6.periodontal disease

8/14/2019 6.Periodontal Disease

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1

Periodontal Diseases

Dr. Mustafa Alkhader

OMFR

Chapter 18

Reference

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AB

PL

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What is meant by thePeriodontium ?

4 components

Attachementapparatus

The periodontium

Gingivitis:Inflammation of the gingiva.

Periodontitis:loss of connective tissue attachment andsubsequent bone loss.

Definitions

Gingivitis commonly starts with local

irritating factors Or poor oral hygiene

Chronic inflammation response

Loss of marginal bone

Apical migration of epithelial attachment

Pocket formation ( soft tissue lesion)

Looseness then loss of teeth ???????


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Contribution of Radiographs in Assessmentof the Periodontal Condition

1. The amount of bone

present

Condition of the alveolar crest

Bone loss in furcaition areas

Width of the periodontal ligament

space

Contribution of radiographs in assessment of the

periodontal condition ( cont )

2. Local irritating factorsthat either cause or

increase severity of

periodontal disease :

CalculusCalculus

Overhangs

overhanging or poorly

contoured or restorations

Calculus

Contr ibut ion of radiographs in assessment of the

per iodontal condit ion ( cont )

3. Root length andmorphology and the crown

- root ratio

4. Anatomical considerations

Position of the maxillary sinus

in relation to a periodontal

deformity.

Missing , supernumerary or

impacted teeth.

Contribution of radiographs in assessment of the

periodontal condition ( cont )

5. Patholog ic cons iderations

Caries

Periapical lesionsRoot resorption

Limitations of radiographs

1. Bony defects are commonly

overlappedby existing bony

walls.


2. Failure to image buccal and

lingual bone as they are

superimposed by the roots of

teeth.


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1. Bony defects are commonly

overlapped by existing bonywalls.

2. Failure to image buccal and

lingual bone as they are

superimposed by the roots of

teeth.

3. Early (mild) destructive

lesions are not detected

radiographically.

Limitat ions of radiographs (cont)

4. Radiographs tend to show less

severe destruction than is actuallypresent.

6. Radiographs will not identify a successfully managed

case as opposed to an untreated one.

5. Radiographs do not demonstrate soft

tissuedefects (as pockets) .


7. Minute variations in the

projection technique

considerably affect the

radiographic appearanceof periodontal tissues.

8. Exposure factors can have a marked effect onthe apparent crestal bone height (overexposurecauses burn - out).

N.B. In treatment planning , radiographs should besupplemented by careful clinical examination.


Technical Procedures

Films Used:

Bitewing

Periapical

Panoramic

Technical procedures

I. Film placement and types of films used:

Interproximal (bitewing) and periapical films are useful for

evaluating the periodontium.


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Periapical Films

Periapical films should

be performed using the

paralleling technique.

The film should be

parallelwith the tooth as

possible to avoid

distortion.


Bitewing FilmsBitewing films are moreaccurate to record thedistance between theCEJ and the crest of thebone.

Because: film parallel to teeth

Contacting teeth

Bitewing Films

Vertical interproximalradiographs: 7 no. 2films to cover allregions of the mouth.

Technical proceduresPanoramic films

Panoramic radiographsare used only for gross evaluation of the

condition.

If more details are required , a full mouth surveyis performed (or

selective areas radiographed).


II. Angles of projection

Criteria assuring the correct

relative position of the teeth in thealveolar process:


The interproximal spaces between

tooth roots not overlapped.

Theproximal contactsbetween

crowns not overlapped.

Overlap of the buccal and lingualcuspsof molars.

Angles of projection (cont)

The optimum vertical and horizontal angles ofprojections will show properly proportioned

anatomic features such as :

CEJ

Crest of the interdental bone.

Correct crown - to - root ratio.



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Special considertions and techniques

The frequency of radiographic examination is determined

by the activity of the disease.

A full mouthintraoral examination is used for:

1. Treatment planning

2. As a baseline for later comparisons.

Normal Anatomyof the alveolar bone

Radiographic appearanceof normal alveolar bone :

Corticated

0-2 mm apical to the level of

the CEJ of adjacent teeth.

