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-DR. IBRAHIM SHAIKH
MDS III
DEPT. OF PERIODONTOLOGY & IMPLANTOLOGY
SEMINAR NO. - 9
Radiographic Aids In Diagnosis ofPeriodontal Diseases Part B
DATE : 24/05/2016
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CONTENTS
1. Interpretation of an OPG
. Interpretation in relation to periodontaldiseases.
!. Ad"ances in radiographs.
#. I$plant i$aging %Brie&'(.
). *i$itations of radiographs.
+. *i$iting radiation e,pos-res.
. /oncl-sion.
0. References.
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Pri!"r#$ Cri%ri" '19(2)
Adequate angulation
1. he radiograph sho-ld sho2 the tips of the$olar c-sps 2ith little or none of the occl-sals-rface sho2ing.
. 3na$el caps and p-lp cha$4ers sho-ld 4edistinct.
!. Interpro,i$al spaces sho-ld 4e open.
#. Pro,i$al caps sho-ld not o"erlap -nless teethare o-t of line anato$icall'.
!
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I*%r+r%"%i,* , "* OPG
#
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Or%!,+"*%,,r"+!
Panoramic perspective
/o$$onl' -sed i$aging $odalit' in dentalpractice.
/o$ple, pro5ection of the 5a2s.
Depicts n-$ero-s anato$ic str-ct-res o-tsideof the 5a2s.
Right and left posterior parts of t
he i$agerepresent lateral "ie2s.
Anterior part of the i$age represents an
anterior6posterior "ie2.)
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Or%!,+"*%,,r"+!sseous Structures
+
a.Pter'goid
plate4.Pter'go$a,ill
ar' 7ss-rec.8'go$atic
process of$a,illa
d.8'go$aticarch
e.e$poralco$ponent oft$5
f. Mastoidprocess of
te$poral4one %noti$aged(
g.*ateral andinferior or4italri$
h.Infraor4ital
canali. Inferior
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Or%!,+"*%,,r"+!sseous Structures
1. Ma,illar' sin-s
. Pter'go$a,illar'7ss-re!. Pter'goid plates#.Ha$-l-s0. 8'go$atic proces11.Middle cranial
fossa
1).Infraor4ital canal1+.
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Or%!,+"*%,,r"+!sseous Structures
0
). >'go$atic arch+. artic-lare$inence.>'go$aticote$porals-t-re?. e,ternal
a-ditor' $eat-s1. lateral 4orderof the or4it1!. infraor4italridge1#. infraor4italfora$en1. nasal sept-$10. anterior nasalspine1?. inferior concha. $a,illar't-4erosit'
). sig$oid notch0. cer"ical
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Or%!,+"*%,,r"+!
Air/Soft tissue shadows
?
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Or%!,+"*%,,r"+!
Ghost images
1=
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Or%!,+"*%,,r"+!
TMJ Evaluation
Bon' an@'loses O"erall o4literation of the 5oint space. Antegonial notching anterior to the angle of
$andi4le.
3longation of coronoid process.
11
Br-,is$ *oss of cartilage erosion of 4one o"er the
cond'lar head. lattening 2idening of the artic-lar e$inence 3longation of coronoid process.
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Or%!,+"*%,,r"+!
OPG nterpretation
1. Assess the peripher' and corners of the i$age .Or4its..Artic-lar processes of the te$poral 4ones %at
the MC(.
./er"ical spine..St'loid processes..Phar'n,..H'oid 4one.
. 3,a$ine the o-ter cortices of the $andi4le .Anterior and posterior ra$i../oronoid processes../ond'les and cond'lar [email protected] 4order.
!. 3,a$ine the cortices of the $a,illa .8'go$atic process of the $a,illa.
1
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Or%!,+"*%,,r"+!
