radiographs do not accurately depict the morphology or depth of
interdental craters, which sometimes appear as vertical defects
• . Like the two-walled crater, this defect may be difficult to visualize on
the radiograph, because the buccal and lingual walls remain intact
and obscure the radiographic image of the defect.
Chronic Periodontitis
sequence of radiographic changes in
periodontitis and the tissue changes
that produce them
1. There is fuzziness and break in the
continuity of the lamina dura at the
mesial or distal aspect of the crest of
the interdental septum. These result
from the extension of gingival
inflammation into the bone causing
the widening of the vessel channels
and a reduction in calcified tissue at
the septal margin
2. Triangulation (Funnelling). Is due
to resorption of the bone along the
mesial and distal aspects causing the
widening of the pdl. The walls of the
triangles is formed along the walls of
the alveolar bone and the root
surfaces, base is towards the gingiva
and the apex towards the root.
It is an early sign of bone
degeneration and necessitate the
search for etiologic factors such as
plaque, calculus, gingivitis and food
impaction.
• 3. The destructive process extends
across the crest of the interdental
septum and the height is reduced.
Fingerlike radiolucent projections
extend from the crest into the
septum. The radiolucent
projections into the interdental
septum are the result of the
deeper extension of the
inflammation into the bone.
• 4. The height of the interdental
septum is progressively reduced by
the extension of inflammation and
the resorption of bone
Aggressive Periodontitis
• The radiographic appearance is
typically that of deep vertical bone
loss with a marked predilection for
the first molar and central incisor
regions with relative sparing of
other segments of the dentition.
• There is an arc-shaped loss of
alveolar bone extending from the
distal surface of the second
premolar to the mesial surface of
the second molar. It is usually
bilaterally symmetrical in both the
first molars of each jaw
Periodontal Abscesses
• The typical radiographic appearance of the periodontal abscess is that
of a discrete area of radiolucency along the lateral aspect of the root.
• However, the radiographic picture is often not typical therefore, it
cannot be relied upon for the diagnosis of a periodontal abscess
Conditions Associated with Periodontal
Diseases
• They include ; occlusal trauma and local irritants
• Trauma from occlusion.
• Traumatic occlusion by itself does not cause periodontitis but can
result in some traumatic lesion in response to occlusal pressures
which are greater than the physiological tolerances of the tooth’s
supporting structures
• can produce radiographically detectable changes in the lamina dura,
morphology of the alveolar crest, width of the periodontal ligament
space, and density of the surrounding cancellous bone.
• The injury phase of trauma from occlusion produces a loss of the
lamina dura at apices, furcations, and/or marginal areas. This loss of
lamina dura results in widening of the periodontal ligament space.
The repair phase of trauma from occlusion radiographically show
widening of the periodontal ligament space, which may be
generalized or localized
• More advanced traumatic lesions may result in deep angular bone
loss, which, when combined with marginal inflammation, may lead to
intrabony pocket formation. In terminal stages these lesions extend
around the root apex, producing a wide radiolucent periapical image
occlusal trauma with considerable increase in periapical bone density
(circle) and in the bone crest (green arrow).
Local irritating factors
• Many local factors contribute
towards periodontal disease. Some
of these factors can be visualised
on the radiographs
• These include calculus deposits
(overhanging restorations, lack of
local contact points, malposed
teeth, partial dentures, faulty
restorations and caries
• A times some of the calculus is not
visible radiographs and is not
interpreted as absence of calculus
SKELETAL DISTURBANCES MANIFESTED IN
THE JAWS
• Skeletal disturbances sometime produce
changes in the jaws that affect the
interpretation of radiographs from the
periodontal perspective
• In scleroderma, the periodontal ligament is
uniformly widened at the expense of the
surrounding alveolar bone.
• In Osteitis fibrosa cystica (Von
Recklinghausen’s disease of bone) there is
osteoclastic resorption of bone creating a
mass known as brown tumor. There is
generalized disappearance of the lamina dura.
• In Paget’s disease, the normal trabecular
pattern is replaced by a hazy, diffuse
meshwork of closely knit, fine trabecular
markings. The lamina dura is absent in it.
•
• In Fibrous dysplasia, there is small radiolucent
area at a root apex or an extensive
radiolucent area with irregularly arranged
trabecular markings. There may be
enlargement of the cancellous spaces, with
distortion of the normal trabecular pattern
giving a ground glass appearance and
obliteration of the lamina dura.
• In osteopetrosis, the outlines of the roots may
be obscured by diffuse radiopacity of the
jaws.
LIMITATIONS OF CONVENTIONAL
RADIOGRAPHS
• 1. Conventional radiographs provide a two
dimensional image of complex, three
dimensional anatomy, which may result in
following problems in periodontal
assessment:
• • Difficult to differentiate between buccal and
lingual crestal bone levels.
• • One wall defects may obscure the rest of the
defects.
• • Tooth or restoration shadows may obscure
bone defects and resorption in furcation area.
2. Due to superimposition, the details of the
bony architure may be lost
3. Radiographs do not demonstrate incipient
disease, as a minimum of 55-60%
demineralization must occur before
radiographic changes are apparent
4. Radiographs do not reliably demonstrate soft
tissue contours, and do not record changes in
the soft tissues of the periodontium.
• 5. Technique variations can affect the
appearance of the periodontal tissues.
• 6. Overexposure may lead to false
interpretations – ‘burn-out’ phenomenon.
• 7. Panoramic radiographs cannot be
completely relied upon although they do
provide a reasonable overview of periodontal
status.
ADVANCED RADIOGRAPHIC AIDS
• Many clinicians are adopting digital X-ray
systems to replace conventional film-
based images because;
• 30% of the bone mass at the alveolar
crest must be lost for a change in bone
height to be recognized on radiographs
• use of computerized images, which can
be stored, manipulated, and corrected for
under- and overexposures.
• This direct digital radiography obtains
real-time imaging, offering both the
clinician and the patient an improved
visualization of the periodontium by
image manipulation and comparison with
previously stored images
• Subtraction Radiography relies on
conversion of several serial radiographs
into digital images and video screen to
detect the changes in density or volume
of bone loss
• In computer assisted densitometric image
analysis system. A video camera
measures light transmitted through
radiograph and signals of the camera is
converted into gray scale images

