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PRESENTED BY : DR DEEPAK KOCHAR READER DEPTT. OF PERIODONTICS
• Radiograph is an adjunct to clinical examination but not a substitute for it.
• It reveal alterations in calcified tissues. • It is a valuable aid in - Diagnosis of periodontal disease. - Determination of the prognosis. - Evaluation of outcome of the treatment.
The earliest signs of periodontal disease must be detected clinically. The radiographic image tends to show less severe bone loss than that actually present. “ Bone loss is always greater than it appears in the radiograph ” • Slight radiographic changes in the periodontal tissues means that the disease has progressed beyond its earliest stages.• Radiograph does not reveal minor destructive changes in bone . .
. shape & the angle of the alveolar crest of inter-dental septum normally vary according to the convexity of the proximal tooth surfaces & the level of the CEJ of the approximating teeth. Lamina Dura is radioopaque border (white line )adjacent to periodontal ligament and at alveolar crest.NORMAL INTERDENTAL SEPTA Width . It represents the bone surface lining the tooth socket.2 mm below CEJ of adjacent teeth. The height of the alveolar crest lies at a level 1.
Crest of interdental bone is normally parallel to a line drawn between the cementoenamel junction of adjacent teeth (arrow). Note also the radiopaque lamina dura around the roots and interdental bone .
• • • .INTRA ORAL PERIAPICAL RADIOGRAPH (IOPA) Prichard established following 4 criterias to determine adequate angulation of periapical radiographs – • The radiograph should show the tips of molar cusps with little or none of the occlusal surface showing. Proximal contacts should not overlap unless teeth are out of line anatomically. Enamel caps & pulp chambers should be distinct. Inter proximal spaces should be open.
Long Cone Paralleling technique is better than bisecting angle . It cause less distortion & produce more realistic image of the level of alveolar bone . (long cone technique) (ii) Bisecting angle technique.• Two intraoral projection techniques are used for periapical radiography(i) Paralleling technique.
.Bitewing Radiographs Bitewing radiographs are used – (1) To visualize the crowns of the posterior teeth and the height of the alveolar bone in relation to the cementoenamel junctions (2) To detect interproximal calculus & caries They more accurately exhibit the bone levels than periapical views because of projection geometry.
• • • • Schematic diagram of periapical (A) and bite-wing (B) radiographs. • In contrast. • Angulation of the x-ray beam and the film on the periapical radiograph distort the distance between the alveolar crest and the cementoenamel junction (CEJ) (compare a-b versus a1-b1). the projection geometry of the bite-wing radiograph allows a more accurate depiction (a-b) of the distance between the alveolar crest and the CEJ (ab). .
Radiographic appearance of periodontal diseases .
PERIODONTITIS • Fuzziness & a break in the continuity of the lamina dura at the mesial or distal aspect of the crest of interdental septum. • The height of the inter dental septum is reduced and finger like radiolucent projections extend from the crest in to the septum. . • A wedge shaped radiolucent area at mesial or distal aspect of crest of septal bone. These are earliest radiographic changes in periodontitis.
Radiographic changes in periodontitis A.Also there are wedge-shaped radiolucent areas at the crest of the interdental bone. C. B. D. Normal appearance of interdental bone. Fuzziness and a break in the continuity of the lamina dura at the crest of the bone . Radiolucent projections from the crest into the interdental bone indicate extension of destructive processes. Severe bone loss .
• • . it may be assumed that the furcation is also involved.FURCATION INVOLVEMENT • The slightest change(fuzziness) in the furcation area should be examined clinically. Diminished radiodensity in the 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. especially if there is bone loss on adjacent roots.
Furcation involvement indicated by triangular radiolucency in bifurcation area of mandibular first molar .
Periodontal abscess Appears as discrete area of radiolucency along the lateral aspect of the root . angular /vertical defects and arc like destructive patterns in first molar region . Its appearance depends on the Stage of the lesion & Location of the abscess Localized Aggressive Periodontitis Bone loss in the incisors & first molars Bilateral .
angular bone loss associated with the maxillary and mandibular first molars and the central incisors.Localized aggressive periodontitis --Radiographs showing localized. vertical. .
TRAUMA FROM OCCLUSION • Increased width of the periodontal space. • A vertical/angular bone loss. • Thickening of the lamina dura and sometimes condensation of perialveolar cancellous bone. .
Skeletal disturbances manifested in the jaws • • • • • • • Osteitis Fibrosa Cystica Paget’s disease Fibrous Dysplasia Langerhan’s cell histiocytosis Multiple Myeloma Osteopetrosis/Marble bone disease Scleroderma .
I.A.ADVANCES IN RADIOGRAPHIC ASSESSMENT • DIGITAL RADIOGRAPHY • SUBTRACTION RADIOGRAPHY • C.T) . (Computer Assisted Densitometric Image Analysis) • CONE BEAM COMPUTED TOMOGRAPHY(C.A.C.D.B.
density & contrast can be lowered for evaluation of marginal bone and increased for evaluation of implant components.(rapid image capture & display) (2) Reduction in radiation received by patient by as much 50% to 80% when compared to conventional radiography.DIGITAL RADIOGRAPHY ADVANTAGES: (1) Ability to produce a image that can instantly be viewed by patient & dentist.(low x-ray exposure) (3) Images can be altered to achieve task specific image characteristics eg. manipulated & corrected for under & overexposure (6) Edge enhancement . (4) Digital imaging also enables dental team to conduct remote consultations( in tele diagnosis & video conferencing) (5) Computerized images can be stored.
2. A laser scanner then reads the exposed plates & reveals digital image data. . CCD receptor is placed intraorally as traditional films & images appear on a computer screen which can be printed or stored. Indirect Method . Indirect method.This method uses a phosphor luminescence plate. which is a flexible film like radiation energy sensor placed intraorally & exposed to conventional x-ray tube.Direct method 2.There are 2 digital radiography methods 1. Direct Method/RVG (radio visio graphy )This method uses a Charge Couple Device (CCD) sensor linked with fiberoptic or other wire to computer system. 1.
• This technique facilitates both qualitative & quantitative visualization of even minor density changes in bone by removing the unchanged anatomic structures from image. . • The serially obtained digital images can then be superimposed & resultant composite viewed on a video screen.SUBTRACTION RADIOGRAPHY • Radiographs are taken with identical exposure geometry – serial radiographs • This technique relies on conversion of serial radiographs into digital images.
• This software system applies an algorithm that corrects angular alignment discrepencies & provide flexibility in imaging procedures.DIAGNOSTIC SUBTRACTION RADIOGRAPHY • This technique combines the use of a positioning device with specialized software designed for digital image subtraction. .
Higher sensitivity. reproducibility and accuracy as compared to Digital substraction analysis. . The camera is interfaced with an image processor and a computer that allow the storage and mathematical manipulation of the images. Advantages: Measures quantitative changes in bone density over time.Computer Assisted Densitometric Image Analysis. (CADIA) Video camera measures the light transmitted through radiograph and the signals from the camera are converted to gray scale images.
Cone-Beam Computed Tomography(CBCT) • Very accurate three-dimensional imaging technique • Much less radiation exposure as compared to conventional CT Scans. . • Very useful technique for implant patients.
CONCLUSION • Conventional and advanced imaging systems have proven a boon for diagnosis in periodontology.rxdentistry.blogspot. www. Further advancements are also expected in near future. • These systems are technique sensitive & not free from mechanical errors so a clinician should also consider clinical signs & symptoms while reaching to final diagnosis for a periodontal condition.com .
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