What+is+the+role+of+radiographs+in+the+diagnosis,+prognosis+and+treatment+of+periodontal+disease

= What is the role of radiographs in the diagnosis, prognosis and treatment of periodontal disease = ** Role of radiographs in the diagnosis, prognosis and treatment of periodontal disease **  The radiographs are an adjunct to the clinical examination, not a substitute for it. Because the lamina dura represents the bone surface lining the tooth socket, the shape and position of the root and changes in the angulation of the x-ray beam produce considerable variations in its appearance.  Prichard establish four criteria to determine adequate angulation of periapical radiographs:
 * The radiograph should show the tips of molar cusps with little or none of the occlusal surface showing.
 * Enamel caps and pulp chambers should be distinct.
 * Interproximal spaces should be open
 * Proximal contacts should not overlap unless teeth are out of line anatomically.

 The earliest signs of periodontal disease must be detected clinically: · Bone Loss: radiographically tends to show less severe bone loss than that actually present. This is noted by the difference between the alveolar crest height and the radiographic appearance. This depends on the angulation. This is measured by the amount; the distance from the CEJ to the alveolar crest. Also the distribution of bone loss is an important diagnostic sign. It points to the location of destructive local factors in different surfaces of the same tooth.  · Pattern of Bone Destruction: in periodontal disease the interdental septa undergo changes that affect the lamina dura, crestal radiodensity, size and shape of the medullary spaces, and height and contour of the bone. Radiographs do not indicate internal morphology or depth of the craterlike interdental defects, which appear as angular or vertical defects. Dense cortical plates on the facial and lingual surfaces of the interdental septa obscure destruction that occurs in the intervening cancellous bone. 
 * Radiographic Appearance of Periodontal Disease:

<span style="color: #000000; font-family: 'Comic Sans MS',cursive; font-size: 10pt;">1. Fuzziness and a break in the continuity of the lamina at the mesial or distal aspect of the crest of the interdental septum have been considered as the earliest radiographic changes in periodontitis. This is the result from extension of gingival inflammation into the bone, causing widening of vessel channels and a reduction in calcified tissue at the septal margin. 2. A wedge-shaped radiolucent area is formed at the mesial or distal aspect of the crest of the septal bone. 3. The destructive process extends across the crest of the interdental septum and the height is reduced. 4. The height for the interdental septum is progressively reduced by the extension of inflammation and the resorption of bone. <span style="color: #800080; font-family: 'Comic Sans MS',cursive;">
 * <span style="color: #800080; font-family: 'Comic Sans MS',cursive;">Furcation:

<span style="color: #000000; font-family: 'Comic Sans MS',cursive; font-size: 10pt;">Definite diagnosis of furcations involvement is made by clinical examination, which includes careful probing with a specially designed probe. Radiographs are helpful but show artifacts that allow furcations involvements to be present without detectable radiographic changes.

<span style="color: #800080; font-family: 'Comic Sans MS',cursive; font-size: 10pt;">To assist in the radiographic detection of furcations involvement, the following diagnosis criteria are suggested: <span style="color: #000000; font-family: 'Comic Sans MS',cursive; font-size: 10pt;">

1. The slightest radiographic change in the furcations area should be investigated clinically, especially if there is bone loss on adjacent roots. 2. Diminished radiodensity in the furcations area in which outlines of bony trabeculae are visible suggest furcations involvement. 3. Whenever there is marked bone loss in relation to a single molar root, it may be assumed that the furcations is also involved. <span style="color: #800080; font-family: 'Comic Sans MS',cursive;">
 * <span style="color: #800080; font-family: 'Comic Sans MS',cursive;">Periodontal Abscess:

<span style="color: #000000; font-family: 'Comic Sans MS',cursive; font-size: 10pt;">The radiographic picture is often most typical because of many variables. Such as the following: 1. The stage of the lesion. 2. The extent of bone destruction. 3. The location of the abscess. <span style="color: #800080; font-family: 'Comic Sans MS',cursive;">
 * <span style="color: #800080; font-family: 'Comic Sans MS',cursive;">Localized Aggressive Periodontitis:

<span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Radiographically would show the following:

1. Bone loss may occur initially in the maxillary and mandibular incisors and/or first molar areas, usually bilaterally, and results in vertical, arc-like destructive patterns. 2. Loss of alveolar bone may become generalized as the disease progresses but remains less pronounced in premolar area. <span style="color: #800080; font-family: 'Comic Sans MS',cursive;">
 * <span style="color: #800080; font-family: 'Comic Sans MS',cursive;">Trauma from Occlusion:

<span style="color: #000000; font-family: 'Comic Sans MS',cursive; font-size: 10pt;">This can produce radiographically detectable changes in the lamina dura, morphology of the alveolar crest, width of the PDL space and density of the surrounding cancellous bone. The radiographic changes are not pathognomonic of trauma from occlusion and must be interpreted in combination with clinical findings, particularly tooth mobility, presence of wear facets, pocket depth, and analysis of occlusal contacts and habits.

1. Injury phase: loss of lamina dura 2. Repair phase manifested by a widen of PDL space, which may be generalized or localized. 3. More advanced traumatic lesions: result in deep angular bone loss, which means when combined with marginal inflammation, may lead to intrabony pocket formation.

a. In terminal stages these lesions extend around the root apex, producing a wide, radiolucent periapical image. b. Root resorption may also result from excessive forces on the periodontium. Particularly those caused by orthodontic appliances. <span style="color: #800080; font-family: 'Comic Sans MS',cursive;"> <span style="color: #800080; font-family: 'Comic Sans MS',cursive; font-size: 10pt;">Additional Radiographic Criteria: <span style="color: #000000; font-family: 'Comic Sans MS',cursive; font-size: 10pt;">1. Radiopaque horizontal lines across the root indicates the portion of the root where the labial or lingual bony plate has been partially or completely destroyed from remaining bone-supported portion. 2. Vessel canals in the alveolar bone. This indicated the course of vascularity supply of the bone. 3. Differential between treated and untreated periodontal disease.