More Related Content

Similar to RADIOGRAPHIC AIDS IN THE DIAGNOSIS OF PERIODONTAL DISEASES.pptx

Common diseases of the teeth
Common diseases of the teethCommon diseases of the teeth
Common diseases of the teeth
Hassan Atheed
 
lecture number 2
lecture number 2lecture number 2
lecture number 2
Lama K Banna
 
Patterns of bone destruction in periodontics
Patterns of bone destruction in periodontics Patterns of bone destruction in periodontics
Patterns of bone destruction in periodontics
Maneesh Ahammed Syed
 
Radiographs in endodontics
Radiographs in endodonticsRadiographs in endodontics
Radiographs in endodontics
IAU Dent
 
Radiographic Features of Head and Neck Trauma
Radiographic Features of Head and Neck TraumaRadiographic Features of Head and Neck Trauma
Radiographic Features of Head and Neck Trauma
Hadi Munib
 
radiographicinterpretation.MS-Ceu.pptx
radiographicinterpretation.MS-Ceu.pptxradiographicinterpretation.MS-Ceu.pptx
radiographicinterpretation.MS-Ceu.pptx
DrCarlosIICapitan
 
Radiographic interpretation
Radiographic interpretationRadiographic interpretation
Radiographic interpretation
moix rafiq
 
Radiographic Aids in the Diagnosis of Periodontal Diseases.pptx
Radiographic Aids in the Diagnosis of Periodontal Diseases.pptxRadiographic Aids in the Diagnosis of Periodontal Diseases.pptx
Radiographic Aids in the Diagnosis of Periodontal Diseases.pptx
RoshnaTalibMustafa
 
RADIOGRAPHIC AIDS IN THE DIAGNOSIS OF PERIODONTAL DISEASES
RADIOGRAPHIC AIDS IN THE DIAGNOSIS OF PERIODONTAL DISEASESRADIOGRAPHIC AIDS IN THE DIAGNOSIS OF PERIODONTAL DISEASES
RADIOGRAPHIC AIDS IN THE DIAGNOSIS OF PERIODONTAL DISEASES
Shivangani Arya
 
vertical root fracture and it's management .....
vertical root fracture and it's management .....vertical root fracture and it's management .....
vertical root fracture and it's management .....
ms khatib
 
Radiographic aids in Periodontal Diagnosis
Radiographic aids in Periodontal DiagnosisRadiographic aids in Periodontal Diagnosis
Radiographic aids in Periodontal Diagnosis
Dr.Shraddha Kode
 
Radiographs
RadiographsRadiographs
Radiographs
smidsperio
 
Radiographic interpretation of periodontal diseases /prosthodontic courses
Radiographic  interpretation of periodontal diseases /prosthodontic coursesRadiographic  interpretation of periodontal diseases /prosthodontic courses
Radiographic interpretation of periodontal diseases /prosthodontic courses
Indian dental academy
 
Radiographs in prosthodontics/dental crown &bridge course by Indian dental ac...
Radiographs in prosthodontics/dental crown &bridge course by Indian dental ac...Radiographs in prosthodontics/dental crown &bridge course by Indian dental ac...
Radiographs in prosthodontics/dental crown &bridge course by Indian dental ac...
Indian dental academy
 
Osseous surgery
Osseous surgeryOsseous surgery
Osseous surgery
Suhani Goel
 
fenestration.docx
fenestration.docxfenestration.docx
fenestration.docx
Dr.Mohammed Alruby
 
Maxillary and jaw lesions
Maxillary and jaw lesionsMaxillary and jaw lesions
Maxillary and jaw lesions
Sangeeta Jha
 
Resective osseous surgery
Resective osseous surgeryResective osseous surgery
Resective osseous surgery
Dr.R.Dhivya.,MDS
 
10.radiographic aids in diagnosing periodontal diseases
10.radiographic aids in diagnosing periodontal diseases 10.radiographic aids in diagnosing periodontal diseases
10.radiographic aids in diagnosing periodontal diseases
punitnaidu07
 
