Radiological aspects of periodontal disease/cosmetic dentistry courses

 The amount of bone present
 Condition of the alveolar crests
 Bone loss in furcation areas
 Width of the periodontal ligament space
 Local irritating factors that cause or intensify
periodontal disease; calculus
Poorly contoured or over extended restorations.
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 Root length and morphology and the crown
to root ratio.
 Anatomical considerations;
 Position of the maxillary sinus in relation to
a periodontal deformity.
 Missing, supernumerary or impacted teeth.
Pathological considerations
 Caries
 Periapical lesions
 Root resorption.

 Changes in the morphology of the supporting alveolar bone: appear
because of the loss of the interproximal crestal bone and bone
overlapping the buccal or lingual aspects of the tooth root.
 Changes to the internal density and trabecular pattern: these
changes reflect a reduction or an increase in bone structure.
 Reduction is seen as an increase in the radiolucency because of a
decrease in the number and density of existing trabeculae.
 An increase in bone is seen as increase in the radiopacity (sclerosis)
as a result of increase in the density and number of trabeculae.

 Bitewing and Periapical radiographs.
 Intraoral grids may be used to evaluate the bone
height.
 OPG – underestimate minor marginal bone
destruction and overestimate major destruction.
 Computers and image –processing techniques
have been used to enhance radiographs to
achieve improved detection of alveolar bone loss
associated with periodontal disease.

 Subtraction radiography and densitometric
image analysis-
assists in showing and measuring subtle
changes in fine alveolar and crestal bone
pattern.
It allows for better detection of small
amounts of bone loss or bone formation
between radiographs made at different times.

 Thin layer of cortical bone often covers the alveolar crest.
Height of alveolar crest:
 Anterior region:
Lies within 1 to 1.5 mm of a line connecting the adjacent
CEJ.
 The alveolar crest is continuous with the lamina dura of
the adjacent teeth and in the absence of disease forms a
sharp angle next to the tooth root.

 Posterior region: lies 1 to 1.5 mm or 2-3
mm below the level of the CEJ of adjacent
teeth.

Radiographic appearance
 Loss in height of the alveolar bone around multiple teeth.
 Horizontal bone loss may be
 Mild
 Moderate
 Severe

Radiographic features
 Commonly localized to one or two teeth.
Types
 Interproximal crater
 Infrabony defect
 Types
 Three-walled
 Two-walled
 One-walled defect

 Radiographs provide no direct evidence of the
soft tissue involvement in gingivitis.
 However in severe cases of acute ulcerative
gingivitis (ANUG) where there has been
extensive cratering of the interdental papilla,
inflammatory destruction of the underlying
crestal bone may be observed.

 Localized erosion of the
interproximal alveolar bone
crest.
 Anterior region: shows blunting
of alveolar crest and slight loss
of alveolar bone.
 Posterior region: loss of sharp
angle between the lamina
dura and alveolar crest.

 Localized buccal or lingual
cortical bone loss
 Increased radiolucency of
the root near the alveolar
crest.
 Semicircular shadow with
the apex of the
radiolucency directed
apically in relation to the
tooth.

 Bone loss and
excessive mobility and
drifting of teeth.
 Extensive horizontal
bone loss or extensive
vertical osseous defect
may be present.

 Osseous deformities in the furcations of
multirooted teeth.
 Periodontal abscess.
 Aggressive periodontitits.

Initial involvement:
 Widening of the periodontal
ligament space.
 In cases of severe bone loss
the defect involves the lingual
and buccal cortical plate and
extend to the root of furcation.
 In maxillary molars the
furcation involvement appears
as an inverted “J” shadow with
hook of the “J” extending into
the trifurcation.www.indiandentalacademy.com

 May develop anywhere in the
membrane, at the side of root,
or at the apex of the tooth.
 First stage: localized thinning of
lamina dura.
 It may develop at bifurcation
or trifurcation area which gives
radiolucent appearance and
may be confused with
furcation involvement of the
teeth.

 Localized aggressive
periodontitis: Vertical bone
loss.
 Generalized aggressive
periodontitis:
 Involves several teeth or the
entire dentition.
 The bone loss may be
vertical, angular or
horizontal.

 Squamous cellSquamous cell
carcinoma-carcinoma-
It usually shows extensive
localised destruction of
bone, having a very
invasive tendency and
should be correlated
clinically.

 It is manifested as a single or multiple regions
of bone destruction around the roots of teeth,
usually no particular tooth is targeted and the
midroot region is the epicentre of bone
destruction which gives the lesion an “ice“ice
cream scoop”cream scoop” appearance.
 The alveolar crest remains intact.

 Systemic disease do not cause periodontal
disease but it influences its cause by limiting
the capacity of the individual to affect repair.

Few diseases that appear to influence periodontium
and periodontal treatment are:
 DM
 Hematological disorders
 Monocytic conditions
 Myelogenous leukemia
 Neutropenia
 Hemophilia
 Abnormal bleeding
 Non- hemophillic polycythemia vera

 Genetic and Hereditary disturbances
 Papillon-Lefevre syndrome
 Down’s syndrome
 Hypophosphatemia
 Chediak-Higashi syndrome

 Puberty
 Pregnancy
 menopause

 AIDS
Show an increase in the frequency and severity
of periodontal disease.
There is rapid progression that leads to bone
sequestration and loss of multiple teeth.
The patient do not respond to standard
periodontal therapy.

 Onset and course of disease
 The altered glucose metabolism leads to
protein breakdown, degenerative vascular
changes, lowered resistance to infection and
increased severity to infections.
 Patients with uncontrolled diabetes show
severe and rapid alveolar bone resorption and
are prone to develop periodontal abscesses.

 Called Papillon-Lefevre syndrome is a rare
heritable condition (autosomal dominant)
manifested by hyperkeratosis of the palms
and soles.
 There is also extensive pre-pubertal
destruction of the periodontal bone which is
manifested as extensive generalized
horizontal bone loss.

 loss of the entire primary dentition by the
age of 5 years and
 loss of secondary dentition before the age of
20 years.
 The affected patients is that bone loss appears
to be arrested once the tooth is lost.

 Radiographs provide two-dimensional view of a three-
dimensional object.
 Radiographs show less severe bone destruction than is
actually present.
 Radiographs do not demonstrate the soft-tissue-to-hard-
tissue relationships and thus provides no information
about the depth of the pocket.

 Bone level is often measured from the
cemento-enamel junction; however, this
reference point is not valid in situations such
as attrition and over-eruption.
 Acute periodontal abscess is not revealed
in its early stages.

Thank you!!!!!!

Radiological aspects of periodontal disease/cosmetic dentistry courses

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