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10.radiographic aids in diagnosing periodontal diseases
- 2. RADIOGRAPHIC AIDS INTHE DIAGNOSIS OF PERIODONTAL DISEASE PRESENTER – PUNIT PG DEPARTMENT OF PERIODONTICS
- 3. CONTENTS 1. INTRODUCTION 2. SELECTIONCRITERIA 3. RADIOGRAPHIC ASSESSMENTS OF PERIODONTAL CONDITIONS 4. INTRAORAL RADIOGRAPHY 5. LIMITATIONS OF RADIOGRAPHY 6. RADIOGRAPHIC DIAGNOSIS IN PERIODONTITIS
- 4. 7. RADIOGRAPHIC CHANGESIN SYSTEMIC DISEASE 8. DIGITAL IMAGING 9. DIGITAL SUBTRACTION RADIOGRAPHY 10.TUNED APERTURE COMPUTED TOMOGRAPHY 11. COMPUTED TOMOGRAPHY 12. PRESURGICAL PLANNING 13.EXTRA ORAL RADIOGRAPHY 14.NEW FRONTIERS 15.CONCLUSION 16. REFERENCES
- 5. Limited number ofmajor tools for the diagnosis of periodontal disease Patient’s history • Visual inspection • Periodontal probing and •Radiographic examination It is a valuable aid in the •Diagnosis •Prognosis •Evaluation of treatment outcome Image – info. of calcified tissues Only clinical correlation will result in a accurate diagnosis. IMAGE NEVER MAKES A DIAGNOSIS, THE CLINICIAN DOES. However, it is an adjunct to the clinical examination, not a substitute for it. INTRODUCTION
- 6. RADIOGRAPHIC ASSESSMENT OFPERIODONTAL CONDITIONS 1. Amount of bone present 2. Condition of the alveolar crests 3. Bone loss in the furcation areas 4. Width of the periodontal ligament space 5. Local initiating factors that cause or intensify periodontal disease • Calculus • Poorly contoured or overextended restorations 6. Root length and morphology and the crown to root ratio 7. Anatomic considerations • Position of the maxillary sinus in relation to a periodontal deformity • Missing, supernumary or impacted teeth 8. Pathologic considerations • Caries • Periapical lesions • Root resorptions
- 7. SELECTION CRITERIA The necessityfor radiographs and their quantity depend solely on the patient’s 1. Clinical findings 2. Oral anatomy 3. Treatment planning goals Simply put no radiograph should be exposed on a patient without performing a thorough clinical examination. The selection of radiographic projections, number of films, speed of film, and settings on the X-ray source are all under the control of the clinician. Proper selection will increase the likelihood of obtaining the required diagnostic information while limiting the risk to the patient due to radiation exposure. Radiographic survey – 14 intraoral films and 4 posterior bitewing films
- 8. RADIOGRAPHIC IMAGE TYPESAND TECHNIQUES INTRAORAL(TRANSMISSION) EXTRAORAL PERIAPICAL BITEWING PANORAMIC VIEW HORIZONTAL VERTICAL
- 9. ADVANCED TECHNIQUES 1. Digitalradiography 2. Digital substraction radiography (DSR) 3. Computed assisted densitometric image analysis system (CADIA) 4. Computed tomography (CT) 5. Cone beam computed tomography (CBCT) 6. Local computed tomography 7. Optical coherence tomography 8. Indirect digital radiography or Computed radiography (CR)
- 10. FILM PLACEMENT ANDBEAM ALIGNMENT The teeth will be depicted in their correct positions relative to the alveolar process when there is (1) No overlapping of the proximal contacts between crowns, (2) No overlapping of roots of adjacent teeth, and (3) Overlapping of the buccal and lingual cusps of molars. (4) Image of the crest as distinct radioopaque line.
