Diagnosis of Periodontal Disease

Radiographic Interpretation

Dr Kevin Nicholson
MDSc (Melb) DipBus(Mgt) RMIT
 Diagnosis of Periodontal Disease
• Disease present & active?

• Extent of disease?

• Severity of disease?
 Diagnosis of Periodontal Disease
• Clinical data • Radiographic Interpret’n
– gingival architecture – quantity of bone
– oedema
– erythema – quality of bone
– gingival recession
– pocket probing depths – width of PDL space
– bleeding index – pattern of bone loss
– Suppuration – Bone loss at furcation sites
– Mobility – Infrabony defects
– Fremitis
– Furcation involvement – Local factors
– Tilting, drifting
 Diagnosis of Periodontal Disease
• Clinical examination
is essential to
determine the
current disease
status of the
periodontium
suppuration.jpeg
Diagnosis of Periodontal Disease

Img065.jpg
Prognosis of Periodontal Disease

• Prediction of the outcome (sequelae)

of existing disease; short term, long
term

• Prediction of the outcome both with, &

without treatment
Prognosis of dental & periodontal
disease
• Age & medical status of patient
• History of previous oral disease
• History of acute episodes, eg acute infection
• Diagnosis; aetiology, risk factor identification
• Extent and severity of disease
• Treatment carried out
• Patient compliance
• Maintenance procedures; frequency, adequacy
Maintaining a functional
dentition - Goals
• Primary treatment • Individual phase goals
goals – Resolution of active disease
– Restoration of gingival form
– Comfort & function
– Function – Restoration of dental form
& function
– Aesthetics
– Functional & stable
– Stable occlusion occlusion
– Long term oral – Maintain dental, periodontal
health and oral health
Prognosis of periodontal disease:
Radiographic assessment
• Amount of bone present • Root length &
morphology
• Condition of alveolar • Crown-root ratio
crests • Adjacent anatomy
– max. sinus
• Width of PDL space – missing, s’numerary,
impacted teeth
• Bone loss at furcation sites • other pathology
– caries
– apical lesions
• Local factors
– root fractures
Diagnosis of periodontal disease:
Limitations of radiographs
• Provides 2-dimensional • No radiographic changes
image of complex 3D seen in gingivitis
anatomy

• Do not demonstrate incipient

disease

• Do not demonstrate soft

tissue contours

• Do not record changes in

soft tissues
Diagnosis of periodontal disease:
Radiographic techniques
• Posterior bite-wings
– XCP BW holder

• Anterior periapical
projection using
paralleling technique
10.124.jpeg
• Anterior vertical
bitewings
Radiographic changes in
periodontal disease
• Inflammatory lesions in marginal • bone loss an indicator of
bone past disease activity
• Histologically, osteoblastic &
osteoclastic activity • with treatment/disease
resolution, bone levels will
• osteoclastic activity causes not increase
changes in the morphology of the
crestal bone; initial response is
bone destruction

• chronic lesions may show some

osteosclerosis
Radiographic changes:
mild to moderate periodontitis
• localised erosions of the • slight loss of bone height
marginal bone <1/3 root length
• thinning of the crestal lamina
dura • may be generalised
horizontal bone loss
• loss of the sharp crestal
border of the laminar dura
with the laminar dura of the
adjacent teeth
mandtor1th.jpg
• loss of ‘spiking’ in anterior
crests
Radiographic changes:
mild to moderate periodontitis
• Localised bone defects • Horizontal bone loss
include: moderate - severe
– vertical bone loss
– loss of buccal & lingual • alveolar crest remains
cortices generally horizontal

• B & L cortex loss difficult to

view radiographically
amalgamoverhangs.jpg

• ? decreased bone density

over root surface
Radiographic changes:
mild to moderate periodontitis

Radiograph5 (1).JPG
Radiographic changes:
mild to moderate periodontitis

Radiograph7.JPG
Radiographic changes:
moderate to severe periodontitis
• May be horizontal or vertical • Actual bone levels may be
bone loss, more extensive than appears
on the radiograph
• or a combination of
generalised horizontal bone
loss, with localised vertical
defects

• bone levels may be in apical

third of root

• clinically, teeth may be

shifting, tilting or drifting
Radiographic changes:
moderate to severe periodontitis

Radiograph4.JPG
Radiographic changes:
moderate to severe periodontitis
Radiographic changes:
vertical bone loss
• May be localised to one or
two teeth
• May be several sites of VBL
• Interproximal crater
– 2-walled defect, located
between adjacent teeth
• Infra (intra) bony defect
– Vertical defect along root of

Fod3.jpg
a tooth
– Initial appearance may be
widening of PDL space
– 1, 2, 3 wall, based on loss
of cortices
Radiographic changes:
furcation bone loss
• Bone loss from periodontal • Bone loss may initiate from
disease may extend into the buccal, lingual palatal
furcations of multi-rooted
teeth

• Initially seen as widening of

PDL space at the crest of the Perio furcation molar.JPG

furcation

• as the lesions progresses,

bone loss progresses apically
Recall & Review:
Radiographic assessment
• Post-treatment radiographs • Review interval is
are appropriate to evaluate determined individually for
treatment outcomes and each patient
disease prognosis
• Remission of periodontal
disease can
• be radiographically
demonstrated by the
reformation of healthy
crestal architecture ie well-
defined crestal lamina dura
Radiographic changes in
periodontal disease
Radiographic changes in
periodontal disease

perio bone defect 4.jpg

Radiographic changes in
periodontal disease
Radiographic changes in
periodontal disease
Radiographic changes in
periodontal disease
Radiographic interpretation in
periodontal disease

Radiograph4.JPG
Radiographic interpretation in
periodontal disease