Periodontal infections
Periodontal infectionsPeriodontal infections
Periodontal infections
Himani Tyagi
 

Similar to RADIOGRAPHIC AIDS IN THE DIAGNOSIS OF PERIODONTAL DISEASES.pptx (20)

Common diseases of the teeth
Common diseases of the teethCommon diseases of the teeth
Common diseases of the teeth
 
lecture number 2
lecture number 2lecture number 2
lecture number 2
 
Patterns of bone destruction in periodontics
Patterns of bone destruction in periodontics Patterns of bone destruction in periodontics
Patterns of bone destruction in periodontics
 
Radiographs in endodontics
Radiographs in endodonticsRadiographs in endodontics
Radiographs in endodontics
 
Radiographic Features of Head and Neck Trauma
Radiographic Features of Head and Neck TraumaRadiographic Features of Head and Neck Trauma
Radiographic Features of Head and Neck Trauma
 
radiographicinterpretation.MS-Ceu.pptx
radiographicinterpretation.MS-Ceu.pptxradiographicinterpretation.MS-Ceu.pptx
radiographicinterpretation.MS-Ceu.pptx
 
Radiographic interpretation
Radiographic interpretationRadiographic interpretation
Radiographic interpretation
 
Radiographic Aids in the Diagnosis of Periodontal Diseases.pptx
Radiographic Aids in the Diagnosis of Periodontal Diseases.pptxRadiographic Aids in the Diagnosis of Periodontal Diseases.pptx
Radiographic Aids in the Diagnosis of Periodontal Diseases.pptx
 
RADIOGRAPHIC AIDS IN THE DIAGNOSIS OF PERIODONTAL DISEASES
RADIOGRAPHIC AIDS IN THE DIAGNOSIS OF PERIODONTAL DISEASESRADIOGRAPHIC AIDS IN THE DIAGNOSIS OF PERIODONTAL DISEASES
RADIOGRAPHIC AIDS IN THE DIAGNOSIS OF PERIODONTAL DISEASES
 
vertical root fracture and it's management .....
vertical root fracture and it's management .....vertical root fracture and it's management .....
vertical root fracture and it's management .....
 
Radiographic aids in Periodontal Diagnosis
Radiographic aids in Periodontal DiagnosisRadiographic aids in Periodontal Diagnosis
Radiographic aids in Periodontal Diagnosis
 
Radiographs
RadiographsRadiographs
Radiographs
 
Radiographic interpretation of periodontal diseases /prosthodontic courses
Radiographic  interpretation of periodontal diseases /prosthodontic coursesRadiographic  interpretation of periodontal diseases /prosthodontic courses
Radiographic interpretation of periodontal diseases /prosthodontic courses
 
Radiographs in prosthodontics/dental crown &bridge course by Indian dental ac...
Radiographs in prosthodontics/dental crown &bridge course by Indian dental ac...Radiographs in prosthodontics/dental crown &bridge course by Indian dental ac...
Radiographs in prosthodontics/dental crown &bridge course by Indian dental ac...
 
Osseous surgery
Osseous surgeryOsseous surgery
Osseous surgery
 
fenestration.docx
fenestration.docxfenestration.docx
fenestration.docx
 
Maxillary and jaw lesions
Maxillary and jaw lesionsMaxillary and jaw lesions
Maxillary and jaw lesions
 
Resective osseous surgery
Resective osseous surgeryResective osseous surgery
Resective osseous surgery
 
10.radiographic aids in diagnosing periodontal diseases
10.radiographic aids in diagnosing periodontal diseases 10.radiographic aids in diagnosing periodontal diseases
10.radiographic aids in diagnosing periodontal diseases
 
Periodontal infections
Periodontal infectionsPeriodontal infections
Periodontal infections
 

More from EUROUNDISA

14 - SPECIAL CONSIDERATIONS FOR ORAL SURGEY IN PEDIATRIC PATIENTS- GROUP D.pptx
14 - SPECIAL CONSIDERATIONS FOR ORAL SURGEY IN PEDIATRIC PATIENTS- GROUP D.pptx14 - SPECIAL CONSIDERATIONS FOR ORAL SURGEY IN PEDIATRIC PATIENTS- GROUP D.pptx
14 - SPECIAL CONSIDERATIONS FOR ORAL SURGEY IN PEDIATRIC PATIENTS- GROUP D.pptx
EUROUNDISA
 
07 - Complications and their management-IMPLANTS.pptx
07 - Complications and their management-IMPLANTS.pptx07 - Complications and their management-IMPLANTS.pptx
07 - Complications and their management-IMPLANTS.pptx
EUROUNDISA
 
MANDIBULAR FRACTURES MANAGEMENT PROTOCO
MANDIBULAR  FRACTURES MANAGEMENT PROTOCOMANDIBULAR  FRACTURES MANAGEMENT PROTOCO
MANDIBULAR FRACTURES MANAGEMENT PROTOCO
EUROUNDISA
 
