9. radiographic aids in dx of periodontol ds_part b.pptx

7/25/2019 9. Radiographic Aids in Dx of Periodontol Ds_Part B.pptx

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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.)


6/60

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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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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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*


31/60A#="*$ i* R"#i,r"+!$

!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


38/60

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*#!


44/60

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


46/60

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 !


51/60

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,*


57/60

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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9. radiographic aids in dx of periodontol ds_part b.pptx

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