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Periodontal Ligament Space:
- Functions as an attachment of the tooth to the lamina dura of the socket
- Appears as a thin radiolucent line surrounding the tooth root
- A widening of PDL space on radiograph indicates tooth mobility.
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Components of the periodontium that can be identified radiographically include the:
- alveolar bone,
- periodontal ligament space,
- lamina dura, and
- cementum.
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A periodontal assessment is incomplete without ______.
accurate radiographs.
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What are the benefits of using radiographs in a periodontal examination?
- Radiographs illustrate:
- ¨-Bony changes caused by disease
- ¨-Tooth root morphology
- ¨-Relationship of the maxillary sinus to the periodontal deformity
- ¨-Widening of the PDL space
- ¨-Advanced furcation involvement
- ¨-Periodontal abscess
- ¨-Local factors (crown, overhang)
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Radiographic Signs of Periodontal Disease:
- Early bony changes
- Horizontal bone loss (most common)
- Vertical bone loss
- Bone defects
- Furcation involvement(multirooted teeth)
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Early Radiographic Signs of Disease:3?
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Early Radiographic Signs of Disease:
Fuzziness?
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Early Radiographic Signs of Disease:
Widening?
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Early Radiographic Signs of Disease:
Radiolucent lines?
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Triangulation:
- Widening of the PDL space caused by bone resorption on either the mesial or the distal of the interdental crestal bone
- Also called funneling
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Interseptal Bone Changes:
- Finger-like radiolucent projections extending from the crestal bone into the interdental alveolar bone.
- Represent a reduction of mineralized tissue adjacent to blood vessel channels in the alveolar bone.
- Anteriors (normal): thin, pointed.
- Posterior (normal): rounded, flat.

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How is bone loss determined?
by using the CEJ of adjacent teeth as points of reference
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Horizontal bone loss
- —bone destruction parallel to a line between CEJs of adjacent teeth

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Vertical bone loss—
- greater bone loss on the interproximal aspect of one tooth than on the adjacent tooth.

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Assessment of Bone Loss:
- Radiograph is a “snapshot” of an instant in time in the disease process.
- Radiograph reveals the bone remaining rather than the bone lost.
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Even though bone loss occurs on all surfaces, radiographs are not able to show the extent on the facial and lingual surfaces.
True or False?
TRUE
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Assessment of Furcation Involvement:
- Is not seen on the radiograph until the bone resorption extends past the furcation area
- Easier to see on mandibular than maxillary
- Maxillary palatal root appears superimposed over furcation of the tooth.
- Furcation involvement often is greater than it appears on the radiograph
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Risk factors detectible on radiographs are?
¤Calculus deposits
¤Faulty restorations
¤Trauma from occlusion
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Calculus Detection:
¨Large interproximal calculus deposits may be visible on radiographs.
¨Large facial and lingual deposits may be visible if there is severe bone loss on the surfaces.
¨Ability to visualize on radiographs depends on the degree of mineralization and angulation of the x-ray beam.
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Faulty Restorations:
- Can cause gingival inflammation, periodontitis, and alveolar bone resorption
- Can be detected on radiographs
- Faulty contours between the first and the second molar restorations create an open contact that may cause food impaction.

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Long-Grayscale/Low Contrast Images:
- Creates many visible shades of gray that make it easier to see subtle changes in bone loss
- Obtained by using a high kVp or digital imaging
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Vertical Radiographs:
- ¨Crestal bone loss of 5 mm+ may not allow optimum coronal bone visualization with horizontal bitewings.
- ¨Vertical bitewings are indicated.
- ¨Long axis of the film is rotated 90 degrees.
- ¨Vertical bitewing adaptor for film holder is used.
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_____bitewings show more of the coronal bone than horizontal bitewings.
- Vertical

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Limitations of radiographs?
- ¨It is only a 2D image of a 3D structure.
- ¨Buccal bone can hide bone loss on the lingual aspect.
- ¨Palatal root makes furcation detection on the maxilla difficult.
- ¨Radiographs do not provide information about noncalcified components.
- ¨Radiographs do not show disease activity.
- ¨They do show effects of the disease.
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¨Radiographic examination is ______ a satisfactory substitute for a clinical periodontal assessment.
never
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Radiographs do not reveal the Following:
- Presence or absence of periodontal pockets
- Early bone loss
- Exact morphology of bone destruction
- Tooth mobility
- Early furcation involvement
- Condition of the bone on the buccal and lingual surfaces Level of the epithelial attachment
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Early Bone Loss must first be detected _____.
clinically, not radiographically.
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Interseptal bony defects less than 3 mm are ____ detected radiographically.
not usually
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Facial and lingual bone height are ___ to evaluate radiographically.
difficult
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Early Furcation Involvement in radiograph?
- X-ray beam alignment may conceal the presence or extent of involvement.
- Use of furcation probe is necessary in determining the actual clinical involvement.
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Extensive Bone Loss in radiographs?
- ¨Crestal bone loss of >5 mm or greater may cause the coronal bone to be poorly seen on normal bitewing radiographs.
- ¨Vertical bitewings are more appropriate.
- ¨Long axis of the film is rotated 90 degrees to be perpendicular to the occlusal plane.
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Recognizing limitations of radiographs and utilizing appropriate radiographic techniques will ensure ___________.
the best possible diagnostic evidence.
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Radiographs assist the hygienist in detecting _____.
changes in the periodontium.
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Radiographs are an essential diagnostic tool in the diagnosis of _____.
periodontitis.
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