Interpretation of Periodontal Disease

1. Interpretation of Periodontal Disease Dr. Vandana Kumar BDS, MDS, MS

2. Periodontal disease • Gingival disease • Periodontitis Group of disease that affect surrounding and supporting tissues of teeth Plaque induced • Non-plaque induced: • Viral/fungal infections • Mucocutaneous/allergic reactions • Traumatic injuries Gingival inflammation Periodontal pocket formation Destruction of periodontal ligament Destruction of alveolar bone Gradual loosening of teeth

3. The causes of periodontal disease • Bacteria • Host related factors • Environmental factors

4. The result… • Chronic inflammation • Pocket formation • Apical migration of the epithelial attachment • Bone loss

5. The contribution of radiographs • Bone loss • Irritating factors • Crown/root ratio • Anatomic considerations • Pathologic considerations Condition of alv. crest Furcations PDL space Calculus Defective restorations Position of max. sinus Missing, supernumerary or impacted teeth Root morphology Crown/Root ratio Caries Periapical lesions

6. Limitations of radiographs… 1-Radiographs are 2D pictures of 3D structures 2-Radiographs show less severe bone destruction than is actually present 3-Do not show soft to hard tissue relationship, no information about depth of soft tissue pockets 4-Bone level measured from CEJ, Not valid in situations like severe attrition and passive eruption

7. Radiographs tend to show less severe destruction than is present

8. Alveolar ridge lies 1-1.5mm From CEJ of adjacent teeth

9. Alveolar crest pointed and well corticated

10. Classification • Early bone changes • Moderate bone changes • Advanced bone changes

11. Early bone changes • Loss of the crest’s cortication • Fuzzy appearance of the crest • Blunting of the crest in anterior teeth • 1-3 mm bone loss

12. Loss of the cortication of the alveolar ridge

14. Developing vertical defect Abnormal widening of PDL

15. Moderate bone changes • 3-5 mm bone loss • Horizontal bone loss • Vertical bone loss • Osseous defects

17. Horizontal defect

19. Vertical bone loss

20. Developing vertical defect Abnormal widening of PDL

21. Vertical bone loss

22. Evaluation of bone defects • Accurate radiograph shows bone defect in interseptal bone • Exact form and shape can be determined only by careful periodontal probing/ surgical exposure • Classification of infrabony pockets ( Goldman and Cohen in 1958) • One walled • Two walled • Three walled

23. Three walled defect Bony walls on three sides with tooth root forming fourth wall Not a circumferential defect Defect may extend around the root and stop on buccal/lingual aspect Two wall defect/ osseous craters Facial and lingual walls are intact But interdental alveolar crest is resorbed

24. Four wall bony defect Completely surrounds tooth One-wall bony defect One wall remains after the facial and lingual walls have been destroyed

25. One wall defect Facial & lingual walls destroyed One wall of interdental septum remains

26. Osseous crater/ Two wall bony defect Dry spiceman

27. Inconsistent bony margins

28. Interproximal crater

29. Advanced bone changes • Bone loss > 5 mm • Furcation involvement • Large bony defects • Periodontal abscess

31. One wall bony defect: Interdental bone slopes down From facial/lingual wall crest of bone toward crest of destroyed facial/lingual bone

32. One wall defect: One bony wall of interseptal bone remains

33. Furcation involvement Furcation involvement

35. Radiographic mobility

37. Periodontal abscess

38. Recognition of Etiologic factors • Calculus deposits • Faulty restorations • Occlusal trauma • Tooth mobility • Aggressive periodontitis

41. Faulty restorations Open contacts Combined perio-endo pathosis #32

42. Squamous cell carcinoma of alveolar crest

43. Aggressive Priodontitis