This document discusses the use of radiographs in assessing periodontal disease and bone destruction. It provides information on normal interdental bone appearance and outlines criteria for evaluating bone loss patterns seen in periodontal disease. Key findings include lamina dura disruption being an early sign of periodontitis and interdental cratering appearing as irregular reduced bone density. Furcation involvement is suggested by diminished bone trabeculae radiodensity or marked bone loss on a single root. Additional imaging techniques like CBCT can provide further detail on lesion morphology.

3. RADIOGRAPHS are an ADJUNCT to
clinical examination .
They reveals changes in calcified tissues
…..
They donot reveal current cellular activity
but reflect effects of past cellular
experiences on bone and roots.

4. NORMAL INTERDENTAL BONE
 In periodontal disease , bone changes
depends mainly on appearance of
interdental bone because dense root
structure obscures facial and lingual bony
plates.
 The INTERDENTAL BONE is outlined by thin ,radiopaque line
adjacent to periodontal ligament and at alveolar crest and
radiographically called as LAMINA DURA
 THE ANGULATION OF CREST OF INTERDENTAL SEPTUM:
parallel to a line between the CEJs of approximating teeth.

6. RADIOGRAPHIC TECHNIQUES
 Periapical
 Bitewing
 Long cone paralleling technique
 Bisecting of the angle technique
 Of the 2 long cone technique is preferred as it accurately projects alveolar
bone level

7. PRICHARD’S 4 criterias to determine
adequate angulation of periapical
radiographs
 1.Radiograph should show the tips of molar cusps
with little or none of occlusal surface showing
 2.Enamel caps and pulp chambers should be
distinct
 3.Interproximal spaces should be open
 4.Proximal contacts shouldnot overlap unless
teeth are out of line anatomically

8. BONE DESTRUCTION IN PERIODONTAL
DISEASE
 BONE LOSS
 Difference between the alveolar crest height and radiographic appearance
ranges from 0mm to 1.6mm.
 AMOUNT
 Radiographs assess the amount of remaining bone than the amount lost.
 Bone lost ….estimated as physiologic bone level-the height of remaining bone.
 DISTRIBUTION
 Distribution of bone loss is important as they indicate location of destructive
local factors in different areas of mouth and in relation to different surfaces
of same tooth.

9. PATTERN OF BONE DESTRUCTION
 IN PERIODONTAL DISEASE,
 LAMINADURA
 CRESTAL RADIODENSITY
 SIZE AND SHAPE OF MEDULLARY SPACES
 HEIGHT AND CONTOUR OF BONE
 Height of interdental bone may be reduced (horizontal /vertical bone loss)
 Radiographs donot reveal extent of involvement on facial and lingual
surfaces.

10. RADIOGRAPHIC APPEARANCE OF
PERIODONTAL DISEASE
 PERIODONTITIS
 1.FUZZINESS AND DISRUPTION OF LAMINA DURA earliest radiographic changes
in periodontitis.
 Presence of an intact crestal lamina dura may be an indicator of periodontal
health.
 2. Continued periodontal bone loss and widening of periodontal space result
in wedge shaped radiolucency at mesial or distal aspect of crest .
 Destructive process extends across alveolar crest reducing the height of
interdental bone.
 Height of interdental septum is reduced by extension of inflammation and
resorption of bone

12.  INTERDENTAL CRATER
 Seen as irregular areas of reduced density on alveolar bone crest.
 Conventional radiographs donot depict morphology or depth of interdental
crater and can appear as vertical depth.

13.  FURCATION INVOLVEMENT
 Large clearly defined radiolucency in furcation areas is easy to identify.
 Diagnostic criteria for radiographic detection of furcation involvement
 Slightest radiographic change in furcation area should be investigated
clinically if there is bone loss on adjacent roots.
 Diminished radiodensity in furcation area in which outlines of bony trabeculae
are visible suggests furcation involvement
 Whenever there is marked bone loss in relation to a single molar root it may
be assumed that the furcation is involved

14.  Definitive diagnosis for furcation must be made by clinical examination
 Probe:Nabers probe
 Root superimposition caused by anatomic variation /improper technique can
obscure radiographic representation of furcation involvement
 Radiographs must be taken at different angles to reduce risk of missing
furcation involvement .
 Radiographic finding of furcation involvement-A large clearly
defined radiolucency in the furcation area.
 Less clearly defined radiographic changes are overlooked.

