Bitewings best for diagnosis. Some feel that paralleling PA’s are best.

Higher kVp recommended (long scale, low contrast).

Compare images from differentvisits (using same technique).

Periodontal Disease

Two-dimensional film with overlapping bony walls, superimposed roots

Clinical picture more advanced

Relationship of hard to soft tissues not evident

Limitation of Radiographs

Radiographs do not demonstrate incipient disease, as a minimum of 55-60% demineralization must occur before radiographic changes are apparent.

Limitation of Radiographs

Periodontitis

Normal Anatomy:

Alveolar crest corticated

Thin & even width of PDL

1-1.5 mm from crest to CEJ

Parallel to line between CEJ’s

Crest is pointed anteriorly

Corticated alveolar crests

1-1.5 mm

CEJ

Alveolar crests morepointed anteriorly

Contributing Factors• Occlusal trauma• Open contacts• Overhangs, poor contours• Calculus• Post-extraction defects• Systemic involvement (diabetes, blood disorders, hormonal changes, stress, AIDS)

Horizontal bone loss: Parallel to line drawn between adjacent CEJ’s

Vertical (Angular) bone loss: More bone destruction on interproximal aspect of one tooth than on the adjacent tooth

Gingivitis

No bone loss

No radiographic signs

Involvement:

LocalizedGeneralized

Periodontitis

Periodontitis

Periodontitis

Mild Moderatesevere

Mild Adult Periodontitis

Loss of cortical density

Rounding off of junction between alveolar crest and lamina dura

Blunting of crest anteriorly

Mild adult periodontitis

Mild Adult Periodontitis

Horizontal bone loss or vertical osseous defects

Total extent of bone loss not evident

May have slight mobility

Moderate Adult Periodontitis

Moderate adult periodontitis(red arrows point to calculus)

Moderate adult periodontitis

Severe Adult Periodontitis

Tooth mobility

Extensive horizontal bone loss or vertical osseousdefects

Furcation involvement

Severe adult periodontitis

Severe adult periodontitis

Severe adult periodontitis