CONDYLAR FRACTURES management and survey
CONDYLAR FRACTURES management and surveyCONDYLAR FRACTURES management and survey
CONDYLAR FRACTURES management and survey
EUROUNDISA
 
14. PD Patients Complaints after deliver
14. PD Patients Complaints after deliver14. PD Patients Complaints after deliver
14. PD Patients Complaints after deliver
EUROUNDISA
 
PERIODONTAL_POCKET pathogenesis and management
PERIODONTAL_POCKET pathogenesis and managementPERIODONTAL_POCKET pathogenesis and management
PERIODONTAL_POCKET pathogenesis and management
EUROUNDISA
 
Techniques of copy denture fabrication.pptx
Techniques of copy denture fabrication.pptxTechniques of copy denture fabrication.pptx
Techniques of copy denture fabrication.pptx
EUROUNDISA
 
DENTURE COPYING PROCEDURES IN PROSTHETIC
DENTURE COPYING PROCEDURES IN PROSTHETICDENTURE COPYING PROCEDURES IN PROSTHETIC
DENTURE COPYING PROCEDURES IN PROSTHETIC
EUROUNDISA
 
1 - ECC, Nursing Caries and Rampant Caries.pptx
1 - ECC, Nursing Caries and Rampant Caries.pptx1 - ECC, Nursing Caries and Rampant Caries.pptx
1 - ECC, Nursing Caries and Rampant Caries.pptx
EUROUNDISA
 
BLOOD (MSB 103).pptThis is a presentation of haemopoiesis
BLOOD (MSB 103).pptThis is a presentation of haemopoiesisBLOOD (MSB 103).pptThis is a presentation of haemopoiesis
BLOOD (MSB 103).pptThis is a presentation of haemopoiesis
EUROUNDISA
 
NUCLEOTIDES(1).pptx Presentation on nucleotides structure
NUCLEOTIDES(1).pptx Presentation on nucleotides structureNUCLEOTIDES(1).pptx Presentation on nucleotides structure
NUCLEOTIDES(1).pptx Presentation on nucleotides structure
EUROUNDISA
 
Introduction Ethics & Morals.pptx presentation on ethics of research
Introduction Ethics & Morals.pptx presentation on ethics of researchIntroduction Ethics & Morals.pptx presentation on ethics of research
Introduction Ethics & Morals.pptx presentation on ethics of research
EUROUNDISA
 
MSB 102 - Medical Anthropology -2 A lecture on every aspect of medical anthro...
MSB 102 - Medical Anthropology -2 A lecture on every aspect of medical anthro...MSB 102 - Medical Anthropology -2 A lecture on every aspect of medical anthro...
MSB 102 - Medical Anthropology -2 A lecture on every aspect of medical anthro...
EUROUNDISA
 
Clinical features,presentation,clinical and surgical management of TMJ disloc...
Clinical features,presentation,clinical and surgical management of TMJ disloc...Clinical features,presentation,clinical and surgical management of TMJ disloc...
Clinical features,presentation,clinical and surgical management of TMJ disloc...
EUROUNDISA
 

More from EUROUNDISA (14)

14 - SPECIAL CONSIDERATIONS FOR ORAL SURGEY IN PEDIATRIC PATIENTS- GROUP D.pptx
14 - SPECIAL CONSIDERATIONS FOR ORAL SURGEY IN PEDIATRIC PATIENTS- GROUP D.pptx14 - SPECIAL CONSIDERATIONS FOR ORAL SURGEY IN PEDIATRIC PATIENTS- GROUP D.pptx
14 - SPECIAL CONSIDERATIONS FOR ORAL SURGEY IN PEDIATRIC PATIENTS- GROUP D.pptx
 
07 - Complications and their management-IMPLANTS.pptx
07 - Complications and their management-IMPLANTS.pptx07 - Complications and their management-IMPLANTS.pptx
07 - Complications and their management-IMPLANTS.pptx
 
MANDIBULAR FRACTURES MANAGEMENT PROTOCO
MANDIBULAR  FRACTURES MANAGEMENT PROTOCOMANDIBULAR  FRACTURES MANAGEMENT PROTOCO
MANDIBULAR FRACTURES MANAGEMENT PROTOCO
 
CONDYLAR FRACTURES management and survey
CONDYLAR FRACTURES management and surveyCONDYLAR FRACTURES management and survey
CONDYLAR FRACTURES management and survey
 
14. PD Patients Complaints after deliver
14. PD Patients Complaints after deliver14. PD Patients Complaints after deliver
14. PD Patients Complaints after deliver
 
PERIODONTAL_POCKET pathogenesis and management
PERIODONTAL_POCKET pathogenesis and managementPERIODONTAL_POCKET pathogenesis and management
PERIODONTAL_POCKET pathogenesis and management
 
Techniques of copy denture fabrication.pptx
Techniques of copy denture fabrication.pptxTechniques of copy denture fabrication.pptx
Techniques of copy denture fabrication.pptx
 
DENTURE COPYING PROCEDURES IN PROSTHETIC
DENTURE COPYING PROCEDURES IN PROSTHETICDENTURE COPYING PROCEDURES IN PROSTHETIC
DENTURE COPYING PROCEDURES IN PROSTHETIC
 