15. DIAGNOSTIC CRITERIA FOR RADIOGRAPHIC
DETECTION OF FURCATION INVOLVEMENT
 1.The slightest radiographic change in the furcation
area should be investigated clinically, especially if
there is bone loss on adjacent roots.
 2.Diminished radiodensity in the furaction area in
which outlines of bony trabeculae are visible suggests
furcation involvement.
 3.Whenever there is marked bone loss in relation to a
single molar root ,it may be assumed that the
furcation is also involved.

18. PERIODONTAL ABSCESS
 Typical radiographic feature of periodontal abcess –DISCRETE AREA OF
RADIOLUSCENCY ALONG LATERAL ASPECT OF ROOT
 The stage of the lesion: In early stages ACUTE PERIODONTAL ABSCESS is extremely
painful but presents no radiographic changes.
 The extent of bone destruction and the morphologic changes of the bone
 The location of the abscess:
 Interproximal lesions are more likely to be seen in radiographs
 Lesions in soft tissue wall of a periodontal pocket are less likely to produce
radiographic changes than those deep in supporting tissues
 Abscesses on facial or lingual surface are obscured by radiopacity of root

19. RADIOGRAPHIC INDICATORS
 Radiographs taken with periodontal probes or other indicators like
HIRSCHFELD POINTERS placed into anaesthetised pocket show true extend of
bone lesion.

21. LOCALISED AGGRESSIVE PERIODONTITIS
 Bilaterally ARC SHAPED LESION extending from………..

22. TRAUMA FROM OCCLUSION
 TRAUMA FROM OCCLUSION produces radiographically detectable changes in
 Thickness of lamina dura
 Morphology of alveolar crest
 Width of PDL space
 Density of surrounding cancellous bone

23.  INJURY PHASE of trauma from occlusion
 Loss of lamina dura in apices, furcations, marginal area
 This loss of laminadura seen as WIDENING OF PDL space
 REPAIR PHASE of trauma from occlusion
 In this phase attempts to strengthen periodontal structures to support
increased load is seen
 In radiographs seen as WIDENING OF PDL SPACE generalised or localised

24. When seen on radiographs, PDL space
variation in width suggest that the
tooth is being subjected to increased
forces.

25.  ADVANCED TRAUMATIC LESIONS:
 Result in DEEP ANGULAR BONE LOSS, when combined with marginal
inflammation lead to INTRABONY POCKET FORMATION.
 TERMINAL STAGES:
 Lesions extend around the root apex, producing a wide radiolucent periapical
image.(CAVERNOUS LESION)

26. ADDITIONAL RADIOGRAPHIC
CRITERIA
 RADIOPAQUE HORIZONTAL LINE ACROSS THE
ROOTS
 VESSELS CANALS IN ALVEOLAR BONE

27. SKELETAL DISTURBANCES MANIFESTED IN
JAWS
 Local or systemic diseases of bones of face can alter cortical and trabecular
architecture of alveolar ridges and mimic radiographic appearance of
periodontitis.
 Langerhans cell histiocytosis
 Malignancy
 Multiple myeloma
 Metabolic diseases like vit D deficiency, hyperparathyroidism, osteoporosis
 Paget’s disease-normal trabecular pattern replaced by hazy, diffuse meshwork
of closely knit,fine trabecular markings, with absent lamina dura or scattered
radioluscent areas may contain irregularly shaped radiopaque zones.
 Scleroderma

29. DIGITAL INTRAORAL RADIOGRAPHY
 2 DIGITAL INTRAORAL SYSTEMS
 Charge-coupled devices (CCD)
 Complementary metal oxide semiconductors (CMOS)

32.  DISADVANTAGE IS ……COST

33. ADVANCED IMAGING MODALITIES
 CBCT

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