OPG nterpretation
#. 3,a$ine the >'go$atic 4ones and arches ). Assess the internal densit' of the $a,illar' sin-ses
./o$pare left and right sides.+. Assess the str-ct-res of the nasal ca"it' and the
palates .he nasal &oor 9 hard palate and conchae..he nasal sept-$ in the $idline..he soft palate seen 4ilaterall'.
. 3,a$ine 4one the pattern of the $a,illa and $andi4le.Assess the densit' and pattern of the
tra4ec-lae for a4nor$alities..In the $andi4le e,a$ine the si>e position
cortication and s'$$etr' of theE inferior al"eolar ner"e canals. $andi4-lar fora$ina.
1!
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Or%!,+"*%,,r"+!
OPG nterpretation
0. Al"eolar processes and teeth.Assess the crestal 4one position of the al"eolar
processes to identif' an' periodontal 4one loss..3,a$ine the periodontal liga$ent space and
la$ina d-ra aro-nd each tooth for signs ofin&a$$ator' disease.
.3,a$ine the follicles and papillae of de"elopingteeth for an'thing aFecting their si>e positionor cortical 4o-ndaries.
.3"al-ate the teeth for presence9 a4sence 9er-pti"e or positional a4nor$alities cariesinade-ate restorations calc-l-sde"elop$ental or ac-ired a4nor$alities.
1#
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I*%r+r%"%i,* i* r"%i,* %,+ri,#,*%" #i$"$$.
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Pri,#,*%" Di$"$$
Severit! of periodontal "one loss
Early bone lossranges fro$ slight4l-nting loss ofcorte, decreased
densit' or a lessde7ned or irreg-larappearance of theal"eolar crests to4one loss of -p to 1
$$. Moderate bone loss
ranges fro$ 1 $$ ofperiodontal 4one loss-p to the $id6root
point.1+
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Pri,#,*%" Di$"$$
Goodson et al# $%&'
S!,# r,*i3# %!"% r"#i,,i" #%%"+ri,#,*%" ,* ,$$ i$ +r## i*i"#%%" i*""%,r +ri,#,*%" #i$"$.
1
Mann et al# $%&() *hocht et al# $%%+
T! ii%"%i,*$ , %! r"#i,r"+!i "i*"%i,* ,+ri,#,*%" ,* ,$$7 $+i" i*%r",r" "*#+"*,r"i r"#i,r"+!7 $% r,*i3# "*#,rr"%i,* 8i%! i*i" *#i*$ i$ i+,r%"*%
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M,r+!,, , Pri,#,*%" ,*L,$$
,ori-ontal "one loss
Bone loss is parallel 2ith the ce$entoena$el 5-nction%/3C( -s-all' in"ol"ing $-ltiple teeth.
10
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M,r+!,, , Pri,#,*%" ,*L,$$
Angular/.ertical defects
he 4one loss is -ne"en and o4li-e centered -pon onetooth $ore than the ad5acent tooth
1?
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M,r+!,, , Pri,#,*%" ,*L,$$
nterdental crater defects
It is often not appreciated on plain D i$aging 4-t $a'appear as a focal h'podense region at the s-perior aspectof the interdental 4one.
=
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M,r+!,, , Pri,#,*%" ,*L,$$
nfra"on! defects
hese refer to focal 4one loss2hich e,tends along a roots-rface apicall'. hese defects can4eEThreewalled 2here 4oth4-ccal and ling-al cortices arepreser"ed.
Twowalled 2here a 4-ccal orling-al corte, is eFaced.
Singlewalled 2here 4oth4-ccal and ling-al cortices areeFaced.
A Si*;8"# defect appearsl-cent and 2ell de7ned 2hereas a
T!r;8"#defect appears1
Single6alled
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M,r+!,, , Pri,#,*%" ,*L,$$
nfra"on! defects
2o6alled
hree6alled
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!