- 11. With the teethin a close approximation of their normal occlusion, the angulation used (positive 7 to 10 degrees) is favorable to projecting the image of both the maxillary and mandibular posterior teeth in their most parallel orientation. BITEWING TECHNIQUE Properly positioned and exposed bitewing radiographs (horizontal or vertical) are considered mandatory in the periodontal "hard-tissue" assessment for most patients, because of the characteristics outlined below: 1. The alveolar crest height is as accurately depicted as possible. 2. The relation of the cementoenamel junction (CEj) to the alveolar crest can be accurately determined. 3. The presence of vertical bony defects can be demonstrated more precisely than with periapical images. 4. Early crestal bone loss in the posterior dentition can be found more readily than with periapical images.
- 12. BITEWING TECHNIQUE ADVANTAGES 1. Thealveolar crest height is as accurately depicted as possible. 2. The relation of the cementoenamel junction (CEJ) to the alveolar crest can be accurately determined. 3. Early crestal bone loss in the posterior dentition can be found more readily 4. Radiation dose is reduced. 5. To some extent standardized DISADVANTAGE Limited view of the osseous crest Limited view of entire tooth & surrounding region
- 13. INDICATIONS FOR PERIAPICALRADIOGRAPHY 1) Detection of apical infection /inflammation 2) Assessment of the periodontal status 3) After trauma to the teeth and associated alveolar bone 4) Assessment of the presence and position of unerupted teeth 5) Assessment of root morphology before extractions 6) During endodontics 7) Preoperative assessment and postoperative appraisal of apical surgery 8) Detailed evaluation of apical cysts and other lesions within the alveolar bone 9) Evaluation of implants postoperatively.
- 14. PERIAPICAL TECHNIQUE • verticalbony defects can be demonstrated • assessing the crown-to-root ratio, • root morphology, • periodontal ligament spaces, and • periapical status The two types of images discussed, bitewing and periapical, are complementary and both image sets most likely will be necessary for patients with periodontal problems.
- 15. PURPOSE AND USEOF EXTRAORAL RADIOGRAPHY • As adjunct for full mouth IOPA • Evaluation of tooth development (mixed dentition) • Assist and assess orthodontic treatment • Evaluate location of 3rd molar • Extensive disease – large lesions which cannot be seen in the intra oral radiographs • Evaluation of developmental anomolies,cysts,tumors • Evaluation of fractures following trauma • Assess underlying bone for pre and post prosthodontic treatment • Initial evaluation image in determining the need for other projections
- 16. EXTRAORAL RADIOGRAPHY(Panoramic radiography) Advantages 1. Image acquisition is relatively fast and simple 2. No need for any intraoral manipulation. 3. It shows all dentoalveolar structures in a single image at a dose that is considerably lower than for an intraoral full-mouth series . Disadvantages 1. Lingual structures will be projected higher on the film than buccal structures. 2. Patient-positioning errors represent one of the main sources of error in panoramic radiography. 3. It is technique sensitivity also. 4. Makes it difficult to reproduce the imaging geometry at a later date. 5. Images show less image detail than intraoral images. 6. Structures outside the image layer are not completely removed , cause so-called ghost images.
- 17. RADIOGRAPHIC ANATOMY OFTHE PERIODONTIUM
- 18. INTERDENTAL SEPTUM ANDCRESTAL LAMINA DURA The interterdental septum, located between the roots of adjacent teeth therefore more clearly visualized than bone that is located on the buccal or lingual aspect of the tooth Shape function of the morphology of the contiguous teeth. Convex teeth Flatter, less convex wider interdental space narrower interdental space broader septa of larger mesiodistal width "septal peak" seen in the anterior regions Loss of this architecture results in "blunting" or loss of septal height and may indicate early periodontitis (although evidence of clinical attachment loss will precede radiographically evident bone loss).
