Understand the difference between needs based and time based decisions regarding how often to take radiographs.

Needs: Do they need it? Caries/bone loss/ restorative

Time: How long has it been? Generally ins. Driven

To understand the differences between radiolucent and radiopaque material when evaluating periodontal structures.

Radiolucent material: Allow the x-ray to easily penetrate and appear as dark gray to black on the radiograph.

Radiopaque material: resist the passage of x-rays and appear light gray to white on the radiograph.

To identify how posterior interproximal bone should look in health and disease.

  Rounded appearance

To identify how mandibular anterior interproximal bone should look in health and disease.

   Knife-like appearance

Cortical bone

Horizontal loss

Extent of loss is calculated by using the CEJ of the tooth being considered.

Loss that is parallel to CEJ

Vertical

Occurs when there is greater bone destruction on the interproximal aspect of one tooth than on the adjacent tooth.

Localized bone loss: occurs in isolated areas of the dentition. Usually considered more aggressive form of disease.

The rate of bone loss is 3-4x faster than chronic PD!

• Has 1 wall remaining
• Occurs when one bony wall of the interseptal bone remains. Can look like a ramp.
• Mesial or distal portion of the interseptal bone has been destroyed

Most commonly occurs in the crest of the interdental bone forming a crater-like defect from the facial to the lingual walls.  Most common defect!

Pocket within the bone. Three remaining bony walls with the fourth wall formed by the tooth root. Orifice of pocket usually open on the crestal bone.

• Can’t see it until bone resorption extends past furcation. If you can see it is bigger than the radiograph reveals.
• Easier to see on Mandibular molars than Maxillary molars because of roots.

Due to the anatomy of the maxillary molar is can be difficult to see through the furcation because of the palatal  root

• Slight thickening of the PDL space in the furcation.
• Severe bone loss is evident on the mesial or distal surface of a multirooted tooth

Why should you use a systematic “road map to interpretation” when viewing all the important structures of the periodontium on RADS?

• Systematic approach to viewing all the radiographs.
• Insures that all structures are looked at and evaluated.
  

1. Where is the bone in relationship to the CEJ?
2. Is it 1-2mm apical to the CEJ?
3. Is it more that 2 mm apical to the CEJ?
4. If so, by how much?
5. Is the bone level consistent on this bitewing or are there site-specific problems?
6. Is the alveolar crest cortication well defined or undefined?
7. Is the lamina dura intact or disrupted?
8. Is the PDL space uniform, indistinct or notably widened?

Early attachment loss.

1-4mm probing depths.

No bone loss in furcations.

Moderate attachment loss.

4-6mm probing depths.

Furcations: up to class III but not through-and-through.

Severe attachment loss.

Probing depths of 7mm or greater.

Furcations: Class III and through-and-through.

• Technology that detects small changes in hard tissue between exams.
• Traditional radiographs don’t allow for detection of small changes.
• This technique has shown to be more that 90% effective in detecting small bony changes.

Tooth pulp

PDL

Bone Marrow

1. Cortical bone of the alveolar crest
2. Trabecular
3. Lamina Dura

• Gingival inflammation
• Periodontitis
• Alveolar bone loss

• Increased width of the PDL due to resorption of the Lamina Dura
• Vertical or anglar bone loss pattern

Look at the Apical bone:

Is the architecture well defined?

Is radiodensity consistant?

Is there evidence of an abcess?

Are there any abnormalities apical to the roots?

Begnign cementoblastoma

• Are the maxillary sinuses and nasal cavity well aerated or opacified?
• Are their bony boundaries intact and well defined?
• Is there thickening of the mucosal lining?

• Is it intact?
• Is it interupted?
• Is it thinned?
• Is it expanded?
• Is it eroded?

Written in the patients chart and includes:

1. Patients name and date taken
2. Patient problems: gagger
3. Number and type of x-rays taken
4. Description of findings
5. Recommendations for future radiographs - Potential caries to be watched
6. Signature of practitioner

30% Early

30-60% Moderate

60-100% Severe

1. Endocrinopathies (diabetes mellitus).
2. Hematologic disorders (Leukemia).
3. Hereditary disturbances (Chediak-Higashi syndrome or Papillon-Lefevre syndrome).
4. Immunodeficiencies (AIDS).