Radiographs

Radiographs

1. RADIOGRAPHIC AIDS IN DIAGNOSIS OF PERIODONTAL DISEASE

2. 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.

3. 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.

4. 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

5. 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

6. 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.

7. 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.

8. 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

9. 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.

10. 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

11. 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.

12. 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.

13. 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

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

15. LOCALISED AGGRESSIVE PERIODONTITIS Bilaterally ARC SHAPED LESION extending from………..

16. 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

17. 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

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

19. 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)

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

21. 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

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

23. DISADVANTAGE IS ……COST

24. ADVANCED IMAGING MODALITIES CBCT

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