1 - ECC, Nursing Caries and Rampant Caries.pptx
1 - ECC, Nursing Caries and Rampant Caries.pptx1 - ECC, Nursing Caries and Rampant Caries.pptx
1 - ECC, Nursing Caries and Rampant Caries.pptx
 
BLOOD (MSB 103).pptThis is a presentation of haemopoiesis
BLOOD (MSB 103).pptThis is a presentation of haemopoiesisBLOOD (MSB 103).pptThis is a presentation of haemopoiesis
BLOOD (MSB 103).pptThis is a presentation of haemopoiesis
 
NUCLEOTIDES(1).pptx Presentation on nucleotides structure
NUCLEOTIDES(1).pptx Presentation on nucleotides structureNUCLEOTIDES(1).pptx Presentation on nucleotides structure
NUCLEOTIDES(1).pptx Presentation on nucleotides structure
 
Introduction Ethics & Morals.pptx presentation on ethics of research
Introduction Ethics & Morals.pptx presentation on ethics of researchIntroduction Ethics & Morals.pptx presentation on ethics of research
Introduction Ethics & Morals.pptx presentation on ethics of research
 
MSB 102 - Medical Anthropology -2 A lecture on every aspect of medical anthro...
MSB 102 - Medical Anthropology -2 A lecture on every aspect of medical anthro...MSB 102 - Medical Anthropology -2 A lecture on every aspect of medical anthro...
MSB 102 - Medical Anthropology -2 A lecture on every aspect of medical anthro...
 
Clinical features,presentation,clinical and surgical management of TMJ disloc...
Clinical features,presentation,clinical and surgical management of TMJ disloc...Clinical features,presentation,clinical and surgical management of TMJ disloc...
Clinical features,presentation,clinical and surgical management of TMJ disloc...
 

Recently uploaded

Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Oleg Kshivets
 
Ketone bodies and metabolism-biochemistry
Ketone bodies and metabolism-biochemistryKetone bodies and metabolism-biochemistry
Ketone bodies and metabolism-biochemistry
Dhayanithi C
 
Aortic Association CBL Pilot April 19 – 20 Bern
Aortic Association CBL Pilot April 19 – 20 BernAortic Association CBL Pilot April 19 – 20 Bern
Aortic Association CBL Pilot April 19 – 20 Bern
suvadeepdas911
 
Osteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdfOsteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdf
Jim Jacob Roy
 
Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
shivalingatalekar1
 
Cell Therapy Expansion and Challenges in Autoimmune Disease
Cell Therapy Expansion and Challenges in Autoimmune DiseaseCell Therapy Expansion and Challenges in Autoimmune Disease
Cell Therapy Expansion and Challenges in Autoimmune Disease
Health Advances
 
Physical demands in sports - WCSPT Oslo 2024
Physical demands in sports - WCSPT Oslo 2024Physical demands in sports - WCSPT Oslo 2024
Physical demands in sports - WCSPT Oslo 2024
Torstein Dalen-Lorentsen
 
Artificial Intelligence Symposium (THAIS)
Artificial Intelligence Symposium (THAIS)Artificial Intelligence Symposium (THAIS)
Artificial Intelligence Symposium (THAIS)
Josep Vidal-Alaball
 
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdfCHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
rishi2789
 
Efficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in AyurvedaEfficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in Ayurveda
Dr. Jyothirmai Paindla
 
Histopathology of Rheumatoid Arthritis: Visual treat
Histopathology of Rheumatoid Arthritis: Visual treatHistopathology of Rheumatoid Arthritis: Visual treat
Histopathology of Rheumatoid Arthritis: Visual treat
DIVYANSHU740006
 
The Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic PrinciplesThe Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic Principles
MedicoseAcademics
 
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptxEar and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Dr. Rabia Inam Gandapore
 
Hiranandani Hospital Powai News [Read Now].pdf
Hiranandani Hospital Powai News [Read Now].pdfHiranandani Hospital Powai News [Read Now].pdf
Hiranandani Hospital Powai News [Read Now].pdf
Dr. Sujit Chatterjee CEO Hiranandani Hospital
 
OCT Training Course for clinical practice Part 1
OCT Training Course for clinical practice Part 1OCT Training Course for clinical practice Part 1
OCT Training Course for clinical practice Part 1
KafrELShiekh University
 
Role of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of HyperthyroidismRole of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of Hyperthyroidism
Dr. Jyothirmai Paindla
 
Tests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptxTests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptx
taiba qazi
 
All info about Diabetes and how to control it.
 All info about Diabetes and how to control it. All info about Diabetes and how to control it.
All info about Diabetes and how to control it.
Gokuldas Hospital
 
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdfCHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
rishi2789
 
CBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdfCBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdf
suvadeepdas911
 

Recently uploaded (20)

Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
 
Ketone bodies and metabolism-biochemistry
Ketone bodies and metabolism-biochemistryKetone bodies and metabolism-biochemistry
Ketone bodies and metabolism-biochemistry
 
Aortic Association CBL Pilot April 19 – 20 Bern
Aortic Association CBL Pilot April 19 – 20 BernAortic Association CBL Pilot April 19 – 20 Bern
Aortic Association CBL Pilot April 19 – 20 Bern
 
Osteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdfOsteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdf
 
Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
 
Cell Therapy Expansion and Challenges in Autoimmune Disease
Cell Therapy Expansion and Challenges in Autoimmune DiseaseCell Therapy Expansion and Challenges in Autoimmune Disease
Cell Therapy Expansion and Challenges in Autoimmune Disease
 
Physical demands in sports - WCSPT Oslo 2024
Physical demands in sports - WCSPT Oslo 2024Physical demands in sports - WCSPT Oslo 2024
Physical demands in sports - WCSPT Oslo 2024
 
Artificial Intelligence Symposium (THAIS)
Artificial Intelligence Symposium (THAIS)Artificial Intelligence Symposium (THAIS)
Artificial Intelligence Symposium (THAIS)
 
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdfCHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
 
Efficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in AyurvedaEfficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in Ayurveda
 
Histopathology of Rheumatoid Arthritis: Visual treat
Histopathology of Rheumatoid Arthritis: Visual treatHistopathology of Rheumatoid Arthritis: Visual treat
Histopathology of Rheumatoid Arthritis: Visual treat
 
The Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic PrinciplesThe Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic Principles
 
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptxEar and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
 
Hiranandani Hospital Powai News [Read Now].pdf
Hiranandani Hospital Powai News [Read Now].pdfHiranandani Hospital Powai News [Read Now].pdf
Hiranandani Hospital Powai News [Read Now].pdf
 
OCT Training Course for clinical practice Part 1
OCT Training Course for clinical practice Part 1OCT Training Course for clinical practice Part 1
OCT Training Course for clinical practice Part 1
 
Role of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of HyperthyroidismRole of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of Hyperthyroidism
 
Tests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptxTests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptx
 
All info about Diabetes and how to control it.
 All info about Diabetes and how to control it. All info about Diabetes and how to control it.
All info about Diabetes and how to control it.
 
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdfCHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
 
CBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdfCBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdf
 

