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
4. Radiographic Technique
• The optimal projections for periodontal
diagnosis in the posterior teeth are
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.
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
7. Vertical bone loss usually localized to
one or two teeth. May be several areas
of vertical bone loss throughout the
The distribution of bone loss on a dental
radiograph can be described as localized
generalized, depending on the areas
• 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.
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
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
• 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.