- 19. LAMINA DURA 1) Theinterdental septum normally presents a thin radiopaque border, adjacent to the periodontal ligament and at the crest, that is referred to as the lamina dura. 2) This appears radiographically as a continuous white line 3) At the top of the crest, it is known as the crestal lamina dura. 4) It has been suggested that loss of the crestal lamina dura may correspond to periodontal disease activity. Greenstein and co-workers report that the crestal lamina dura is not significantly related to any of a number of clinical periodontal parameters. Absence of the crestal lamina is not indicative of current or impending disease activity, Presence of a crestal lamina dura may be associated with clinical stability. 5) Increased density of the crestal lamina dura has been reported after successful periodontal therapy.
- 21. 1) Normally, thealveolar crest meets the lamina dura at a right angle when teeth are tipped, the appearance of the crestal lamina may mimic a vertical bone defect because of the Improper vertical angulation CEJ is inferior to Adjacent tooth creating an impression of vertical defect but in reality no defect. 2) A similar "CEJ discrepancy" can occur as a anatomic variation Some people have a mesial tilt to the posterior teeth vertical defects adjacent to the mesial surfaces of multiple teeth Ritchey and Orban report that lines drawn between the adjacent CEJs should parallel the crestal lamina dura, and this simple test will readily distinguish true vertical defects from "pseudo-defects" caused by tooth angulation.
- 22. PERIODONTAL LIGAMENT SPACE 1)Thin radiolucent line interposed between the root and the radiopaque line that outlines the root. 2) The width of the PDL has been considered important in the diagnosis of various conditions, including occlusal trauma . 3) However, the PDL width varies with varying tube/film geometry and exposure conditions and with root morphology. 4) Occlusal trauma may be manifested as a widening of the PDL space or may present as a funneling of the coronal aspect of the PDL space.
- 23. LIMITATIONS OF RADIOGRAPHS A two-dimensional view of a three-dimensional situation. Bony defects overlapped by higher bony walls may be hidden Overlapping tooth structure However, subtle changes in the density of the root structure (which is more radiolucent) may indicate bone loss on the buccal or lingual aspect of the tooth. Furthermore, use of multiple images made at different angulations, as in a full- mouth set, allows the viewer to use the buccal object rule to obtain three- dimensional information Radiographs typically show less severe bone destruction than is actually present. The earliest (incipient) mildly destructive lesions in bone do not cause a sufficient change in density to be detectable. Radiographs do not demonstrate the soft-tissue-to-hard-tissue relationships and thus provide no information about the depth of soft tissue pockets.
- 24. Bone levelis often measured from the cementoenamel junction; however, this reference point is not valid in situations in which either overeruption or severe attrition with passive eruption exists. It is not possible to render a definitive periodontal diagnosis by means of a radiograph. For example, 1. Advanced periodontitis good clinical response to therapy. minimal probing depths, but the radiographic bone levels will likely remain largely unchanged after treatment It will be impossible to determine whether that individual requires further treatment by examining post-treatment radiographs alone. Conversely, serial radiographs taken at baseline (pretreatment) and at subsequent appointments may reveal ongoing bone loss but only in the context of supplementing the findings from the clinical examination.
- 25. 2) Endodontically involvedmandibular molar reveals radiolucency in the furcation region no increase in probing depth or clinical attachment loss ,there has been no apical migration of epithelial attachment, sulcus is not continuous with furcation area. This is strictly an endodontic problem unless and until the sulcus becomes continuous with the furcation. Nevertheless, the radiographic image may mimic the appearance of significant furcation involvement caused by periodontal destruction.
- 26. ADDITIONAL RADIOGRAPHIC CRITERIAIN THE DIAGNOSIS OF PERIODONTAL DISEASE • Radiopaque horizontal line across the roots. This line demarcates the portion of the root where the labial and/or lingual bony plate has been partially or completely destroyed from the remaining bone supported portion. • Vessel canals in the alveolar bone. Hirschfeld described linear and circular radiolucent areas produced by interdental canals and their foramina, respectively.
