periodontal disease l oral radiology MCQs for dental students

Radiographic interpretation of periodontal disease l oral radiology MCQs for dental students 

Important points to remember in Interpretation of Periodontal Disease

1. The term periodontal disease refers to a group of diseases that affect the tissues around teeth.
2. Thorough clinical and dental image examinations are necessary to detect, diagnose, and evaluate periodontal disease. Clinical examination provides information about soft tissues, and the dental image examination provides information about supporting bone and hard tissues.
3. Dental images can be used to document periodontal disease and determine the success or failure of periodontal therapy.
4. Interpretation of periodontal disease on dental images should include an evaluation of alveolar bone; bony changes can be described in terms of pattern (horizontal or vertical), distribution (localized or generalized), and severity (slight, moderate, or severe).
5. Dental images can be used in the classification of periodontal disease. On the basis of the amount of bone loss, periodontal disease can be classified as ADA Case Type I (gingivitis), Case Type II (mild/slight periodontitis), Case Type III (moderate periodontitis), and Case Type IV
6. (advanced/severe periodontitis).
7. Dental images can also be used to detect local irritants, including calculus and defective restorations, which contribute to periodontal disease.
8. Technique used: The standard exposure technique for periodontal imaging procedures is undoubtedly the intraoral radiography using a strict paralleling technique.
9. Digital radiography: In digital radiography dedicated software for periodontal filtering may offer an optimized image to inspect crestal cortication, lamina dura and periodontal ligament space. The drawbacks of this system for periodontal imaging remain the sensor rigidity and the restricted active area of the sensor and the cable. To avoid bite marks and damage to the latter, a clip system in conjunction with the beam-aiming device is essential but often not available.
10. Panoramic radiography: The panoramic image gives an overview of both the jaws including the teeth, their periodontal status and the adjacent anatomical structures.
11. Normal periodontium: The normal periodontium is characterized by an alveolar crest level 2 mm below the CEJ, a well-delineated alveolar crest, continued in a radio-opaque lamina dura bordering a radiolucent 0.2 mm periodontal ligament space.
12. Initial lesion: The initial periodontal breakdown becomes obvious as a local disappearance of the radio-opaque cristae and/or the lamina dura. The sharp edge and the corner between the alveolar crest and lamina dura are evidently lost.
13. Horizontal bone loss: Horizontal bone loss implies that the interdental bone loss is horizontal and thus equal for buccal, lingual and approximal aspects.
14. Vertical bone loss: It implies that the bone loss occurs at different rates on buccal or lingual bone plates, thus one side being resorbed more than the other, creating two bone levels, which can be visualised on the radiograph.
15. Advanced periodontitis: Periodontal breakdown in this stage is widely spread over the entire dentition, and the radiological observations confirm these clinical findings.
16. Calculus: If calculus formation is persistent and large enough, it may be visualised radiographically as moderate and irregular radio-opaque structures attached to the roots.
17. Occlusal trauma: When dealing with occlusal trauma, one can radiographically detect the typical widening of the periodontal ligament.
18. Systemic diseases: Detection of initial and often characteristic periodontal lesions (e.g. thinning or absence of the lamina dura) may even lead to an early diagnosis of the metabolic disease. In Paget disease, a generalised absence of the lamina dura as well as a hypercementosis of the roots is noticed.
19. Other diseases with a generalized effect on the periodontium (e.g. absence of lamina dura) are hyperparathyroidism, hyperthyroidism, uncontrolled diabetes, Cushing syndrome, Langerhans cell disease, osteomalacia and scleroderma. Osteoporosis is another widespread systemic disease affecting the periodontium, but its relation with periodontitis is not yet fully understood