radiographs in perio
TRANSCRIPT
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Dr. Mahesh Narayanan
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• Radiographs are valuable in1. Diagnosis
2. Determination of prognosis
3. Evaluation of outcome of treatment
• It is an adjunct to clinical examination and not a substitute
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Normal periodontium• Interdental septum
• Thin radioopaque border- the lamina dura
• Appears as continuous white line but in reality its perforated by blood vessels, lymphatics and nerves
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• Variations in interdental septum occurs due to– Prominent convex
proximal surface– Level of
cementoenamel jn of adjacent teeth
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Distortions due to radiographic technique
• Prichards criteria 1. Radiographs should show the tips of
molar cusps with no occlusal surface2. Enamel caps and pulp chambers
should be distinct3. Interproximal spaces should be open4. Proximal contacts should not overlap
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Bone destruction in PDL disease
• Does not reveal minor destructive changes • Hence clinical evaluation significant• Reveals less severe bone loss than actually
present
• However it shows
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1. Amount of bone loss
2. Distribution of bone loss
3. Pattern of bone destruction
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Radiographic changes in periodontitis
• Fuzziness and break in continuity of lamina dura
• Wedge shaped radiolucent area at the mesial/ distal crest of the septal bone
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• Fingerlike radiolucent projections extend from crest into the septum
• Height of interdental septum is progressively reduced
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Radiographic appearance of interdental craters
• Appears as reduced radiolucency on the alveolar bone
• Mostly appear as vertical defects
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Furcation involvement• Better clinically• Radiographs helpful
but show artifacts
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Following criteria helpful1.Slightest radiographic change
should be investigated clinically
2.Diminished radiodensity in the furcation 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
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Periodontal abscess• Discrete area of
radiolucency along the lateral aspect of root
• Many variables affect diagnosis– Stage of lesion– Extent of bone
destruction and morphological bone changes
– Location of abscess
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Radiographs & clinical probing
• Use radiographic indicators to assess buccal & lingual / palatal defects eg: Hirschfeld pointers, GP points, K files
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Trauma from occlusion• Injury phase- loss of
lamina dura• Repair phase- widening
of PL space• Advanced lesions-
deep angular bone loss, intrabony pockets, cavernous lesions, root resorption
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Additional radiographic criteria• Radioopaque horizontal
lines across the root
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• Vessel canals in alveolar bone.
• Differentiation between treated and untreated periodontal disease
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conclusion• Radiographs are valuable aids in periodontal
diagnosis and treatment plan, however they are an adjunct and not a substitute for clinical examination.