- 27. RADIOGRAPHIC DIAGNOSIS INPERIODONTITIS a. Bone Destruction in Periodontal Disease slight radiographic changes in the periodontal tissues mean that the disease has progressed beyond its earliest stages The Earliest Signs Of Periodontal Disease Must Be Detected Clinically
- 28. The radiographic imagetends to show less severe bone loss than that actually present. the difference between the alveolar crest height and the radiographic appearance 0 to 1.6 mm, accounted for by x-ray angulation b. Distribution of Bone Loss The distribution of bone loss is an important diagnostic sign. It points to the location of destructive local factors in different areas of the mouth.
- 29. d) Pattern ofBone Destruction interdental septa may be reduced in height, crest horizontal and septa may have a angular defect perpendicular to the long axis horizontal bone loss angular or vertical bone loss
- 30. Page & Schroeder(1982) 2.5 mm range of influence of the subgingival plaque “when the bone surface has been resorbed to about 2.5mm apical or lateral to site of bacteria, bone loss appears to cease and bone production takes over” infrabony lesions seldom develop on the buccal surface Tal (1984) <2.6mm rarely infrabony defect seen Interdental distance >3.1mm infrabony defect seen
- 31. RADIOGRAPHIC CHANGES INPERIODONTITIS • Fuzziness and a break in the continuity of the lamina dura • A wedge-shaped radiolucency • The height of the interdental septum is progressively reduced by the extension of inflammation and the resorption of bone.
- 32. RADIOGRAPHIC APPEARANCE OFCRATERS appear as angular or vertical defects • do not indicate the internal morphology or • depth of the craterlike interdental defects • do not reveal the extent of involvement on the facial and lingual surfaces Reasons for this 1. Facial and lingual surface bone destruction is obscured by the dense root structure, and 2. Bone destruction on the mesial and distal root surfaces may be partially hidden by a dense mylohyoid ridge. A reduction of 0.5mm or 1.0mm in the thickness of the cortical plate is sufficient to permit radiographic visualization of destruction of the inner cancellous trabeculae. In most cases it can be assumed that bone losses seen interdentally continue in either the facial or lingual aspects creating a troughlike lesion.
- 33. Gutta perchapacked around the teeth increases the usefulness of the radiograph for detecting the morphologic changes of osseous craters and involvement of the facial and lingual surfaces. However, this is a cumbersome technique and is seldom performed. The true lesion can only be detected by clinically probing the defect. Surgical exposure and visual examination provide the most definitive information regarding the bone architecture produced by periodontal destruction.
- 34. RADIOGRAPHIC CHANGES INLOCALIZED, AGGRESSIVE PERIODONTITIS Juvenile periodontitis is characterized by a combination of the following radiographic features: • Bone loss may occur initially in the maxillary and mandibular incisor and/or first molar areas, usually bilaterally, and results in vertical, arc like destructive patterns .
- 35. b. Loss ofalveolar bone may become generalized as the disease progresses but remains less pronounced in the premolar areas.
- 36. RADIOGRAPHIC CHANGES INTRAUMA FROM OCCLUSION Trauma from occlusion can produce radiographically detectable changes in the lamina dura, morphology of the alveolar crest, width of the periodontal space, and density of the surrounding cancellous bone
- 37. PHASES OF TRAUMAFROM OCCLUSION The injury phase a loss of the lamina dura that may be noted in apices, furcations, and/or marginal areas. The loss of lamina dura results in widening of pdl space. The repair phase attempt to strengthen the periodontal structures widening of the periodontal ligament space More advanced traumatic lesions result in deep angular bone loss when combined with marginal inflammation lead to intrabony pocket.