RADIOGRAPHIC AIDS IN THE DIAGNOSIS OF PERIODONTAL DISEASES.pptx

  • 1. RADIOGRAPHIC AIDS IN THE DIAGNOSIS OF PERIODONTAL DISEASES GROUP A
  • 2. Course outline 1.Introduction 2. Diagnostic Requirements of Radiographs 3. Radiographic Techniques for Assessing Periodontal Diseases 4. Radiographic Features of Healthy Periodontium • Alveolar Bone • Interdental Septa • Periodontal Ligament Space 5. Radiographic Changes in Various Periodontal Conditions • Osseous Defects • Chronic Periodontitis • Aggressive Periodontitis • Furcation Defects • Periodontal Abscesses • Conditions Associated with Periodontal Diseases • 6. Skeletal Disturbances Manifested in the Jaws • 7. Limitations of Conventional Radiographs • 8. Advanced Radiographic Aids
  • 3. INTRODUCTION • Radiographs are an integral component of a periodontal assessment for those with clinical evidence of periodontal destruction • Radiographs are considered as a valuable adjunct to the clinical examination, because essential information is provided about the bony tissues covered by the gingiva that cannot be diagnosed by clinical inspection alone. • Radiographic image formation is based on the principle of projecting a 3-D object onto a 2-D image plane, and therefore this technique also has limitations.
  • 4. DIAGNOSTIC REQUIREMENTS OF RADIOGRAPHS 1. Radiographs should only be considered following a full clinical examination. 2. A provisional diagnosis should be made with the choice of radiographs based on the type, severity and distribution of disease. 3. Radiographs taken for reasons other than periodontal disease (e.g. horizontal bitewings for caries diagnosis) will often provide useful information and should be examined before further radiographs are requested 4. Prichard established the following four criteria to determine the adequate angulation of periapical radiographs: • The radiographs should show the tips of molar cusps with little or none of the occlusal surface • Enamel caps and pulp chambers should be distinct • Interproximal spaces should be open • Proximal contacts should not overlap unless teeth are out of line anatomically.
  • 5. RADIOGRAPHIC TECHNIQUES A) Panoramic radiographs: • Panoramic radiographs provide a general view of the oral structures, and are useful for screening bone loss patterns in general. • They are not suitable for accurate assessment of the degree of bone loss associated with individual teeth, as there is severe distortion and the outline of the bone margin is often unclear due to superimposition of intervening structures. • Panoramic view is useful when assessing generalized periodontitis, where large areas of jaws have to be viewed.
  • 6.
  • 7. B) Periapical radiographs • Frequently used not only to aid the differential diagnosis of patient’s presenting symptoms, but also to screen for otherwise undetected pathological processes of the teeth and surrounding alveolar bone. • In the diagnosis of periodontal diseases, periapical radiographs can provide useful information that cannot be obtained through examination of the soft tissues alone.
  • 8. C) Bitewing Radiographs • These are taken to show the proximal surfaces of the teeth and the crest of the alveolar bone of both the maxilla and the mandible on the same film. • While they are used primarily to detect interproximal decay, they can also provide some information on the patient’s periodontal status. • The height of the interproximal alveolar bone margin relative to the CEJ can be observed. • Also, deposits of subgingival calculus may be detected. • Limitation- Only the coronal sections of the roots of the teeth are observed, and they are limited to the molar-premolar regions. • The posterior bitewing projection offers both optimal geometry and the fine detail of intraoral radiography for patients with small amounts of uniform bone loss
  • 9.
  • 10. RADIOGRAPHIC FEATURES OF HEALTHY PERIODONTIUM A) ALVEOLAR BONE • The dense cortical alveolar bone forming the wall of the socket of tooth appears radiographically as a distinct, opaque, uninterrupted, white line parallel to the tooth root known as the lamina dura. • The lamina dura is a continuation of the jawbone cortex, which encases the root in a socket of cortical bone. • The alveolar crest in a young individual is close to the CEJ. The alveolar crests are situated approximately 2 to 3 mm apical to the CEJ of the teeth. The shape of the alveolar crest may vary from rounded to flat
  • 11. Cont’d • Between incisor teeth, the alveolar crest will usually appear pointed. • Between premolar and molar teeth the alveolar crest will be parallel to a line between the adjacent CEJs, where the enamel thins and disappears. The alveolar crest will be continuous with the lamina dura of the adjacent teeth. • When viewing the lamina dura and the periodontal ligament, only the interproximal portions are visible. The buccal and lingual areas are not seen in the radiograph. • Widening of the periodontal ligament space and loss of lamina dura can be interpreted as resorption of the alveolar bone. • The trabecular pattern of interdental bone is distinct and fills the inter- radicular space
  • 12.
  • 13. B) INTERDENTAL SEPTA • The interdental septum, or septal bone, is located between the roots of adjacent teeth. • It is therefore more clearly visualized than bone that is located on the buccal or lingual aspect of the tooth. • The shape of the interdental septum is a function of the morphology of the contiguous teeth
  • 14. C) PDL SPACE • The periodontal ligament is composed of connective tissue which appears as a fine, black, radiolucent line next to the root surface. • The radiolucent image between the lamina dura and tooth is the periodontal space and is known radiographically as the lamina lucida. • With disease, the periodontal ligament space may appear at varying thicknesses. • A widened periodontal space is considered to be a sign of chronic inflammation. • However, it varies.
  • 15. USES OF RADIOGRAPHIC ASSESSMENT Radiographs are helpful in evaluation of the following: 1. Amount of bone present 2. Condition of the alveolar crests 3. Bone loss in the furcation areas 4. Width of the periodontal ligament
  • 16. RADIOGRAPHIC CHANGES IN VARIOUS PERIODONTAL CONDITIONS • OSSEOUS DEFECTS • Horizontal bone loss • Clinically, horizontal bone loss is seen in suprabony pocket. • Radiographically, horizontal bone loss appears as decreased alveolar marginal bone around adjacent teeth. Normally, the crestal bone is located 1-2 mm apical to the cementoenamel junction. • With horizontal bone loss, both the buccal and lingual plates of bone, as well as interdental bone resorbs. The remaining bone margin is roughly perpendicular to long axis of tooth, which occurs when the epithelial attachment is coronal to the bony defect
  • 17. Furcation defects • The furcation is where multiple tooth roots divide at the trunk of the tooth. It is usually filled with bone. Furcation exposure results from intra-radicular bone loss due to advanced periodontal disease • In class I furcation involvement of the furcation shows that there is decreased density of bone at the furcation area. • In class II bone loss may or may not be seen in the furcation area. • In class III there is complete bone loss visible in the radiograph. • In the maxillary molars, the palatal roots’ superimposition makes the furcation of the mesial and distal roots and is presented as arrows radiolucency. The furcation btwn the mesial and palatal roots is clearly seen
