2. Radiographic interpretation of periodental disease

3. periodontium
The tissues that invest and support the teeth such as the gingiva and alveolar bone.
The radiographic appearance of healthy alveolar bone:
lamina dura: In health, LD around the roots of the teeth appears as a dense RO
Alveolar crest: normal healthy AC located 1.5 to 2.0 mm apical to the CEJ of adjacent teeth
Anterior AC appears pointed and sharp and is normally very RO

4. Posterior AC appears flat, smooth, and parallel to a line between adjacent CEJ, and appears slightly less RO than anterior AC
Periodontal ligament space: normal PLS appears as a thin RL line between the root of the tooth and the LD
In health, PLS is continuous around the root structure and is of uniform thickness

6. Interpretation OF PERIODONTAL DISEASE
With periodontal Disease, AC is no longer located 1.5 to 2.0 mm apical to the CEJ and no longer appears RO
INSTEAD
AC appears indistinct, and bone loss is seen
Periodontal disease may result in severe destruction of bone and loss of teeth

7. Useful radiographical view
PA with parallel technique and vertical BW radiograph are the film of choice for the evaluation of periodontal disease
With the paralleling technique, the height of CB is accurately recorded in relation to the tooth root
If the bisecting technique is used to expose PA radiographs, a dimensional distortion of bone is seen because of the vertical angulation used. As a result, PA films using the bisecting technique may appear to show more or less bone loss than is actually present

8. The horizontal BW has limited use in the detection of periodontal disease; severe interproximal bone loss cannot be adequately visualized on horizontal BW radiographs
The panoramic film has little diagnostic value in the identification of periodontal disease and is not recommended to demonstrate the anatomic features of this condition

9. Radiographs are especially helpful in the evaluation of the following points:
Amount of bone present
Condition of the alveolar crests
Bone loss in the furcation areas
Width of the periodontal ligament space
Local initiating factors that cause or intensify periodontal disease
Calculus
Poorly contoured or overextended restorations
Root length and morphology and the crown-to-root ratio
Anatomic considerations
Position of the maxillary sinus in relation to a periodontal deformity
Missing, supernumerary, or impacted teeth
Pathologic considerations
Caries
Periapical lesions
Root resorption

10. Limitation of radiographs
Radiographs may provide an incomplete presentation of the status of the periodontium
Radiographs provide a 2-dimensional view of a 3-dimensional situation. Because the radiographic image fail to reveal the 3-dimensional structure, bony defects overlapped by higher bony walls may be hidden
Also, because of overlapping tooth structure, only the interproximal bone is seen clearly. However, subtle changes in the density of the root structure may indicate bone loss on the buccal or lingual aspect of the tooth
Radiographs typically show less severe bone destruction than is actually present. The earliest mild destructive lesions in bone do not cause a sufficient change in density to be detectable

11. Radiographs do not demonstrate the soft-tissue-to-hard- tissue relationships and thus provide no information about the depth of soft tissue pockets
Bone level is often measured from the CEJ; however, this reference point is not valid is situation in which either over eruption or sever attrition with passive erupted exists

12. INTERPRETATION OF PERIODONTAL DISEASE
Bone Loss
Radiograph view the amount of bone remaining rather than the amount of bone lost. However, in documenting bone levels, the amount of bone loss that has occurred is recorded rather than the amount of bone that remains
The amount of bone loss can be estimated as the difference between the physiologic bone level and the height of remaining bone

13. PATTERN
The pattern of bone loss can be described as either horizontal or vertical. The CEJ of adjacent teeth can be used as a plane of reference in determining the pattern of bone loss present
Horizontal bone loss occurs in a plane parallel to the CEJ of adjacent teeth
Vertical bone loss (also known as angular bone loss), the bone loss does not occur in a plane parallel to the CEJ of adjacent teeth

14. Horizontal bone loss
Vertical bone loss

15. Severity
The severity of bone loss is measured as a percentage of loss of the normal amount of bone:
Mild bone loss: crestal changes
Moderate bone loss: bone loss of 10-33%
Sever bone loss: bone loss of 33% or more

16. Classification of periodontal disease
American Dental Association classified periodontal disease as follows:
ADA Case Type I (gingivitis)
ADA Case Type II (early periodontitis)
ADA Case Type III (moderate periodontitis)
ADA Case Type IV (advanced periodontitis).
Radiographs can also be used to detect the contributing factors of periodontal disease, such as calculus and defective restorations.

17. Predisposing Factors for periodontal diseases
Calculus
Defective restorations

18. CALCULUS Calculus appears RO on a dental radiograph
Although calculus may have a variety of appearances, it most often appears as pointed or irregular RO projections extending from the proximal root surfaces

19. CALCULUS
Calculus may also appear as a ring-like RO encircling the cervical portion of a tooth, a nodular, or a smooth RO on a root surface

20. DEFECTIVE RESTORATIONS
Faulty dental restorations act as potential food traps and lead to the accumulation of food debris and bacterial deposits
They can be detected both clinically and radiographically
Radiographs show restorations with open or loose contacts, poor contour (Fig. 31—26), uneven marginal ridges (Fig. 31—27), overhangs (Fig. 31—28), and inadequate margins (Fig. 31—29), all of which may contribute to periodontal disease.

22. Radiographical features of pulpal lesions
Pulpal sclerosis
Pulpal obliteration
Pulp stones

23. Pulpal sclerosis
Is a diffuse calcification of the pulp chamber and pulp canals of teeth that results in a pulp cavity of decreased size
Pulpal sclerosis is associated with aging
No clinical features are associated with pulpal sclerosis AND of little clinical significance unless endodontic therapy is indicated

24. Pulpal Obliteration
Some conditions (attrition, abrasion, caries, dental restorations, trauma, and abnormal mechanical forces) may act as irritants to the pulp and stimulate the production of secondary dentin, which results in obliteration of the pulp cavity
On a dental radiograph, a tooth with
pulpal obliteration does not appear to have
a pulp chamber or pulp canals
Teeth with pulpal obliteration are non
vital and do not require treatment

25. Pulp Stones
Pulp stones are calcifications that are found in the pulp chamber or pulp canals of teeth
The cause is unknown
Pulp stones appear as round, ovoid, or cylindrical RO; some pulp stones may conform to the shape of the pulp chamber or canal
Pulp stones may vary in shape, size, and number. Pulp stones do not cause symptoms and do not require treatment