- 38. RADIOGRAPHIC APPEARANCE OFPERIODONTAL ABSCESS Abscess is that of a discrete area of radiolucency along the lateral aspect of the root . However the radiographic picture is often not typical • In the early stages presents no radiographic changes. • The extent of bone destruction and the morphologic changes of the bone. • The location of the abscess – lesion in the soft tissue wall of periodontal pocket less likely to produce radiographic changes
- 39. FURCATION DEFECTS Etiology periodontitis endodontic infection, root perforation during dental procedures, or occlusal trauma. These changes are most readily seen in the mandibular molar region. Maxillary molars have three roots, early change in their furcation areas are more difficult to assess. But 30% to 55% of grade 2 or 3 furcation involvements have a furcation arrow present on the radiograph.
- 40. Diagnostic criteria aresuggested: • The slightest radiographic change in the furcation area should be investigated clinically, especially if there is bone loss on adjacent roots . • Diminished radiodensity in the furcation area in which outlines of bony trabeculae are visible suggests furcation involvement. • Whenever there is marked bone loss in relation to a single molar root, it may be assumed that the furcation is also involved .
- 41. ROOT MORPHOLOGY The radiographis the only method, short of direct observation, of visualizing the morphology of the roots. Radiographic parameters help in clinical significance: length of the root trunk root length, root divergence/convergence root resorption, and root shape gemination or fusion root dilacerations
- 42. OPEN CONTACTS a. Whenthe mesial and distal surfaces of adjacent teeth do not touch, the patient has an open contact. This condition is potentially dangerous to the periodontium. b. Similar potential situations in which periodontal disease may develop include discrepancies in the height of two adjacent marginal ridges or tipped teeth. LOCAL IRRITATING FACTORS a. Calculus b. Overhanging restoration margin
- 43. SKELETAL DISTURBANCES MANIFESTEDIN THE JAWS a. Osteitis fibrose cystica (Recklinghausen's disease of bone) develops in advanced primary or secondary hyperparathyroidism and causes osteoclastic resorption of bone with fibrous replacement and hemorrhage with hemosiderin deposition, creating a mass known as brown tumor. b. In Paget's disease, the normal trabecular pattern is replaced by a hazy, diffuse meshwork of closely knit, fine trabecular markings, with the lamina dura absent, or scattered radiolucent areas may contain irregularly shaped radiopaque zones. c. Fibrous dysplasia may appear as a small radiolucent area at a root apex or as an extensive radiolucent area with irregularly arranged trabecular markings. There may be enlargement of the cancellous spaces, with distortion of the normal trabecular pattern ("ground glass" appearance) and obliteration of the lamina dura.
- 44. d. Langerhans cellHistiocytosis they appear as single or multiple radiolucent areas, which may be unrelated to the teeth or entail destruction of the tooth supporting bone. e. In osteopetrosis (marble-bone Albers-Schonberg disease) the outlines of the roots may be obscured by diffuse radiopacity of the jaws. In less severe cases the increased density is confined to the bone in relation to the nutrient canals and the lamina dura. f. In scleroderma, the periodontal ligament is uniformly widened at the expense of the surrounding alveolar bone.
- 45. PRESURGICAL PLANNING FORPLACEMENT OF IMPLANTS Before surgical intervention, it is necessary to know the location of vital structures that may be in proximity to the surgical site. Many implant protocols call for a certain minimal space (e.g., 2 mm) between the apical extent of the osteotomy site and any vital structure, such as the mandibular canal. Because this type of surgery often involves placing implants in relatively close proximity to such structures, it is necessary to know the vertical and horizontal magnification of the radiographic image.
- 46. DIGITAL RADIOGRAPHY There arecurrently two competing technologies available for the implementation of digital imaging. One uses solid-state detectors, the other photostimulable phosphor
- 47. Digital imaging offersa number of advantages compared to film. • The elimination of chemical processing is considered one of the main benefits. • Shorter exposure-to-display time. • Integration with existing electronic office and patient-management systems. • Image processing can be used to enhance the perceived quality, either to restore the subjective quality of the image as a whole or to enhance a selected region in the image for a specific diagnostic task. • Furthermore, the software offers a variety of measurement tools, most of which are digital versions of existing analog tools. • The benefits of digital imaging are obtained along with a reduction in radiation exposure, although the amount of exposure reduction is dependent on the type of receptor.
