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Radiographs are used in the evaluation

of periodontal disease in the following:
Determination of the condition from the
affected teeth such as : clinical crown-root
ration, shape and size of the crown and root,
position of roots of multirooted teeth and
position of a tooth in relation to adjacent
Identification of predisposing factors such as
calculus, the contour and status of
restorations (overhangs or poor contours)

Identification of early bone changes

Evaluation of the amount and location of
bone loss
Determination of the prognosis of affected
teeth through radiographic examination of
the width of the periodontal ligament space
and the continuity of the lamina dura
Evaluation of posttreatment results

The characteristic radiographic

appearance of the alveolar crestal bone
The alveolar crest will appear radiopaque
on a radiograph and is located 0.5 to 2
mm below the CEJ.

The alveolar crests have a variety of

shapes: flat and wide; narrow and
rounded; angulated. The approximate
levels of adjacent CEJ's and the convexity
of the proximal surfaces of the teeth are a
couple of factors that may determine the
shape of the alveolar crests.

Between the anterior teeth the

radiopaque alveolar crest will usually
appear pointed whereas between the
posterior the crests are usually flat.
The alveolar crest is continuous with
the lamina dura of adjacent teeth.
In the absence of disease, the bony
junction between the alveolar crest and
the lamina dura will be seen to form a
sharp angle adjacent to the root tooth

Radiograph of normal periodontal tissue

Bone level determined

Using a probe or millimeter marked
ruler place the tip of the probe or end
of the ruler at the cementoenamel
junction (CEJ) and note the distance
between the CEJ and alveolar crest.
If the distance is more than 2
millimeters, there is bone loss.

Early Bone Changes

The early lesions of chronic periodontitis
appear as areas of localized erosion of the
interproximal alveolar bone crest
The anterior regions show blunting of the
alveolar crests and slight loss of alveolar
bone height. The posterior regions may
also show a loss of the normally sharp
angle between the lamina dura and
alveolar crest

Early Bone Changes

In early periodontal disease, this angle may lose its
normal cortical surface (margin) and appear rounded off,
having an irregular and diffuse border.
Signicant loss of attachment must be present for 6 to 8
months before radiographic evidence of bone loss
Variations in angle of projection of the x-ray beam can
cause a slight change in the apparent height of the
alveolar bone.
Small regions of bone loss on the buccal or lingual
aspects of the teeth are much more difcult to detect.

Initial periodontal disease is seen as a loss of cortical density and a

rounding of the junction between the alveolar crest and
the lamina dura (arrow).

Horizontal Bone Loss

Horizontal bone loss is a term used to describe
the radiographic appearance of loss in height of
the alveolar bone where the crest is still
horizontal (i.e., parallel to an imagined line
joining the CEJs of adjacent teeth) but is
positioned apically more than a couple of
millimeters from the CEJs.
Horizontal bone loss may be mild, moderate, or
severe, depending on its extent.

Horizontal Bone Loss

Mild bone loss may be dened as approximately
a 1- to 2-mm loss of the supporting bone
Moderate loss is anything greater than 2 mm
up to loss of half the supporting bone height.
Severe loss is anything beyond this point.
In horizontal bone loss, the crest of the buccal
and lingual cortical plates and the intervening
interdental bone have been resorbed

Vertical Bone Defects

The term vertical (or angular) osseous defect
describes a bony lesion that is localized to a
single tooth, although an individual may have
multiple vertical osseous defects.
The radiographic presentation is a vertical
deformity within the alveolus that extends
apically along the root of the affected tooth from
the alveolar crest.
The outline of the remaining alveolar bone
typically displays an oblique angulation to an
imaginary line connecting the CEJ of the
affected tooth to the neighboring tooth.

Vertical Bone Defects

In its early form, a vertical defect appears
as abnormal widening of the PDL space at
the alveolar crest.
The vertical defect is described as
three walled (surrounded by three bony walls)
when both buccal and lingual cortical plates
two walled when one of these plates has been
resorbed and as one walled when both plates
have been lost

Interdental Craters
The interproximal crater is a two-walled,
troughlike depression that forms in the crest of
the interdental bone between adjacent teeth.
The buccal and lingual outer cortical walls of the
interproximal bone extend further coronally than
does the cancellous bone between them, which
has been resorbed.
Radiographically this presents as a bandlike or
irregular region of bone with less density at the
crest, immediately adjacent to the more dense
normal bone apical to the base of the crater

Buccal or Lingual Cortical Plate Loss

The buccal or lingual cortical plate adjacent to the teeth
may resorb.
Loss of a cortical plate may occur alone or with another
type of bone loss such as horizontal bone loss. This type
of loss is indicated by an increase in the radiolucency of
the root of the tooth near the alveolar crest.
The shape seen usually is a semicircular shadow with
the apex of the radiolucency directed apically in relation
to the tooth
Lack of bone loss at the interproximal region of the tooth
may make this kind of defect difcult to detect.

Furcation Involvement
The term furcation involvement describes the
radiographic appearance of bone loss in the
furcation area of the roots which is evidence of
advanced disease in this zone.
Although central furcation involvements are
seen more readily in mandibular molars, they
can also be seen in maxillary molars despite the
superimposed shadow of the overlying palatal

Diagrams illustrating the radiographic appearances of

varying degrees of furcation involvement in lower molars
(arrowed). A Very early involvement showing widening of
the furcation periodontal ligament shadow. B Moderate
involvement. C Severe involvement.

very early furcation involvement