2o6alled
hree6alled
One6alled
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M,r+!,, , Pri,#,*%" ,*L,$$
nfra"on! defects
Presence appreciation of periodontal defects$orpholog' incl-ding "ertical defects is 4estappreciated 2ith "ol-$etric i$aging techni-esincl-ding M/ and /B/ (Langen et al. 1995;
Fuhrann et al. 1995! 199"; Mengel et al. #$$5;Mis%h et al. #$$&; Mol ' alasundara #$$);*andenberghe et al. #$$)+
#
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M,r+!,, , Pri,#,*%" ,*L,$$
urcation defects
3arl' in&a$$ator' disease in"ol"e$ent of a f-rcation-s-all' presents radiologicall' as a 2idened periodontalliga$ent space at the f-rcation.
On plain D i$aging l-cent and relati"el' 2ellde7ned$andi4-lar $olar f-rcations are -s-all' onl' seen 2henthere is destr-ction of either the 4-ccal or ling-al corticalplates or 4oth.
If 4oth or one of cortices are preser"ed the $andi4-lar$olar f-rcation defect appears as a focal region of"ar'ing h'podensit' and de7nition.
)
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M,r+!,, , Pri,#,*%" ,*L,$$
urcation defects
D radiographic e,a$ination for f-rcation defects isli$ited especiall' of the $a,illar' $olars largel'4eca-se of the presence of the palatal root.
/lassicall' descri4ed CJshaped l-cent appearance isso$eti$es seen.
+
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M,r+!,, , Pri,#,*%" ,*L,$$
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M,r+!,, , Pri,#,*%" ,*L,$$
urcation defects
It sho-ld also 4e noted that an in&a$$ator' f-rcationlesion $a' also 4e of p-lpal origin related to accessor'p-lpal canals root resorption or iatrogenic perforation.
0
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M,r+!,, , Pri,#,*%" ,*L,$$
Perio0endo defects
hese are l-cent lesionse,tending fro$ the crestal4one to the ape, of a toothroot 4-t are not al2a's
clearl' apparent on plain Di$aging.
Radiologicall' it can 4ediLc-lt to disting-ish
4et2een the "ario-s ca-sesaltho-gh the $orpholog' ofthe lesion $a' pro"ide -sef-lcl-es 2hich can 4e correlated2ith the clinical 7ndings.
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M,r+!,, , Pri,#,*%" ,*L,$$
Trauma from occlusion
I*
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!1
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C,+%r A$$i$%# D*$i%,%ri I"A*"$i$ S$% %/ADIA(
1rs 2r3gger et al $%&&
A "ideo ca$era $esa-res the light trans$ittedthro-gh the a radiograph
Signal are con"erted to gre' scale i$ages
/a$era is interfaced 2ith co$p-ter and i$ageprocessor for storage and $athe$atic $anip-lation ofi$age
OFers an o45ecti"e $ethod for st-d'ing al"eolar 4onechanges -antitati"el'
High degree of sensiti"it' acc-rac' andreprod-ci4ilit' . !
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C,+%r-"$# T!r" I"i*
Pro"e!e Thermal maging S!stems
/o$pare the re2ar$ing rates ofnor$al and in&a$ed h-$angingi"a.
Gingi"al te$perat-re
$eas-re$ent. Infra6red ther$ograph' pro"ides a
non6in"asi"e $ethod. echni-e is no $ore in -se.
!!
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C,+%r-"$# T!r" I"i*
Pro"e!e Thermal maging S!stems
!#
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C,+%r S,%8"r +r,r"$
enta Scan5 i 6at .ision5 6arestream 74 maging5 Sim
Pro"ides co$p-ted to$ographic %/( i$aging of the$andi4le and $a,illa in three planes of referenceEa,ial panora$ic and o4li-e sagittal.
Assess$ent of 4one "ol-$e 4one height -alit'.
Proper length of i$plant can 4e selected. /lear "is-ali>ation of inferior al"eolar canal.
!)
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Dii%" %,,$*%!$i$ 'DTS)
Digital to$os'nthesis%DS( is a li$ited6angleto$ographic techni-e.
