1. Radiology of Periodontal
Disease

2. Limitations of Radiographs
Radiographs do not record changes in
the soft tissues of the periodontium.
Since gingivitis is a lesion of soft tissue
only, no radiographic changes will be
seen.

3. The Role of Radiology in
Assessment of Periodontal Disease
-All radiographs should be evaluated for
bone loss and examined for other
predisposing factors that may contribute
to periodontal disease.
- It is generally appropriate to evaluate the
outcome of care and the progress of
disease by taking post-treatment
radiographs

4. Radiographic Technique
• The optimal projections for periodontal
diagnosis in the posterior teeth are
bitewing radiographs
In the anterior teeth, anterior periapical
projections, exposed using the
paralleling technique, are adequate

5. The amount of bone loss can be
estimated as the difference between the
physiologic bone level“ within 2
millimeters of the cemento-enamel
junction (CEJ)” and the height of
remaining bone. Bone loss can be
described in terms of the pattern,
distribution and severity of loss.

6. Pattern
The pattern of bone loss viewed on a dental
radiograph can be described as horizontal or
vertical. With horizontal bone loss, the bone
loss occurs in a plane parallel to the CEJs of
adjacent teeth, but with vertical bone loss
(angular bone loss), the bone loss does not
occur in plane parallel to the CEJs of
adjacent teeth.

7. Vertical bone loss usually localized to
one or two teeth. May be several areas
of vertical bone loss throughout the
mouth

12. Distribution
The distribution of bone loss on a dental
radiograph can be described as localized
generalized, depending on the areas
involved.
• Localized bone loss occurs in isolated areas,
with less than 30% of the sites involved.
• Generalized bone loss occurs evenly
throughout the dental arches, with more than
30% of the sites involved.

17. Severity
Bone loss viewed on a dental
radiograph can be classified as mild,
moderate, or severe.
• In mild bone loss alveolar bone level
approximately 3 to 4 mm apical to the
CEJ

20. With moderate bone loss the alveolar
bone level is approximately 4 to 6 mm
apical to the CEJs of adjacent teeth.

23. Finally in severe bone loss the
alveolar bone level is 6 mm or greater
from the CEJ. Furcation involvement
also seen with severe bone loss

26. Predisposing factors
Calculus
• It most often appears as pointed or irregular
radiopaque projections extending from the
proximal root surfaces.
• Calculus may also appear as a ring-like
radiopacity encircling the cervical portion of
a tooth, a nodular radiopaque projection or
smooth radiopacity on a root surface.

28. Defective restorations
Radiographs allow to identify
restorations with open or loose
contacts, poor contour, uneven
marginal ridges overhangs, and
inadequate margins, all of which may
contribute to periodontal disease.

29. Overhanging ledge

31. amalgam restorations with poor
marginal adaptation

32. Open contact between maxillary
premolars