- 48. ADVANCED DIAGNOSTIC TECHNIQUES Mostassessment of bone loss in clinical practice today is achieved by visual comparison of the radiographs. The radiograph contains so much information that it is difficult for the human eye to detect small changes in bone support in the presence of a busy background containing the teeth and bone. Studies have shown that a 30% to 50% change in bone mineral is needed to be visible even to the experienced clinician. Techniques have been developed that enhance our ability to “see” small changes over time in the bone. These include • Digital Substraction radiography • Computer assisted densitometric image analysis
- 49. DIGITAL SUBTRACTION RADIOGRAPHY(DSR) Zeidses des Plantes (1935) : 1st demonstrated use of subtraction imaging Depends up on conversion of serial radiographs into digital images. The serially obtained digital images are superimposed & image intensities of corresponding pixels are subtracted If change has occurred The brighter area represents gain Darker area represents loss
- 50. CONCEPT OF DSR •When two images of the same object are registered and the image intensities of corresponding pixels are subtracted, a uniform difference image will be produced. • If a change in the follow-up image has occurred, this change will show up as a brighter area when the change represents gain and as a darker area when the change represents loss. • The strength of DSR is that it cancels out the complex anatomic background against which this change occurs.
- 51. d. Subtraction imagesallow detection of mineral changes of as little as 5%. In addition to early detection, a number of quantitative measurements can be made, such as linear, area, perimeter and density measurement. e. An early technical challenge in DSR was the requirement that the consecutive images be closely aligned for an accurate comparison to be made. This was accomplished using custom stents and other devices that made the technique less practical. f. For clinical use recent technologic enhancements have enabled compensation for imprecision in placement, thereby allowing for the accurate "superimposition" of the images, which is required for DSR. This has made DSR much easier, and it is widely used in periodontal research. However, the technique is still not commonly used by clinicians.
- 52. Overall contrast is improved Trabecularmarrow spaces are visualized Enhancement of low and high density no objective description High standardization of x rays No reduction in exposure ADVANTAGES DISADVANTAGES
- 53. COMPUTER ASISTED DENSITROMETRICIMAGE ANALYSIS SYSTEM Introduced by Urs Brägger et al 1988 A video camera measures the light transmitted through the a radiograph Signal are converted to grey scale images Camera is interfaced with computer and image processor for storage and mathematic manipulation of image Offers an objective method for studying alveolar bone changes quantitatively High degree of sensitivity ,accuracy and reproducablity
- 54. Advantages Objective method –Quantitative measurements Higher sensitivity reproducibility Higher accuracy Urs Brägger et al in 1988 CADIA was more sensitive than subtraction radiography CADIA was capable of assessing differences in remodeling activity over 4–6 weeks after periodontal surgery Objective method to quantify alveolar bone density
- 55. CONVENTIONAL X-RAY TOMOGRAPHY PRINCIPLE Designed to image a slice or plane of tissue It consists of an x ray tube and radiographic film rigidly connected which moves about a fixed axis and fulcrum As exposure begins tube and film move in opposite direction simultaneously . Objects located with in the fulcrum remain in fixed positions and are viewed clearly ADVANTAGES Offers true cross sectional images of the alveolar ridge Useful during placement of single or multiple implants LIMITATIONS Blurring of structures on either side of focal plane Time required for reposition of the patient for every image. Cost is higher
- 56. COMPUTED TOMOGRAPHY PRINCIPLE A thinfan-beam of X rays rotates around the patient to generate in one revolution a thin axial slice of the area of interest. Multiple overlapping slices are obtained With the help of a computer a 3 D digital map of the jaws is the advantage of the CT. ADVANTAGES 1. Three dimensional 2. Precise detailed information 3. Images can be adjusted and printed without magnification. 4. Vertical & horizontal rulers adjacent to each image. 5. Digital format 6. Bone & soft tissue contrast 7. Excellent resolution
- 57. CT Image construction Computeralgorithms use photon counts to construct digital images Images are displayed in individual blocks -----VOXELS Each square of the image is matrix----PIXELS Each pixel is assigned a CT number representing tissue density CT number HOUNSFIELD units Range -1000 to 1000
- 58. DISADVANTAGES • Requires specialisedequipment • Much higher radiation dose to the patient • Metallic restorations can cause artifacts. • Cost is significantly high.