Onl' s$all rotationangles %a fe2 tens ofdegrees( 2ith a s$alln-$4er of discretee,pos-res are -sed.
Pro"ides so$e of theto$ographic 4ene7ts ofco$p-ted to$ograph'%/(.
At red-ced dose andcost.
!+
* Ogawa et al 89$9
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Dii%" %,,$*%!$i$ 'DTS)
Proposed the -se of 4oth DS and /B/reconstr-ction $ethods as an integrated sol-tion forpro"iding to$ographic data in dental application.
!
6 2eda in 89$9
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O+%i" C,!r* T,,r"+!
Optical coherenceto$ograph' %O/( is anoptical signal ac-isition andprocessing $ethod
An interfero$etric techni-ee$plo'ing near6infrared light.
O/ is 2ell6s-ited forperiodontal diagnosis.
Poc@et $orpholog' andattach$ent le"el are digitall'
recorded.
!0
* Ogawa et al 89$9
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O+%i" C,!r* T,,r"+!
De$onstrate the capacit' of O/ to deter$inegingi"al thic@ness and the shape and conto-r of theal"eolar crest.
!?
Otis :#: et# al# 899'
O/ i$aging can oFer three6di$ensional i$aging ofperiodontal soft tiss-es and 4one at a "er' highresol-tion .
Identif' acti"e periodontitis 4efore signi7cant al"eolar4one loss occ-rs.
Relia4le $ethod for deter$ining attach$ent le"el
;iang et al# 899%
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TACT-%*# "+r%r CT
Based on the principles of to$os'nthesis.
*o2 costlo2 dose !D I$aging st'ste$.
#=
Series of radiographs
ta@en fro$ diFerentangles
Soft 2are %2or@ 4ench(stac@s the 4asic i$agesand reconstr-ct in to$-lti planar i$ages
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TACT-%*# "+r%r CT
/o$pared the potentials of con"entional and A/DSR detecting si$-lated 4one6gain in periodontaldefects in "itro
A/6DSR pro"ide greater sensiti"it' and techni-e
&e,i4ilit' in detecting periodontal 4one6gain thanstandard DSR.
#1
Onanong 6hai0104om 8998
/o$pared the diagnostic eLcac' of t-ned6apert-reco$p-ted to$ograph' %A/( and con"entional t2o6
di$ensional direct digital radiograph' %DDR( in an in"itro en"iron$ent for detecting 4one loss in $id64-ccal and ling-al crests.
A/ perfor$ed signi7cantl' 4etter than DDR
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S" >, CT
or$ of /B/.
tili>es s$all 7eld high resol-tion detector togenerate high resol-tion !D "ol-$e.
Generall' co$para4le to si>e of intraoral radiographs.
#
Based on co$parison$ade 4et2een a f-ll /
geo$etr' and a local /geo$etr'.
local / of dentalstr-ct-res appears to 4e a
pro$ising diagnostic
van 4aatselaar 8997
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I+"*% I"i*#!
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I+"*% I"i*
I$ages sho-ld ha"e appropriate diagnostic -alit' andnot contain artefacts that co$pro$ise anato$ic6str-ct-re assess$ents.
I$ages sho-ld e,tend 4e'ond the i$$ediate area ofinterest to incl-de areas that co-ld 4e aFected 4'i$plant place$ents.
Practitioners sho-ld ha"e appropriate training in
operating radiographic e-ip$ent and co$petence ininterpreting i$ages fro$ the $odalit' -sed.
##
rinciples of imaging for dental implant assessment
i
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I+"*% I"i*
I I i
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Panora$ic radiograph'sho-ld 4e -sed as ani$aging $odalit'.
R3/OMM3
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I+"*% I"i*
Goal 1
3sta4lish characteristics of resid-al al"eolar4one.
Goal
Deter$ining orientation of RAR.
Goal !
Identif'ing local conditions restricting i$plantplace$ent.