Continuous with the lamina

dura of adjacent teeth.

2 mm

2 mm

Radiographic appearance ofalveolar bone (cont) :

Between the anterior teeththe alveolar crest ispointed and dense.

Between the posteriorteeth :

1. The alveolar crest and thelamina dura form asharp well defined angle.

2. The alveolar crest is parallelto a line connecting theCEJ of posterior teeth.

Alveolar Bone Loss

Physiologic level of bone

Height of remaining bone

Alveolar Bone LossTypes

Horizontal bone loss

Vertical bone loss

( oblique- angular )

There is loss of height of thealveolar bone but the crest

is still horizontal.

Bone loss occurs in an oblique

or vertical plane to the CEJ of

adjacent teeth.

Alveolar Bone LossTypes

Horizontal bone loss


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Alveolar Bone LossTypes Vertical bone loss

Horizontal Bone Loss

According to the region involvedLocalized generalized


SeverityMild bone loss : 20 - 30 %

Moderate bone loss : 30 - 50 %Severe bone loss : more than50 %

Mild bone loss

Severe bone loss

moderate bone loss

According to the extent of bone loss

Mild - moderate - severe

e.g. Generalized moderate .


Mild bone loss

Severe bone loss

moderate bone loss

Supra-eruption and passive eruption increaseddistance between CEJ and bone level

Alveolar Bone ResorptionAlveolar Bone Resorption

Which is horizontal and which is vertical ABR ?

A B


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Alveolar Bone Resorption

Which is mild , which is moderate

and which is severe?

Interdental Craters

Buccal or Lingual

Cortical Plate LossFurcation Involvement

Osseous defects in the furcation ofmultirooted teeth

Widening of the periodontal ligament spaceat the

apex of the inter radicular bone crest.

Furcation Involvement

If involves only buccal or lingual cortical plate + extends underthe roof of the furcation

appears irregularand moreRLcompared to adjacent normalbone.



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Ifsufficient bone lossoccursbuccally and

lingually

the lesion will be sharplyoutlinedbetween the

roots


Inverted J shadow

Hook of J extending

into trifurcation

Septal bone lost from buccal or lingualcortical

plate ???

Convergent rootsobscure furcation defects

Limitations of Radiographs

in Viewing

Furcation AreaIn maxillary molars:

palatal rootsuperimposed

on the defect

In lower third molar region:

External oblique ridgemay

mask furcation.

Limitations Of Radiographs In

Viewing The Furcation Area :

Changes in Bone density

Like all inflammatory conditions, maystimulate reaction in bone(RO or RL)

Dental Conditions Associated

With Periodontal Disease

Occlusal trauma

Open contact (food impaction)

Local irritating factors

* Calculus

* Defective restorations

* Tilted teeth


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Calculus Occlusal trauma

Wideningof the

PDLS

Thickening of L.D.Normal PDLS

and L.D.

Occlusal trauma

Normal PDLSand L.D.

Occlusal trauma

Wideningof the periodontal ligament space.

Decreased definition of the lamina dura.

Bone loss(commonly angular)

Altered trabeculation.

Less commonly hypercementosis and root fracture.

Evaluation of Periodontal Therapy

Follow - up serial radiographs

Radiographs should be standardized:

film placement

angulation

exposure factors

processing techniques.

Special considertions and techniques

Occlusal templatemay be used especially when

follow up of the case is indicated.


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Evaluat ion o f per iodontal th erapy

Successful periodo ntal therapy means :No evidence of new bone loss.

The cortical bone in the inter-septal area may

become more dense.

The affected margins of bone may become

more sclerotic (radiopaque).

Other Patterns of Periodontal Bone Loss

Abscess

Aggressive Periodontitis

Differential Diagnosis

Effect of Systemic Diseases on periodontal Disease

AIDS

D.M.

Radiation Therapy

Not Included

Questions ?

6.periodontal disease

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