- 59. CONE BEAM COMPUTEDTOMOGRAPHY (CBCT) Developed in 1982 for angiography Utilizes cone shaped source of ionizing radiation & 2D area detector fixed on a rotating gantry . Multiple sequential images are produced in one scan • Rotates 360° around the head • Scan time typically < 1 minute
- 60. CT V/S CBCT Conventional CT scanners make use of a fan-beam and Provides a set of consecutive slices of image Conventional CT makes use of a lie-down machine with a large gantry. Greater contrast resolution & More discrimination between different tissue types (i.e. bone, teeth, and soft tissue Utilize a cone beam, which radiates from the x-ray source in a cone shape, encompassing a large volume with a single rotation. a sitting-up machine of smaller dimensions Commonly used for hard tissue Ease of operation Dedicated to dental Both jaws can be imaged at the same time Lower radiation burden
- 61. TUNED APERTURE COMPUTEDTOMOGRAPHY (TACT®) The motivation behind the development of TACT® was to be able to achieve 3 D with existing dental equipment and without the high cost and dose associated with computed tomography. PRINCIPLE TACT® is built on the basic principles of tomosynthesis: by shifting and combining a set of basic projections, arbitrary slices through the object can be brought into focus. The basic projections are conventional transmission radiographs. Each radiograph is taken from a different angle relative to the object and the receptor. Ongoing research seeks to further improve this technology and determine optimal parameters for various clinical applications.
- 62. OPTICAL COHERENCE TOMOGRAPHY Optical coherence tomography (OCT) generates cross-sectional images of biological tissues using a near-infrared light source. The light is able to penetrate into the tissue without biologically harmful effects. Differences in the reflection of the light are used to generate a signal that corresponds to the morphology and composition of the underlying tissues. The feasibility of its clinical use was demonstrated by capturing high- resolution images of oral structures, including soft tissue and hard tissue boundaries of the periodontium. While it is yet too early to judge the potential success of OCT as a routine clinical tool, the initial results warrant keeping an eye on further developments of this technology.
- 63. CONCLUSION a. Radiographs canprovide critical information for diagnosis and treatment planning, which can also serve as baseline information for the assessment of treatment outcomes. b. Commonly used modalities include bitewing, periapical and panoramic radiography. c. One of the main limitations is the two-dimensional representation of three- dimensional structures. d. There also needs to be a substantial amount of mineral loss (30–50%) before bone resorption can be detected. These limitations reduce the sensitivity of conventional radiography and generally result in underestimating actual bone loss even when high quality images are produced. e. Misdirection of the central ray of the X-ray beam as well as exposure and processing errors further limit accuracy. f. The radiograph and clinical periodontal examination complement one another. Neither is sufficient by itself, but together they can provide a sound foundation for diagnosis and treatment planning. g. Despite certain limitations, the conventional dental radiograph is an indispensable adjunct in diagnosis and treatment planning.
- 65. REFERENCES 1. Carranza’s ClinicalPeriodontology 10th Edition. 2. Oral Radiology – White & Pharoah 3. Periodontics Medicine, Surgery,and Implants - Rose, Mealey 4. Periodontology 2000, vol-34, 2004, 34-48. 5. Clinical practice of dental hygienist, 9th edition, Wilkin’s 6. Fundamentals of periodontics – Wilson & Korman 7. Advances in periodontics – Wilson, Korman 8. Diagnosis & risk prediction of periodontal disease - Axelsson
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