Goal #
Match i$aging 7ndings to the prosthetic plan.
8# Preoperative site speci>c imaging
I % I i
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8# Preoperative site speci>c imaging
/B/ i$aging sho-ld 4econsidered if 4one
reconstr-ction anda-g$entation proced-res%e.g. ridge preser"ation or4one grafting( ha"e 4eenperfor$ed to treat 4one
"ol-$e de7ciencies 4eforei$plant place$ent.
R3/OMM3
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7# Post0operative imaging
In the a4sence of clinical signs ors'$pto$s -se IOPAs or OPGs.
R3/OMM3
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Lii%"%i,*$ , R"#i,r"+!$)=
Li i% %i R #i !
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Lii%"%i,*$ , R"#i,r"+!$
More than != of 4one $ass at al"eolar crest $-st 4elost to 4e recogni>ed on radiographs
Radiographs pro"ide a 6di$ensional "ie2 of a !6
di$ensional sit-ation pro"ides onl' infor$ation a4o-tinter pro,i$al 4one le"el.
Radiographs do not de$onstrate soft tiss-e 6 to 6 hardtiss-e relationship hence no infor$ation a4o-t
depth of soft tiss-e poc@et.
D-e to s-peri$position the details of the 4on'architect-re $a' 4e lost.
)1
Li i% %i R #i !
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Lii%"%i,*$ , R"#i,r"+!$
Do not record soft tiss-e conto-rs %Gingi"itis is noseen on radiograph poc@ets can not 4e seen onradiographs(.
Meas-re$ent of 4one le"el fro$ /3C is not "alid ins-pra er-ptions passi"e er-ptions.
Interdental craters cannot 4e identi7ed 4'radiographs.
idening of periodontal liga$ent does not necessaril'$ean tooth $o4ilit'.
)
Lii%"%i,*$ , R"#i,r"+!$
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Lii%"%i,*$ , R"#i,r"+!$
he' cannot s-ccessf-ll' disting-ish 4et2een treated -ntreated cases.
-rcations cannot 4e seen properl' %e.g. f-rcation in
$a,illar' $olars are $as@ed 4' the palatal roots it4eco$es diLc-lt to e"al-ate radiographicall' onl' (.
Resorption of ling-al or 4-ccal cortical plates cannot4e diFerentiated 4' radiographs alone.
)!
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Lii%i* R"#i"%i,* E+,$r)#
Lii%i* r"#i"%i,* +,$r
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Lii%i* r"#i"%i,* +,$r
-se of the fastest i$age receptor co$pati4le 2ith thediagnostic tas@ %6speed 7l$ or digital(.
/olli$ation of the 4ea$ to the si>e of the receptor
2hene"er feasi4le.
Proper 7l$ e,pos-re and processing techni-es.
se of protecti"e aprons and th'roid collars 2hen
appropriate.
*i$iting the n-$4er of i$ages o4tained to the$ini$-$ necessar' to o4tain essential diagnosticinfor$ation.
))
A4A recommendations 89$8
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C,*$i,*)+
C,*$i,*
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C,*$i,*
C,*$i,*
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C,*$i,*
Radiograph' $-st not 4e a s-4stit-te for clinicalin"estigation
6ra's sho-ld 4e -sed as a co$ponent of periodic
e,a$inations.
Ad"anced i$aging s'ste$s li@e /s /B/s ha"eena4led 4etter "is-ali>ation of periodontal str-ct-resand pathologies in !D th-s helping in 4etter
diagnosis and treat$ent planning.
he cost factor and other technical diLc-lties ha"eli$ited their clinical -tilit' 4-t their -tilit' as aresearch tool is -n-estiona4le.
)0
R
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Rr*$
1. /linical Periodontolog' And I$plant Dentistr': Can
*indhe: +
th
3dn. Oral Radiolog'6principles And Interpretation: St-art /.
hite: )th3dn
!. /linical Periodontolog':
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