  • 19. Vertical bone loss: • Clinically, vertical bone loss is seen in infrabony pocket which occurs when the walls of the pocket are within a bony housing. • Radiographically, vertical bone defects are generally V shaped and re sharply outlined.
  • 20. Interdental craters: • seen as irregular areas of reduced radiopacity on the alveolar bone crests. They are generally not sharply demarcated from the rest of the bone, with which they blend gradually. • Radiographs do not accurately depict the morphology or depth of interdental craters, which sometimes appear as vertical defects • . Like the two-walled crater, this defect may be difficult to visualize on the radiograph, because the buccal and lingual walls remain intact and obscure the radiographic image of the defect.
  • 21. Chronic Periodontitis sequence of radiographic changes in periodontitis and the tissue changes that produce them 1. There is fuzziness and break in the continuity of the lamina dura at the mesial or distal aspect of the crest of the interdental septum. These result from the extension of gingival inflammation into the bone causing the widening of the vessel channels and a reduction in calcified tissue at the septal margin 2. Triangulation (Funnelling). Is due to resorption of the bone along the mesial and distal aspects causing the widening of the pdl. The walls of the triangles is formed along the walls of the alveolar bone and the root surfaces, base is towards the gingiva and the apex towards the root. It is an early sign of bone degeneration and necessitate the search for etiologic factors such as plaque, calculus, gingivitis and food impaction.
  • 22. • 3. The destructive process extends across the crest of the interdental septum and the height is reduced. Fingerlike radiolucent projections extend from the crest into the septum. The radiolucent projections into the interdental septum are the result of the deeper extension of the inflammation into the bone. • 4. The height of the interdental septum is progressively reduced by the extension of inflammation and the resorption of bone
  • 23. Aggressive Periodontitis • The radiographic appearance is typically that of deep vertical bone loss with a marked predilection for the first molar and central incisor regions with relative sparing of other segments of the dentition. • There is an arc-shaped loss of alveolar bone extending from the distal surface of the second premolar to the mesial surface of the second molar. It is usually bilaterally symmetrical in both the first molars of each jaw
  • 24. Periodontal Abscesses • The typical radiographic appearance of the periodontal abscess is that of a discrete area of radiolucency along the lateral aspect of the root. • However, the radiographic picture is often not typical therefore, it cannot be relied upon for the diagnosis of a periodontal abscess
  • 25. Conditions Associated with Periodontal Diseases • They include ; occlusal trauma and local irritants • Trauma from occlusion. • Traumatic occlusion by itself does not cause periodontitis but can result in some traumatic lesion in response to occlusal pressures which are greater than the physiological tolerances of the tooth’s supporting structures • can produce radiographically detectable changes in the lamina dura, morphology of the alveolar crest, width of the periodontal ligament space, and density of the surrounding cancellous bone.
  • 26. • The injury phase of trauma from occlusion produces a loss of the lamina dura at apices, furcations, and/or marginal areas. This loss of lamina dura results in widening of the periodontal ligament space. The repair phase of trauma from occlusion radiographically show widening of the periodontal ligament space, which may be generalized or localized • More advanced traumatic lesions may result in deep angular bone loss, which, when combined with marginal inflammation, may lead to intrabony pocket formation. In terminal stages these lesions extend around the root apex, producing a wide radiolucent periapical image
  • 27. occlusal trauma with considerable increase in periapical bone density (circle) and in the bone crest (green arrow).
  • 28. Local irritating factors • Many local factors contribute towards periodontal disease. Some of these factors can be visualised on the radiographs • These include calculus deposits (overhanging restorations, lack of local contact points, malposed teeth, partial dentures, faulty restorations and caries • A times some of the calculus is not visible radiographs and is not interpreted as absence of calculus
  • 29. SKELETAL DISTURBANCES MANIFESTED IN THE JAWS • Skeletal disturbances sometime produce changes in the jaws that affect the interpretation of radiographs from the periodontal perspective • In scleroderma, the periodontal ligament is uniformly widened at the expense of the surrounding alveolar bone. • In Osteitis fibrosa cystica (Von Recklinghausen’s disease of bone) there is osteoclastic resorption of bone creating a mass known as brown tumor. There is generalized disappearance of the lamina dura. • In Paget’s disease, the normal trabecular pattern is replaced by a hazy, diffuse meshwork of closely knit, fine trabecular markings. The lamina dura is absent in it. • • In Fibrous dysplasia, there is small radiolucent area at a root apex or an extensive radiolucent area with irregularly arranged trabecular markings. There may be enlargement of the cancellous spaces, with distortion of the normal trabecular pattern giving a ground glass appearance and obliteration of the lamina dura. • In osteopetrosis, the outlines of the roots may be obscured by diffuse radiopacity of the jaws.
  • 30. LIMITATIONS OF CONVENTIONAL RADIOGRAPHS • 1. Conventional radiographs provide a two dimensional image of complex, three dimensional anatomy, which may result in following problems in periodontal assessment: • • Difficult to differentiate between buccal and lingual crestal bone levels. • • One wall defects may obscure the rest of the defects. • • Tooth or restoration shadows may obscure bone defects and resorption in furcation area. 2. Due to superimposition, the details of the bony architure may be lost 3. Radiographs do not demonstrate incipient disease, as a minimum of 55-60% demineralization must occur before radiographic changes are apparent 4. Radiographs do not reliably demonstrate soft tissue contours, and do not record changes in the soft tissues of the periodontium. • 5. Technique variations can affect the appearance of the periodontal tissues. • 6. Overexposure may lead to false interpretations – ‘burn-out’ phenomenon. • 7. Panoramic radiographs cannot be completely relied upon although they do provide a reasonable overview of periodontal status.
  • 31.
  • 32. ADVANCED RADIOGRAPHIC AIDS • Many clinicians are adopting digital X-ray systems to replace conventional film- based images because; • 30% of the bone mass at the alveolar crest must be lost for a change in bone height to be recognized on radiographs • use of computerized images, which can be stored, manipulated, and corrected for under- and overexposures. • This direct digital radiography obtains real-time imaging, offering both the clinician and the patient an improved visualization of the periodontium by image manipulation and comparison with previously stored images • Subtraction Radiography relies on conversion of several serial radiographs into digital images and video screen to detect the changes in density or volume of bone loss • In computer assisted densitometric image analysis system. A video camera measures light transmitted through radiograph and signals of the camera is converted into gray scale images